Race, Ethnicity, and Language Data: Standardization for Health Care Quality Improvement
H. Contra Costa Health Plan Language Assistance Database and Ethnicity Categories
Contra Costa Health Plan (CCHP), founded in 1973, is sponsored by the county of Contra Costa, California. It is the only county run health plan in California, and it was the first federally qualified county sponsored HMO in the United States. Today, CCHP serves approximately 85,000 people, including public and commercial members. The plan is licensed by the California State Department of Managed Health Care and the provisions of California SB853 apply for determining the language needs of its membership.
CCHP has developed, in collaboration with other health plans, a set of race, ethnicity, and spoken and written language categories applicable to its service population (see following pages). After analysis of its membership needs, CCHP determined that there were 15 detailed ethnicity and language categories that would be most frequently used by its members at different sites. Initially, a top 10 list was compiled, but it was apparent that the top 10 list at each service site was not the same; by developing the top 15 list, the top 10 categories at all sites were covered. To further increase interoperability among parts of the health system, CCHP is trying to promote the top 15 categories into the data collection systems of all county health centers and the Contra Costa Regional Medical Center. A need remains, however, to crosswalk the CCHP codes to different codes used at the state level (e.g., for hospital discharges).
The top 15 ethnicities and languages are visible on drop down menus for selection by staff and the system has the capacity to access the full list if an individual self-identifies with a category not included in the top 15. For example, if a member services representative types the letter "e," English will pop up from the top 15 list, but if the patient speaks another language starting with "e," a second keystroke brings up other language choices beginning with "e" such as Estonian (see entry screen and training instructions on the next page). Additionally, they have helpful features such as allowing population of those fields for other family members at the same time. The CCHP phone script for member services staff has evolved over time from a lengthy explanation of the need for these data for quality improvement to simply request for verification; collection of the data takes practice and monitoring. Collecting these four variables (i.e., race, ethnicity, spoken language, and written language) takes, on average, one minute and thirty seconds per call. To ensure that the race, ethnicity, and language data are being collected, production metrics regularly report on the number of records fully completed by member services staff, which is reviewed by the member services manager.
CCHP collects ethnicity separately from race and avoids aggregating detailed ethnicities to OMB race categories whenever possible. To ensure compliance with HEDIS reporting requirements and minimize redundancy in data collection, CCHP automatically populates a variable on the individual's Hispanic ethnicity based on his or her responses to the language, race, and detailed ethnicity questions.
Contra Costa Health Plan's Language Assistance Data Base Member Services Staff Training
The Collection of Spoken/Written Language, Race and Ethnicity is meant to be at the end of a call; after a member has been helped with the issue they called about.
Add this step to your conversation at the end of the call as a verification process. This sentence has been shown to be effective:
"We are verifying that we have the most accurate information about our members on file."
Then proceed to ask the four questions listed below.
Notice that the top 15 (most frequent) are at the top of the list; the complete list follows at the bottom. At the end, ask if the information applies to all family members. If it does check all family box in left corner of the screen, if it does not enter the family members individually.
Tab—will move the cursor to the next field. Example: from Spoken Language to Written Language.
Pressing a letter: Example "S" will take to the cursor to Spanish in the top 15 list, by pressing S again will take you to Samoan, then Sangho and so on...
Go to Table H-1 for the Language Assistance Data Base (LADB), based on Centers for Disease Control and Prevention (CDC) race/ethnicity codes and International Organization for Standardization (ISO) language codes. Table H-2 lists ISO spoken language codes, and Table H-3 lists ISO written language codes.