30 years ago, 86% of Americans identified as Caucasian. Today that number is 64% and by 2050 is expected to be 46%.
By 2050 the Census Bureau estimates that there will be no single racial/ethnic group that makes up the majority of the American population.
As a country, we’re not ready for these inevitable changes. As an industry, healthcare is headed for a potential 2050 disaster.
A recent AHRQ study finds that across 20 access-to-care measures, Hispanics (who will be 30% of the population in 2050) reported worse care than Caucasians for 75% of the measures. African Americans reported worse care than Caucasians for 50% of measures. While the Hispanic population hovers around 18% nationally (40% in California and 39% in Texas), and is predicted to grow significantly, only 5% of practicing physicians today identify as Latino. Even fewer– just 3.8% (as compared to the 13% of the total population) identify as African American.
What does this look like in the real world?
A CDC study estimated that if African Americans had the same adjusted rates of preventable hospitalizations as their Caucasian counterparts, there would have been almost a half million fewer hospitalizations between 2004-2007. A groundbreaking study commissioned by C-Change estimated the cost of cancer disparities to be just under $200 billion annually. African American women are twice as likely to die from cervical cancer (an easily detectable, highly treatable cancer) than Caucasian women.
We know from people who have studied healthcare and health outcomes just how important it is for a patient to be treated by a doctor they can understand–and who understands them. We also know that the healthcare system as we know it today is heavily oriented toward Caucasian English speakers. This is a problem when we have an increasing number of multicultural patients, particularly those enrolled in Medicaid, who make up 60% of national Medicaid enrollment. This growing mismatch between the needs of Medicaid patients and the healthcare system seeking to serve them, results in poor health outcomes for patients and higher cost for payers.
Translation alone is not enough
Properly deployed, technology and data can improve engagement with multicultural patients, resulting in increased quality scores and improved health outcomes. Combined with a true cultural lens, technology can be a tool that actually reduces barriers to care for patients.
Simply translating messages from English to other languages isn’t enough (at my company we call this “multicultural patient engagement 1.0”).
We need to engage patients in a way that speaks to them and says, “We understand you. We get what you’re going through. And we can help.”
A translation isn’t going to do that, no matter how much technology you throw behind it.
Language isn’t enough to tell you if there’s widespread food insecurity where your patients live. It’s not enough to tell you whether something as simple as a routine blood draw for a cholesterol screening is against a patient’s religious beliefs. Language isn’t going to tell you that your patient is living in a building with a terrible mold problem and that’s why your asthmatic patient has been to the E.D. three times this month. But culture can. That’s where Multicultural Engagement 2.0 comes in.
Multicultural Engagement 2.0
The Cambridge Dictionary defines culture as, “The way of life of a particular people, especially as shown in their ordinary behavior and habits, their attitudes toward each other, and their moral and religious beliefs.” When you get to know a patient’s culture, you get to know them. And once you know your patients, then you start to understand how to reach them. Then you can create content in the languages your patients speak, and you’ll have an engagement that speaks to them.
Data also plays a big role in getting to know your patients and their culture. Too often we in healthcare look at patients as a collection of data points, trying to solve each problem one as an isolated problem that is unrelated to all of the other data points. We ignore the “unsafe neighborhood” data point and try to solve the “sedentary diabetic” data point. But that’s not the way people work. Culture takes all of those data points and creates a holistic picture of who that patient is, how they’re likely to react/act, and what will move them. Technology can then come into play in bringing all of these cultural understandings and the relevant engagement to scale.
The best approach to scaling a solution is both large and small. “Large,” because the same technology can be used to engage millions of patients. “Small” because it is best utilized in the hands of local community physicians whose practices can range from a few hundred to thousands of patients. Why are doctors the best choice over health plans or healthcare systems? Because patients trust their doctors. One study found that while 60% of patients trust their doctors to make the right decisions about their health, 24% of patients also rated their insurance plan as having a “low/poor” reputation.
While doctors are the best choice to engage patients, they’re also stretched thin. 70% of doctors still practice in groups smaller than 30. 55% of doctors report symptoms of burnout. But even with these challenges, there’s still a desire to do more. The biggest obstacle actually isn’t bandwidth or burnout, it’s cost. In fact, 65% of doctors report that the biggest roadblock to increasing their efforts of patient engagement is cost. With the right strategy and mindset, this is an opportunity for payers to step in and provide resources that will help doctors engage patients better. When doctors engage patients better, both doctors and payers win.
Four-steps to re-shaping a patient engagement strategy
It may seem like a daunting task to fundamentally re-shape a patient engagement strategy, especially for organizations who serve millions of patients across hundreds of communities and dozens of states, but it’s actually not. In fact, it’s only a four-step process:
- Meet doctors where they’re at. Take the time to get buy-in from doctors. Be flexible about working within their bandwidth and work with their existing technology. Make resources available but don’t demand or penalize for slow adoption.
- Understand local communities. Identify existing health disparities, help patients utilize community resources, work with both patients and doctors to identify potential solutions
- Design culturally appropriate content and campaigns. Culture matters. Speaking to patients in a way that they understand matters more than providing a ride or a nurse hotline. Get to know your patients and then connect with them. If doctors don’t have the bandwidth to get this far into the data weeds, contract with a vendor who can on their behalf.
- Share results and close the data loop. When everyone has the same data, everyone wins, especially patients. Data is the currency of knowledge, and knowing your patients better means better care and better outcomes.
It may not seem like a lot, but re-centering healthcare strategy to focus on patient and strengthening the patient-doctor relationship could be the difference between a 2050 disaster and a 2050 triumph.