How Does Language Support Fit Into Value-Based Care?

The U.S. spends almost double the amount of any other economically-similar country. But all that spending isn’t resulting in better health outcomes...

We have significantly more chronic diseases, such as obesity, heart disease, and diabetes. We also spend more on expensive tests, procedures, and prescription medications. We also have a much higher rate of hospitalization and death from preventable diseases.

Value-based care efforts aim to change those dynamics.

What is Value-based Care?

Since 1965, our healthcare systems operated on a fee-for-service (FFS) model. Providers and facilities made money based on how much care they provided — like surgeries or office visits — but we didn’t tie those services to outcomes. We didn’t account for whether the care was medically necessary or the patient was healthier as a result.

The Affordable Care Act (ACA) of 2010 shifted the decades-long FFS model to a value-based care (VBC) model. The Centers for Medicare and Medicaid Services (CMS) introduced multiple (and continually evolving) programs to curb unnecessary healthcare costs and improve quality.

At its core, value-based care focuses on:

• Care Coordination. Patients get the right care in the right place at the right time. Providers work together and share medical information to avoid care silos and duplicated services and tests. They encourage patients to get preventive care and use lower-cost options when appropriate. For example, sending patients to urgent care instead of an emergency room for non-life-threatening medical issues.
• Risk Management. Providers and payers manage patients with the highest risks and prevent disease instead of just treating it. For example, providers and patients proactively manage chronic disease to avoid ER visits. There is more focus on preventive care to reduce the risk of developing chronic illnesses.
• Quality Metrics. Healthcare providers get paid for achieving specific quality outcomes. For example, a provider must show that their diabetic patient’s A1c levels are under control because of their care. This is a significant shift from FFS (reimbursed for an office visit) to value-based care (reimbursed for the outcome of that visit).

How Will CMS’s New Expectations Impact Organizations?

By now, most organizations are familiar with value-based care. There are hundreds of Medicare Accountable Care Organizations (ACOs) covering millions of Medicare beneficiaries. Many commercial payers are also using VBC models for non-Medicare beneficiaries. The biggest challenge is moving toward VBC while still juggling all the costs and responsibilities (and the ingrained habits) of an FFS model. Medicare reimbursements are already subject to some VBC metrics (which will increase over time) so it’s important that organizations take the necessary steps to get there.

To succeed with VBC, healthcare facilities need:

• Buy-in from everyone — administrators, physicians, and staff — on the importance of VBC
• Tools to capture and report on quality metrics
• Partners that reduce care costs and improve quality

Where Does Language Support Come In?

Language support plays a critical role in improving services and reducing the cost of caring for limited-English proficient (LEP) patients. These individuals make up about 8.5% of the U.S. population — more than 25 million people.

Numerous studies show that LEP patients are at much higher risk of negative health outcomes when they cannot understand information about their care or communicate effectively with providers. The challenges also extend to cultural barriers that prevent someone from getting proper care. Errors are more likely to occur during:

• Medication reconciliation
• Informed consent about risks and benefits of specific types of care
• Emergency department care
• Surgical care

When errors happen, they cause significant patient harm and increase total care costs. Without access to a medically qualified interpreter, LEP patients have:

• Hospital stays 0.7 to 4.3 days longer than English-speaking patients
• Greater risk of line infections, surgical infections, and falls
• Higher risk of surgical delays because they cannot understand instructions on how to prepare for a procedure
• Higher chance of hospital readmission for chronic health conditions because they don’t understand how to manage conditions or take medications
• Difficulty understanding what symptoms would require follow-up care or when to get follow-up care after a hospital stay

How Healthcare Organizations Can Improve Health Equity and Prepare for VBC

Organizations that want to increase quality and reduce costs for VBC can immediately impact both by having language support available for LEP patients. Proper language support should include:

• Medically qualified interpreters — available in hundreds of languages to meet the needs of a diverse LEP population
• Translation services to translate important patient education documents into various languages, including surgery instructions, medication information, and more
• Translation & localization services for your website and other public-facing information
• Transcreation services that go beyond just translating the specific words, but also address cultural factors that can influence meaning and interpretation

Be Prepared With GLOBO

GLOBO is a partner that can help you prepare for the shifts that are coming — and the ones that are already here. We offer a wide range of language support solutions to organizations that want to address health disparities and improve care.

Additional Resources:

• Language Data Collection & Patient Safety: A Correlative Look
• The No Surprises Act & Language Access: How to Prepare
• The ONC Cures Act: Impact on Patients, Providers & Facilities
• Best Practices for Working with an Interpreter
• Tips for Improving Patient Safety for Limited-English Speakers
• Cultural Competence in Healthcare