A Massachusetts-based HMO with its own network of health centers is trying to diversify the makeup of physician staffs to bridge neighborhood language and cultural barriers.
Harvard Community Health Plan started the program last year and now has a strategic plan under the direction of a vice president of work-place diversity.
Among the initiatives moving past the pilot stage this year is a medical residency program aimed at introducing minority and foreign-born prospects to the HMO model of practice and getting them to consider New England-and Harvard Community, specifically-as a practice destination.
About 8% of the physicians in the HMO's staff-model division are minorities, and the goal is to improve that by another 4 to 5 percentage points, said Barbara Stern, the office of workplace diversity's vice president.
But the main emphasis is "not so much the percentage as much as meeting the needs of members at specific locations," Stern said.
Though New England may not be commonly thought of as a region with a high percentage of minorities and significant language barriers, some projections show it headed in that direction, with a climbing rate of Hispanic, Haitian, African-American and Asian populations (See chart).
From routine care to medical emergencies, understanding of language and culture can make a difference in meeting healthcare needs. An internal report on diversity challenges put it this way: "When a non-English-speaking man agrees to a course of medical action without fully understanding it because, in his country, `you don't question the authority of a physician,' we miss a cultural difference that could have serious consequences."
Harvard Community's diversity push is a way to get a jump on planning for those cultural differences. "It's not only an ethical thing to do, but it's good business to reach out to them," said Patti Embry-Tautenhan, a spokeswoman for the health plan.
Already, employers and other payers are "giving us the message that they're going to require that we diversify our provider mix," Stern said. For example, some purchasers want health plans to identify multilingual physicians in their network directories.
And the state's Medicaid program has required participating plans to indicate multilingual and minority physicians by service area. "They want to know if there are significant barriers to delivering care in those areas," Stern said.
More than a year ago, Harvard Community surveyed every site to determine the four primary lan-guages spoken by enrollees. Starting this year, compensation for the top 50 senior managers will depend in part on steps taken to match their hiring to community need and to improve the organizational culture for diversity, Stern said.
In January, the Brookline, Mass.-based HMO and Pilgrim Health Care of Norwell, Mass., merged to form Harvard Pilgrim Health Care, a managed-care company with nearly a million enrollees throughout New England.
Pilgrim's network of independent practice associations and Harvard Community's division of capitated group practices operate "at arm's length" from the HMO instead of being controlled and salaried by the organization like the staff-model division, Stern said.
The diversity project for now will continue to focus on the staff-model health centers, which also are concentrated more in the urban areas of Boston where the need for diversity is greater, she said.
An assessment of those centers last year uncovered shortages of multicultural and bilingual staff.
To help solve the problem, the HMO came up with a plan to sponsor a monthlong elective residency program in managed care for minorities, targeting primary-care medical residents in their second or third year of residency when they're looking for a place to settle down.
Most residency programs offer an opportunity for elective study, and the Harvard Community initiative was designed to offer a short-term exposure to an urban managed-care practice style.
Because elective courses of study are subsidized by the residents' school, the only direct expenses for the HMO were for brochures to attract the first contingent of eight residents and the housing and travel expenses-about $15,000 to $20,000. A full-time coordinator for the program cost another $30,000.
The residents were sought mainly from medical programs on the East Coast for the first year's pilot project. That would reduce travel inconvenience and increase the likelihood that residents would move to Boston if interested in the practice setting, Stern said.
After the elective residencies ran their course in March through May, one resident from Howard University's medical program in Washington accepted a physician position. Problems with the foreign student's visa, however, have held up the hiring process.
The lessons learned from the pilot project will fine-tune the selection and timing as residency programs get their new year under way this month, Stern said.
Last year's residents were mainly in their third year, and the program was scheduled late in the academic year. As a result, most already had made their practice commitments.
This year the HMO will be aiming to bring in residents during their second year. Or the program may be able to schedule third-year students during the fall if they learn about the residency in time to make the elective arrangements.
The program also will draw on its community research to better target the ethnic backgrounds and languages needed most in the organization, she said. For example, the health centers have a significant influx of Haitian enrollees. The HMO also has identified a need for an African-American woman internist.
And because of the visa problems experienced during the first round, the office of workplace diversity "would like people who don't have complications around citizenship," Stern said.