II. Quality Monitoring

Cultural Competence Guidelines in Managed Care for Latino Populations

Quality Monitoring and Improvement

Standard

The Health Plan should have a regular quality monitoring and improvement program with defined indicators applicable to evaluating services to Latinos and other minority populations.

Implementation Guidelines

The Quality Improvement Plan should include:

Sampling approaches of current and past utilization patterns, by modality (including pharmacotherapy), and level of care.
Quality improvement teams including Latino consumers and Latino Mental Health Specialists which review data from quality indicators relating to Latino and other minority populations. If irregularities or deficiencies in care are found, special quality studies and corrective actions should be undertaken to identify causes and address root causes/processes.
Consumer satisfaction surveys, translated into local languages and dialects, implemented by members of the community independent from the Health Plan. Surveys should be available in various formats to facilitate the participation of consumers at all socioeconomic and educational levels. Sampling should include involvement of Health Plan drop-outs.
Periodic assessment of functional outcomes which are valid and applicable to Latino populations, for consumers and families receiving services, as well as the entire covered population.
Service provision, quality and outcome data for Latino consumers and families identified by provider. Data should be reported on a regular basis to the governing entity and used as a basis for determining contract renewal.
Credentialing and privileging standards specific to different disciplines which include cultural and linguistic competence knowledge, skills, and attitudes relevant to the Latino population. These should include a continuing education requirement and performance based competency testing.
A record of, and regular reporting on, all appeals, grievances, and law suits differentiated by ethnicity of the complainant and the specific provider. Disproportionate trends by ethnicity should require measurable and timely corrective action.
De-listing criteria and tracking for providers and practitioners which are open for review, analyzed by ethnicity of provider and able to account for differing service needs of diverse populations, including Latinos.
Tracking of movement across levels of care, of the use of intrusive, specialized or restrictive interventions, and of unusual occurrences by age, ethnicity, and specific practitioner, with sanctions for desirable and unacceptable performances.
Identification and tracking of high-cost consumers resulting in the review and adaptation of their treatment plans to better address their needs.

Recommended Performance Indicators

Presence of a Quality Improvement Plan.
Representativeness of Latino consumers, providers, and community members on the quality improvement team.
Occurrence of special quality studies focusing on deficiencies in the care of Latino consumers.
Linguistically and culturally factored consumer satisfaction surveys which are independently administered and include Health Plan drop-outs and short term recipients.
Regular reporting of Latino-specific quality assurance data to the governing entity, including appeals and grievances.
Systematic tracking of high-cost consumers with support to treatment teams to identify and implement successful interventions.
Systematic tracking and open reporting of provider de-listing by ethnicity.

Recommended Outcomes

Consumer and family satisfaction with services for Latinos
Benchmark: Comparable to overall service population
Rates of drop-out, grievances, restrictive care, unusual occurrences, and adverse events for Latinos
Benchmark: Comparable to overall service population
Match between level of care/restrictiveness of modality and level of treatment need for Latinos

Benchmark: Level of match comparable to overall population
Functional outcomes in domains of daily living (e.g., housing, access to primary health care, family role, vocational/educational/employment, community tenure)

Benchmark: Improvement over time, rates comparable to overall community
Comparability of access and benefit from service

Benchmark: Comparable rates of access, consumer satisfaction and clinical results across overall service population
Rates of recidivism into restrictive level of care or other restrictive placements

Benchmark: Comparable to overall population served and significant reductions where inequities exist

Table of Contents

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