Health equity

Policies and practices: 

• Ensure equitable access and nondiscriminatory practices
• Identify and understand the needs of individuals and families 
• Work with natural, informal support and networks within culturally diverse communities 
• Align with national and state standards

Strategic direction includes:

• Assessing population health to determine community needs
• Addressing targeted needs to help determine interventions 
• Using best practice solutions for use based on proven interventions for the target population
• Evaluating and measuring practice effectiveness
• Providing affordable, quality care that addresses SDOH and is affordable

Training emphasizes:

• Personal and organizational values that impact health care delivery
• Communication and empathy to create connections
• Knowledge and skill integration to improve health outcomes and prevent institutionalized racism and discrimination

How members internalize health equity:

• Self-reflection
• Values
• Awareness
• Knowledge
• Integration

How providers and organizations apply health equity:

• Federal guidelines, like the national standards for Culturally and Linguistically Appropriate Services (CLAS) in health and health care
• Sales proposals and contracts
• Policies and procedures
• Workforce
• Environment

Our goal is to provide a personalized care experience for members in their communities. We can do this by leveraging assets and partnerships with trusted community-based organizations — so we can be ready to address members’ whole-person needs, such as:

• Nutritious food
• Employment
• Housing
• Education 
• Transportation
• Interpersonal safety

These needs are often called social determinants of health. Our investment in digital platforms allows us to better identify, connect and monitor member needs and link them with community resources.

The equity journey begins with knowing ourselves, our communities and the members we serve. Our goal is to connect, listen, learn and improve conditions. To meet this goal, we:

• Assess the population
• Analyze the information
• Ensure that data guides interventions and decision-making at all levels 

We want to reduce health disparities and ensure health care equity and justice for every member, including historically marginalized groups. So we remain committed to continuously:

• Increasing cultural sensitivity
• Advancing health literacy
• Implementing best practice programs 

Our multimodal approach addresses health equity root causes through:

• Added services
• Traditional care management (CM)
• Disease management programs
• Focused community-based programs

Our programs have helped members overcome disparities, leading to improvements in behavioral health and pregnancy outcomes, as well as management of chronic conditions like diabetes and hypertension. 

Priorities for our Cultural Competency Department include meeting member needs based on their literacy and culture. We also want to provide language access services and culturally competent care.

To achieve these goals, we’ve developed a cultural competency plan that:

• Addresses the diverse needs of our system
• Fosters internal and external collaboration
• Ensures provision of high-quality language services at no cost to members

You can help ensure people get the best care possible and understand the care they’re receiving by:

• Becoming more culturally competent
• Recognizing the importance of health literacy

You can choose from each of these topics below to learn more. 

Becoming more culturally competent means understanding different cultures, especially how they view and access health care services. 

Understanding health care disparities

Despite advances in diagnostic and treatment protocols, disparities remain. Here are some examples:

Education and health³

• People with less education are more likely to be at risk for obesity, substance use, and intentional/unintentional injury, compared with people who have more education.
• Higher levels of education generally mean longer life and a higher likelihood of health literacy (finding and understanding basic health information and services to make good health decisions).

Mortality and chronic disease rates⁴

Compared to their white counterparts, Native Americans have:

• Mortality rates almost 50 percent higher 
• Infant mortality rate at 1.5 times higher 

Native Americans are also more likely to die from heart disease than white people and have higher risk and rates of chronic disease than other groups.⁴

You can learn more about some health care disparities among different groups of people from the Centers for Disease Control and Prevention (CDC).

Why culturally competent care matters

Various causes are behind disparities in health care. Health insurance policies and facility locations add to these disparities, as do lifestyles that may be common in some minority communities. So, what can you do?

Even unconscious clinical decision-making, stereotyping and bias can have an impact. Studies have shown that historically marginalized groups are more likely to feel:

• Their preferences are not respected
• Like they have less of a partnership with their doctors
• Dissatisfied with their health care encounters

It’s important to understand culturally competent care and how to continue improving your own cultural competency.

The culturally competent provider

Here are some key traits of a culturally competent provider⁵:

• Explores and respects patients’ beliefs, values, preferences and needs
• Builds rapport and trust
• Finds common ground
• Is aware of their biases
• Is knowledgeable about other cultures
• Is aware of health disparities and discrimination affecting minorities
• Effectively uses interpreter services when needed

Increase your cultural competency

Various models exist for cross-cultural communication. They’ve been designed to provide health care providers with simple, straightforward ways to view and approach patient communication.

One model of cross-cultural communication is the LEARN approach:

• Listen with sympathy and understanding to the person’s perception of the problem
• Explain your perceptions of the problem
• Acknowledge and discuss the differences and similarities
• Recommend treatment
• Negotiate treatment

Following these simple steps helps bring patients into the decision-making process, where historically marginalized groups often feel left out.

Providers often communicate at levels beyond a layperson’s ability to comprehend. This can lead to negative outcomes, complaints and even malpractice suits.⁶

Health literacy has a big impact on comprehension. It refers to a person’s ability to obtain and understand basic health information and services and to follow instructions for treatment. It is estimated that more than one-third of American adults lack adequate health literacy.

Low health literacy rates are more common among^6,7:

• Older adults
• Minorities
• Those with low socioeconomic status
• Medically underserved people
• Those with limited English proficiency (LEP) or with English as a second language (ESL)
• Those who didn’t finish high school
• Those with a low income or who are unemployed

A more patient-friendly communication style — one that encourages questions — can help people with limited health literacy better understand their diagnoses and therapies. 

Those with limited health literacy:

• Report poorer overall health
• Are less likely to make use of screening
• Present in later stages of disease
• Are more likely to be hospitalized
• Have poorer understanding of treatment
• Have lower adherence to medical regimens

Some possible signs of limited health literacy may include⁶:

• Incomplete or inaccurate forms
• Missed appointments
• Noncompliance with medication regimens
• Failure to get prescribed lab or imaging tests

Be sure to engage in patient-friendly communication, using easy-to-understand language in both conversation and your written materials. 

Some tips for clear patient communication

Here are some tips you can try for clear communication⁶:

• Ask patients to bring in their medications, so they don’t have to name them all during their appointment.
• Offer help in filling out forms.
• Make sure forms are in the patient’s language.
• Make sure any handouts are easy to read and understand.
• Speak more slowly.
• Don’t overwhelm the patient with too much information. Keep it short and simple.
• Avoid medical jargon.
• Consider showing or drawing pictures to aid in understanding.
• Ask patients to repeat your instructions, so that you can make sure they understand.
• Encourage questions. Using the Ask Me 3 program can help patients feel comfortable.

You can get more tips on communicating with patients and improving health literacy. Check Health literacy and patient safety: help patients understand (PDF). You can also check the provider training section later on this page.

Our member education services include tools to improve understanding of benefits and services. These services result in improved health outcomes and independence. 

We provide materials and support in formats best suited to populations and members we serve in person, telephonically and/or virtually. To improve the quality of health care services for our members, we align all our practices with the:

• National Standards for Culturally and Linguistically Appropriate Services (NCLAS)
• National Committee for Quality Assurance (NCQA) 
• Americans with Disabilities Act (ADA) regulations

Improving health starts by ensuring a person has basic information about the health care services available, what they mean and how to access them. The best approach is to ask during our first contact and offer a variety of options to get them the information they need. We do this through a combination of in-person, telephonic and virtual methods, including:  

• Listening sessions and focus groups
• Street fair events
• Social media
• New member welcome packet
• Videos on YouTube
• Virtual applications 
• Telehealth

We have 6 committees and councils that help us serve the community and improve services for members: 

• Governance committee
• Member advocacy committee
• Foster and adoptive care committee 
• Culturally and Linguistically Appropriate Services (CLAS) committee
• Arizona Long Term Care System (ALTCS) member advisory council 
• Youth Leadership Council (YLC) 

Members, as well as their families and friends, can join when we have openings. Visit our committees and councils page to learn more about each group’s role. We’re committed to listening to the community and our members.

Members have access to all written materials in the threshold languages of the communities we serve. They also have access to interpreters for all verbal communications. 

We meet the needs of our members through our Spanish member website and our Arabic member website, which:

• Offers tools and services in Spanish, English and Arabic to help members make informed decisions and keep themselves and their families physically and financially healthy
• Includes a glossary of common medical and health insurance terms written in everyday language to help ensure members understand disease management programs, as well as plan materials and descriptions
• Offers questions members can ask their health care providers to help make health care visits better and more productive
• Employs Spanish-speaking member services representatives who can speak directly with members who prefer Spanish-speaking support

Members with disabilities have access to auxiliary aids and alternate methods of communication. To meet the needs of those who are deaf or hard of hearing, we train staff to:

• Use text telephone (TTY)/telecommunication device for the deaf (TDD)
• Ensure that members understand communication about new member enrollment or care management (CM) programs 
• Recognize when a member needs extra support to engage more fully in their health care

Our platforms support closed-loop referrals for services such as food and housing. They can filter and identify organizations by “populations specialized in serving deaf or hard of hearing.” This allows us to find trusted community organizations to help meet member needs. 

We comply with the Web Content Accessibility Guidelines (WCAG) 2.0, which define how to make web content more accessible to people with disabilities.

To meet the needs of those who are blind or visually impaired, we train staff to understand member rights. For example, we ensure members receive materials like the member handbook or treatment plans in large font size or braille if they request it. 

Since materials alone can’t guarantee that members are able to fully engage with their care, it’s vital that our staff and network providers can recognize the need for extra support. They also need to find the appropriate resources that are accessible to members in the community.  

• Recruit, promote and support a culturally and linguistically diverse provider network responsive to the population in the service area.
• Educate and train providers in health equity, which includes an understanding of unconscious bias, ACES, SDOH, health disparities, institutionalized racism and culturally and linguistically appropriate practices.
  
• Ensure that providers inform all members of the availability of language assistance services clearly and in their primary language, verbally and in writing.
• Collect and publish information on the languages contracted providers speak fluently, or languages for which translation services are offered.
  
• Collect and disclose provider race and ethnicity data. 
• Analyze the provider network’s ability to serve members’ health needs and develop ways to address gaps. 

We have 6 committees and councils that help us serve the community and improve services for members: 

• Governance committee
• Member advocacy committee
• Foster and adoptive care committee
  
• Cultural and Linguistically Appropriate Services (CLAS) committee
• Arizona Long Term Care System (ALTCS) member advisory council 
• Youth Leadership Council (YLC) 

Providers can join when we have openings. Visit our committees and councils page to learn more about each group’s role. We’re committed to listening to our diverse network of providers.

• A Physician's Guide to Culturally Competent Care from the Office of Minority Health (with up to 9.0 hours of category 1 AMA credits at no cost)
• Health literacy and patient safety: help patients understand (PDF) from the American Medical Association Foundation and American Medical Association
• Tools, resources and guides from the Think Cultural Health resource library
• Better Communication, Better Care - Provider Tools to Care for Diverse Populations (PDF) from the ICE Cultural and Linguistics Workgroup 
• Cultural religious competence in clinical practice from the National Center for Biotechnology Information, National Library of Medicine
• Culture, language, and health literacy information from the Health Resources & Services Administration (HRSA)

• Workforce development training and resource site
• Network management webinars, like the social determinants of health slides (PDF) or recording 
• Our annual provider conference
• Newsletters and notices with relevant training or news

You can learn more about provider education on our events and training page.

Community resources: Community resource guide

Provider manuals: Mercy Care provider manuals, materials and guides

Eligibility, claims, tools and resources: Provider Portal