Immigrants have social, healthcare challenges

CMs work to understand their culture

The key to managing the care of a multicultural population is to understand the people with whom you are working and to be aware of the challenges they face, says Sherry Rumbaugh, RN, director of care coordination for Passport Health Plan, a Medicaid health plan with headquarters in Louisville, KY.

That's why the health plan requires every employee to go through diversity and cultural competency education that provides insight into the multicultural community they serve, adds Marcelline Coots, manager of public affairs for the health plan. In addition, the health plan provides training and culture-specific information for providers, and makes education available to immigrants about healthcare options, and an overview of the health plan to newly resettled refugees.

The Louisville area has a growing immigrant population, Rumbaugh says. In fact, students in the Louisville school system speak more than 90 languages. "We have a large Hispanic population in the area, as well as a large number of Somali and Vietnamese families," Rumbaugh says. "Families from Iraq, Sudan, and Burma are also settling here."

Many people have misconceptions about immigrants, Coots says. "They don't know that when refugees arrive in America, they are already in debt. They have to pay the U.S. government back for the cost of transporting them to this country. They receive support for only 180 days, during which time they have to become acclimated to life in America, to go to English as a Second Language classes, and find a job. After the 180 days of support runs out, if they can't speak English or get a job, they often become homeless."

One training session required of all Passport employees is called, "Our Newest Neighbors," and gives participants a glimpse of what the refugees have experienced, beginning in the refugee camps, their journey to America, and after they arrive in Louisville and receive assistance from the resettlement agency.

Rumbaugh reports that the diversity training provides great insight for case managers who work daily with refugees who are chronically ill and/or high utilizers of healthcare services. "Refugees face the same problems as our other members on Medicaid, but the refugees' problems are worse because they are in a new place where they don't understand the language or the culture, and they are bewildered by the healthcare system," she says.

Case managers work with Paige Kolok, a former Peace Corps volunteer, who is Passport's cultural and linguistic services coordinator. Before joining the Passport team, Kolok worked at a local resettlement agency. Coots says: "She understands what refugees, immigrants, and undocumented members are going through. The fact that she worked with the resettlement agency gives her great insight into the situation."

When the case managers have trouble getting patients to have screenings or tests, they can call on Kolok to help them understand the problem and how to overcome it. For example, with some cultures, women don't feel comfortable making decisions, and the husband has to be involved in setting appointments, "It's very rewarding for the case managers and social workers when we use our understanding of a member's culture to make an impact on his or her healthcare," Rumbaugh says.

The case managers' goal is to help the members understand the healthcare system and learn to manage their care. Often, they have to take care of social needs first. "If people are worried about having a roof over their head, or where their next meal is coming from, it's hard to get them to adhere to their treatment plan. We can't stabilize someone medically without first addressing their social and economic needs," she says.

For example, one case manager worked with a refugee who was about to become homeless because the local housing partnership did not provide him with information in a language he could understand. The case manager contacted Passport's Kolok who worked with the local housing authority to remedy the situation.

The case managers work with the health plan's provider relations department to identify physicians who speak the language of the members, whenever possible. When they work with members who are not fluent in English, they use a tele-interpreter service to enhance communication "The telephone interpreter translates questions and answers as we educate members on managing their care and the importance of adhering to their treatment plan," Rumbaugh says.