Benefits: one size does not fit all - health benefits and minorities

Business & Health, May, 1997 by Janet Gemignani

Abacus oversees the Employers' Managed Health Association, a Rhode Island health purchasing coop of 150 small employers. One out of four of the covered workers is Hispanic, says Abacus president Michael Follick, which prompted the group to write, Como elegir un plan de salud, or How to choose a health plan. The booklet, now available only in Spanish and English, will be translated into other languages, he says.

Chris Zarcadoolas, a sociolinguist, developed the guides after three years' research funded by the Agency for Health Care Policy and Research. They're written on a fourth-grade reading level and were used for the co-op's open enrollment for the first time last fall. "What we found pervasive was a lack of a very basic understanding of managed care," says Zarcadoolas. Participants in focus groups she conducted were unfamiliar with terms like co-pay and PCP; for example, many workers thought the abbreviation for primary care provider was a reference to a street drug.

Noting that, "You have to start where the consumer is," Zarcadoolas describes how the Abacus guide works: New enrollees start by watching the video and are then given step-by-step instructions in filling out a workbook that helps them assess the family's health needs, compare plan costs, check convenience of providers and pharmacies and read (and interpret)comparison charts. Chart reading in general is a challenge even for literate adults, Zarcadoolas points out, but it's far harder for those without much formal education. "Most people look for a doctor rather than looking at the family's health considerations. Or they forget to check that the network pharmacy is near them or the doctor's hours are convenient." The chart helps them match plan and need. Noting that ER misuse is a consequence of lack of understanding, she says her guide helps enrollees use their health plans far more cost effectively.

MOLDING THE PLAN TO FIT THE NEED

When Monfort Inc., a meatpacking company in Greeley, Cob., conducted a risk management investigation to find out the reason for its astronomical childbirth costs, the firm discovered that many of the Latin workers--or wives of workers--were skimping on prenatal care. Money wasn't the reason, since it was covered under Monfort's health plan. Instead, company investigators found that some of the women were uncomfortable getting pelvic exams from male physicians. Others avoided going to doctors who didn't speak their language.

Outcomes improved when Monfort, which has a 21,000 largely Hispanic workforce, made arrangements to have women get their prenatal care at Weld County Health Department in Grail, where many nurse practitioners, midwives and office workers are bilingual. To make it easier, the company arranged the service so there are no forms to fill out, no co-payments and no deductibles. To make sure women got the care, Monfort added a "carrot and stick approach" as well.

As of 1994, the self-insured company required every expectant mother to go for her first prenatal check-up within the first four months of the pregnancy and to have six subsequent visits, says Pat Campbell, director of employee health and wellness. Those who meet the criteria get 100 percent coverage of all pregnancy-related claims. Otherwise, the company pays only 50 percent.