Improving Health Outcomes for Members with Limited English Proficiency


How health plans communicate with members is vital for continuous quality improvement. Delivering health information at a reading level and in a format that a member can understand enables plans to build trust, improve health literacy and connect members to the care they need to improve their health.

However, social determinants of health (SDOH) can significantly impede outreach efforts, especially if you do not incorporate your member’s preferred languages. Using English-only communications to engage members results in lower health outcomes, increased member abrasion and poor member experiences. Shifting to a multilingual approach can have a powerful impact on plan performance.

As regulators stress the need for health equity and better access to care for diverse and vulnerable communities, health plans should begin incorporating health equity strategies to evaluate and address language as a SDOH.

How Language Affects Health Outcomes

Members who have limited English proficiency (LEP) experience significant challenges in accessing and understanding the care they need. Failing to provide health information in a member’s preferred language can negatively affect all aspects of their health, resulting in:

  • Lower quality of care
  • Higher rates of hospitalizations and readmissions
  • Longer hospital stays
  • Lower member satisfaction
  • Higher rates of mismanagement of chronic conditions

Health literacy is also impacted by language, as members with LEP are less likely to understand how to manage chronic conditions, navigate their health plan benefits and determine what treatment they need. Even the most comprehensive outreach will fail to close care gaps and improve plan performance if they are not presented in a language and at a reading level that members can understand.

Language barriers affect members of all ages and all lines of business. Spanish-speaking parents and caregivers overwhelmingly report language as a major challenge in seeking care for children, impeding their ability to receive appropriate and timely pediatric care. Members with LEP make up nearly 8% of Medicare Advantage enrollees, but present higher risks of developing serious medical conditions, resulting in lower quality scores and higher costs of care. Compared to members who only spoke English, older Latino and Asian immigrants with LEP are at higher risk of poor physical and mental health and less likely to use health services. This is in large part due to language barriers that stagger patient-provider communication and limit the ability for members with LEP to access healthcare information.

In order to advance health equity and expand access to care to all members, health plans need to focus on identifying members with LEP, providing communications in preferred languages and developing community-specific engagement strategies.

Identify Members’ Preferred Languages

One of the biggest data gaps facing health plans is language preference. Approximately one-quarter of consumers ages 18- to 64-years-old did not report a preferred spoken or written language during the Affordable Care Act open-enrollment period, according to the Centers for Medicare and Medicaid Services (CMS). CMS has estimated spoken languages based on the American Community Survey to determine roughly 21% of the U.S. population spoke a language other than English, but this only serves as a proxy, rather than an accurate assessment of language preferences.

If you want a more accurate picture of language preferences among member populations, digital surveys can help fill the gap. Health plans that use Healthmine’s member engagement solutions can surface a First Time Experience survey to immediately capture a member’s preferred language once they register with our member-facing web portal or application. Plans can also leverage our digital-first health risk assessment to identify language preferences, social risk factors, care gaps, race and ethnicity, all of which is available in a real-time dashboard.

Using digital surveys to field members’ preferred languages enables plans to comply with CMS’ requirement to source 80% of race, ethnicity and language data from members as part of the new Standardized Patient Assessment Data Elements (SPADEs) added to patient assessment tools in 2020.

Stratify Member Outreach for Targeted Engagement

Once you have a clearer picture of language preferences within your population, the next step is to determine how to action this data into meaningful engagement strategies that close care gaps and health outcomes.

For example, if you identify that your Spanish-speaking population has low compliance rates for breast cancer screenings, creating a Spanish-specific campaign will help you to effectively communicate the importance of timely screenings and connect them with relevant care, such as mammogram centers or mobile clinics. This methodology allows you to trim outreach lists to a specific demographic, reduce the cost of distribution and improve member engagement.

To eliminate complex spreadsheet calculations, Healthmine’s member engagement platform allows plans to filter smart lists based on language preferences, care gaps, zip codes and age to inform targeted campaigns. Plans can also incorporate communication preference into their filters to refine their strategies and ensure they are communicating to members through the most effective channels.

Communicate with Members in Their Preferred Language

When developing materials for members with LEP, it is important to focus on how you translate and present content. Poor translations and design choices risk causing member abrasion, which will reduce the likelihood a member will engage with your outreach and improve health outcomes.

For example, a direct translation from English to Spanish risks misinterpreting idioms and figures of speech, which can lead to awkward sentences and confusion. The translated copy may also not fit the design of the material and result in text-heavy content, further increasing member abrasion.

Rather than relying on direct translations, leverage localized materials that incorporate culturally relevant language and member-friendly designs. This extends not only to the copy but also the images presented in materials.

Consumers are more likely to respond positively and engage with materials that feature people of diverse backgrounds and demographics, especially if they feel represented in the materials. Diverse and inclusive imagery that features a wide range of races, ethnicities, genders, ages and body types will have a stronger impact on your outreach campaigns.

Engage Diverse Communities with the Right Partner

Finding the right member engagement partner is key to creating impactful outreaches for members with LEP. CMS encourages health plans to develop internal language assistance programs to evaluate, monitor and improve multilingual services at all levels of a health plan. However, operational capacity and budgets may limit how much these programs can focus on member outreach, while a member engagement partner allows for operational scale and efficiency.

Healthmine’s member engagement solutions empower health plans to engage diverse, multilingual populations in improving their health. Plans can incorporate a robust library of member-friendly marketing outreach efforts and translate them into up to 170 different languages to ensure every member has access to the care they need. We work closely with our clients and print vendors to manage marketing budgets and return on investment, while offering the option to switch to unlimited digital engagement through emails, text messages and secure messages to further reduce costs.

As CMS and state regulators make health equity a top priority for quality improvement programs, you need to develop the right digital tools to address the evolving needs of diverse communities. Connect with Healthmine to see how our member engagement solutions empower you to expand access to care through multilingual, culturally relevant and member friendly outreach campaigns.

More Like This