How Payers Can Bridge Care Gaps for LEP Patients
In today’s complex healthcare ecosystem, payer organizations play a more active role in care delivery than ever before.
As the processor of member claims data, they often have a more complete view of the care and services an individual receives. This big-picture perspective makes payers uniquely suited to help improve the quality of care. And as the party responsible for reimbursing provider services, they also play a key role in reducing the total cost of that care.
One of the best ways payer organizations can improve quality while reducing costs is by helping members eliminate costly care gaps – which are especially prevalent among people with limited English proficiency (LEP).
The Importance of Closing Care Gaps
A care gap, also called a treatment gap, occurs when there’s a discrepancy between the care an individual receives and recommended best practices.[1] They’re particularly important to payers because these care gaps often result in a higher cost of care and poor health outcomes.
For example, if a member doesn’t schedule an annual wellness visit, he may only learn of his congestive heart failure (CHF) diagnosis after a trip to the emergency department for chest pain. Due to the gap in care, the patient will be billed for a high-cost hospital readmission – and he has lost out on critical time to manage his chronic condition through preventative care, which would have resulted in a better health outcome.
The same is true for transitions of care. When a member is discharged from the hospital or is transferred to a post-acute setting, ensuring he or she follows recommended discharge instructions has been proven to reduce readmission rates.
When payers focus on closing care gaps, it can result in healthier members and lower healthcare costs. But there’s one major incentive: reimbursement. Due to the prominence of value-based care models, quality metrics have become a primary metric by which health plans are evaluated. State and Federal programs such as NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) and CMS Medicare Star Ratings regularly measure and report on plan performance. Meanwhile, these metrics can impact reimbursement and member retention rates.
The Relationship Between Language Barrier and Care Gaps
While care gaps can occur anywhere, they are more common for LEP members. According to the Centers for Medicare & Medicaid Services (CMS), communication barriers lead to care gaps in a number of areas.[2]
People with LEP have more difficulty getting care and screenings, are less likely to have a regular healthcare provider, and have fewer community support services. These statistics offer further evidence:
- LEP patients are 40% more likely to experience physical harm associated with an adverse event than English-speaking patients.[3]
- 20% of LEP patients admit to not seeking healthcare services for fear of not understanding.[4]
To underscore the scope of the problem, consider this: The U.S. Census Bureau reports 68 million people speak a language other than English at home. If 20% of those people are not seeking healthcare because of language barriers, that represents more than 13 million people across the country. That’s a lot of care gaps!
Close Care Gaps with Language Services
To close care gaps, LEP members need to clearly understand their diagnosis, treatment plans, and follow-up care. They need to build strong relationships with providers – which can lead to regular preventative care and screenings. And they need to become active participants in their own care journey.
Language services, such as the medical interpretation offered by AMN Healthcare Language Services, can help bridge this gap. By relying on professional, medically qualified interpreters, payer organizations can bring a higher level of cultural competency to the table – empowering clear and accurate communication between case managers, providers, and patients.
In a provider setting, the results speak for themselves: Compared to English-proficient patients, hospital stays for LEP patients average about 1.5 days longer when professional interpreters are not used at admission and discharge.[5] And a 2017 study[6] reported a 4.4% decrease in hospital readmission rates among LEP patients with 24-hour access to remote interpreter services, resulting in an estimated monthly savings of more than $160,000 in hospital expenditures.
When payers ensure LEP members have access to timely, accurate interpretation services, everyone benefits. Members experience better health outcomes; providers can deliver more effective care; and payer organizations can improve clinical and financial performance.
To learn more about how AMN Healthcare Language Services can help close care gaps for your LEP members, visit www.amnhealthcare.com/language-services/.
[1] Pathare S, Brazinova A, Levav I. Care gap: a comprehensive measure to quantify unmet needs in mental health. Epidemiology and Psychiatric Sciences. 2018;27(5):463-467. doi:https://doi.org/10.1017/s2045796018000100
[2] Centers for Medicare & Medicaid Services. Improving Care for People with Limited English Proficiency. Published 2023. https://www.cms.gov/files/document/cms-2023-omh-lep-infographic.pdf
[3] Chandrika Divi et al., Language Proficiency and Adverse Events in U.S. Hospitals: A Pilot Study, 19 Int’l J. Qual. Health Care 60 (2007).
[4] Wilson E, Chen AH, Grumbach K, Wang F, Fernandez A. Effects of limited English proficiency and physician language on health care comprehension. J Gen Intern Med 2005. Sep;20(9):800-806. 10.1111/j.1525-1497.2005.0174.x
[5] Lindholm M, Hargraves JL, Ferguson WJ, Reed G. Professional language interpretation and inpatient length of stay and readmission rates. J Gen Intern Med. 2012;27(10):1294-1299. doi:10.1007/s11606-012-2041-5
[6] Karliner LS, Pérez-Stable EJ, Gregorich SE. Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients With Limited English Proficiency. Med Care. 2017;55(3):199-206. doi:10.1097/MLR.0000000000000643
