Caring for Latinos requires more than knowing Spanish

Presbyterian Healthcare Services, based in Albuquerque, offers some services in Spanish, but doesn't have programs or initiatives specifically for the Latino population, according to a spokeswoman.

Houston-based Memorial Hermann also doesn't provide programs targeted at Latinos. Instead, the health system implements programs focused on patients' insurance status or disease, said Carol Paret, senior vice president and chief community health officer. “Houston is certainly a multi-ethnic community, so we find that there are more important kinds of breaks in populations rather than just ethnicity,” she said. “Houston has a huge uninsured population, so we deal with that population.”

Texas, which didn't expand Medicaid, had a 16.6% uninsured rate in 2016, the highest in the U.S. According to 2010 census data, 39.4% of the population was Latino.

Memorial Hermann tries to enroll the uninsured and Medicaid populations who are high users of the emergency room in medical homes. The system also hires patient navigators who are bilingual. The goal is to set patients up in a model that will work best for them. “We do this at the individual patient level,” Paret said. “What do you need and what will work for you?”

Albuquerque-based Lovelace Health System and Oakland, Calif.-based Kaiser Permanente have both made more targeted approaches to care for the Latino population. About 38% of Lovelace's patient population is Latino, according to Dr. John Cruickshank, CEO of the system's medical group. Because of that percentage, “We really need to pay a lot of attention to meeting the needs of that group culturally.”

Lovelace, which operates five hospitals in New Mexico, opened a clinic early last year in a predominantly Latino neighborhood in Albuquerque because there were limited healthcare options there. Lovelace also hired a bilingual Latino physician to work there.

Lovelace is also currently working with the National Institutes of Health and the National Cancer Institute on a mobile app targeted at Latino women to manage their diabetes. The app is still in development, but Lovelace plans to roll it out to its patient population during the pilot phase.

“It's important to focus our work on women; the Latino family structure is a matriarchy, so they are making a lot of decisions about diet and how the family receives healthcare,” Cruickshank said.

Kaiser Permanente has focused on training its workforce to understand and consider the unique culture of Latinos. One of its programs offers education to physicians about Latino culture and how it might affect care. For instance, classes touch on how to address religious beliefs and any alternative care Latino patients might be seeking outside of traditional Western medicine, such as herbal treatments.

Seniors gather for meals and coffee every day at Alivio's Casa Maravilla, a housing and activity center for adults ages 55 and over. The center opened in 2011 and provides meditation, fitness classes and wellness courses. (Bill Healy)

“We want to make sure our staff are all trained so they know how best to care for our patients, and it's not only about language but cultural nuances,” said Dr. Gina Gregory-Burns, physician director of diversity and inclusion at Kaiser Permanente.

Kaiser also provides English and Spanish education classes for patients on different diseases like diabetes and hypertension. Weight loss and emotional wellness sessions are offered, too. A bilingual health educator typically runs the classes.

Lack of insurance also can prevent Latinos from seeking care, allowing conditions to worsen, Alivio's Corpuz said. To address this, the center deploys a mobile wellness unit to different parts of the community to let residents know healthcare is an option for them even if they lack insurance. As a federally qualified health center, Alivio offers free services to those who qualify and charges others on a sliding scale determined by their income. A typical visit costs $30.

Although hospitals are required to offer interpreter services to patients, it's much more beneficial if the provider can speak in the patient's preferred language, Corpuz said.

Corpuz said it's become increasingly more competitive to recruit providers who speak Spanish because the pool of options is not only small, but more hospitals are realizing such providers are an asset.

Efforts and initiatives to improve those numbers are underway. A program at UCLA, called the International Medical Graduate Program, recruits immigrants from Latin America with medical degrees to complete their residency training in primary care. The program helps students pass the U.S. medical board examinations, which can be difficult without the additional help because of differences in testing practices.

The doctors are then required to work in an underserved community with a high Latino population for at least two years. A large majority of the doctors—75%—choose to stay in the community after the two years are up, said Dr. Michelle Bholat, executive director of the program.

A total of 128 students have participated in the program since it started in 2007. “No other program in the country exists that does this, and we hope that we can take this concept and make it work in the Southeast and North,” Bholat said. “It is about serving your community and where your community is missing doctors.”

Finding the right providers has been essential to Alivio's approach, which emphasizes the fact that all parties benefit if culturally sensitive care is provided properly. “It's not just about patient experience,” Corpuz said. “It has an effect on compliance and really the whole continuum of care.”