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February 21, 2005As seen the week of:

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Benefit communications redesignedfor diverse workforceBy JOANNE WOJCIK

Recognizing that the American workforceis becoming increasingly multilingualand multicultural, many employers andhealth plans have been redesigning theirhealth benefit communications to reachthis diverse population.

But merely translating brochures, Websites and other materials into other lan-guages is not enough, communicationexperts say, because, in addition to thelanguage barriers, there often are culturalbarriers that prevent employees fromdiverse backgrounds from seeking appro-priate medical care.

To be effective, benefit communica-tions must take these cultural differencesinto account and, in some cases, gobeyond the traditional workplace modeland extend into the homes and commu-nities of the groups being targeted, bene-fit communication experts say.

“In the written and verbal communi-cation, we spend much more time help-ing them understand the health caresystem in this country,” which is differ-ent from that in most other countries,said Kirk Rothrock, president and chiefexecutive officer of CompBenefits Corp.,a dental and vision plan based inAtlanta.

Most people from other countries typi-cally received their health care services inclinics, whereas in the United States, “wehave a generalist and a specialist commu-nity in health care, dental and vision.They struggle with this. It’s not enoughto translate the materials to say ‘Go to ageneralist for this’ or ‘Go to a specialistfor that,’” Mr. Rothrock said.

Furthermore, “this population is notfocused on prevention,” he added.

For example, “they only go to the den-

tist or optometrist as needed,” eventhough virtually every dental insuranceplan covers preventive care at 100%, Mr.Rothrock said.

To encourage prevention and, hopeful-ly, reduce future dental costs,CompBenefits employs a significantnumber of bilingual call center employ-ees who have been trained to steer theconversation toward preventive care andclearly explain available benefits, he said.

Roswell, Ga.-based HispaniCare hasbeen building bilingual versions ofhealth plan and third-party administra-tor-sponsored Web sites that not only aretranslated from English into Spanish butare specifically designed to address thespecial health needs of Hispanic planmembers.

For example, because Hispanics areprone to diabetes, which is linked to dietand obesity, HispaniCare has developedan interactive weight management sitespecifically designed for Hispanics, saidDirk Schroeder, executive vp ofHispaniCare.

HispaniCare is working with severallarge employers in Texas to test the effec-tiveness of the site and will present itsfindings at the June meeting of theNational Business Group on Health’sInstitute on Obesity, he said.

“Health care is a unique field when itcomes to communication,” said Mr.Schroeder, who has spent 20 yearsresearching cross-cultural and multicul-tural health care issues. “It’s technical;people don’t understand it, and they’rescared.”

And that is why people who are notnative speakers of English may be morecomfortable discussing their health carewith others who speak their languageand share their culture, he said.

“You may be fluent in French, but ifyou’re in Paris and you’ve been diag-nosed with breast cancer and your doctoris discussing with you whether or not tohave a mastectomy, wouldn’t you wantto hear it in your native language?” heasked.

In acknowledgement, the BlueFoundation for a Healthy Florida, BlueCross & Blue Shield of Florida’s philan-thropic affiliate in Lakeland, recentlyawarded We Care of Polk County a grantto hire a part-time, bilingual outreachcoordinator.

“It is difficult at times for us to commu-nicate with our minority clients who donot speak English or do not speak itwell,” said Sandy Swanson, director ofWe Care of Polk County. “This grant willallow us to better serve our clients, pro-viding a bilingual coordinator to followup with patients and ensure they com-plete the necessary treatment plan.”

Even when the language is understood,though, cultural nuances could alsointerfere with communication, accordingto Robert Oscar, president and founder ofRxEOB, a Web-based communicationsvendor based in Richmond, Va. Earlierthis month, RxEOB launched a Spanish-language version of its Web site under apartnership with Triple-S of Puerto Rico, aBlue Shield licensee.

“It’s important to be sensitive. That’sone reason we ask our clients to reviewthe Web site to make sure we’re not acci-dentally saying something inappropri-ate,” Mr. Oscar said.

There is an assumption at some com-panies that, because their employees arerequired to speak English and have atleast a high school education, there is noneed to engage in any special communi-cations in other languages.

February 21, 2005 Business Insurance

Spanish versions ofpages from theChristus Health andAtlantiCare Web sitesare more than simplytranslations from theEnglish-languagepages. They aredesigned to address the needs of Hispanicplan members.

But even highly educated people whocan speak conversational English maynot be able to understand the abstractEnglish used to describe health caresymptoms, conditions and treatments,said Shani Dowd, director of clinical cul-tural competence training at the Institutefor Linguistic & Cultural Skills at theHarvard Pilgrim Healthcare Foundationin Quincy, Mass.

“They may be quite fluent in both lan-guages but may not be fluent in medicalterminology,” Ms. Dowd said.

Even in medical offices with bilingualstaff, communication errors could occur,leading to noncompliance with certaintreatments or, worse, to medical errors,she said.

“A lot of bilingual staff who are calledupon to interpret may not have trainingin medical terminology or understandingwhy physicians ask questions the waythey do,” she explained.

The institute provides two levels oftraining for medical interpreters—a basicprogram and an advanced program forthose who need disease-specific informa-tion, including translations for describingcommon treatments or tests that areused.

“There clearly is a growing awarenessand interest in trying to provide moreinformation and support in different lan-guages,” said Suzanne M. Kenney, a com-munications consultant at Hewitt

Associates Inc. in Lincolnshire, Ill.In some cases, employers are using

nontraditional benefit communicationvenues, she said.

“For example, in some cultures, par-ticularly if it’s a first-generation immi-grant to the United States, there may bea greater sense of confidence and trustand comfort with a local newspaper, orperhaps a particular person in the com-munity who is considered an activist,”she said.

In fact, Hewitt has been talking withsome ethnic media organizations inCalifornia about running announce-ments on employers’ health promotionefforts, she said.

The alternate venue has proved effec-tive in the African-American community,according to Virgil Simons, founder andpresident of Prostate Net, a nonprofithealth education company based inGuttenberg, N.J.

More than 10,000 men were screenedfor prostate cancer after they learnedabout the disease at their local barber-shops, which had been recruited byProstate Net as part of a nationwide cam-paign that also included partnering withLos Angeles-based Metro-Goldwyn-Mayer Inc. in the release of the 2004 film“Barbershop 2.”

“Barbershops are places where mencome to socialize, engage in dialogue,open and free communication. It’s acountry club, of sorts, where men can lit-erally ‘let their hair down,’” he said.

“There’s also a historical paradigmrelated to African-American barber-shops,” he said. “Going back to the civilrights movement, the planning andmobilization sessions took place in thebarbershop, because it was considered asafe place to talk and share strategy.”

Though Prostate Net’s program is cur-rently focused on prostate cancer screen-ing, plans are to expand it to includeother diseases endemic in the African-American male population, according toMr. Simons.

“From a benefit manager’s standpoint,it’s important that they recognize thattheir traditional ways of communicatinghave to be expanded to include somekind of community partnerships to reallyget the messages out and get them actedupon and adopted by the communities,”he said.

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‘There clearly is a growingawareness and interest intrying to provide moreinformation and support indifferent language.’

Suzanne M. KenneyHewitt Associates inc.