CBH Practitioner Conection
Volume XIV, 4th Quarter

Facilitating Cultural & Language Match in Behavioral Care

The Problem

In a given year, one in four adults suffers from a diagnosable mental disorder according to the National Institute of Mental Health, yet only one-third of Americans with a mental health problem seek care. The Mental Health: Culture, Race, Ethnicity Supplement to the Mental Health Report of the Surgeon General (SMA-01-3613) indicates that the percentage of African Americans receiving needed care is only half that of non-Hispanic whites, while among Hispanic Americans with a mental disorder, fewer than 1 in 11 contact a mental health specialist and fewer than 1 in 5 contact a general health care practitioner for assistance.

The Response

CIGNA Behavioral Health (CBH) identified and continues to monitor the problem through annual analysis and comparison of the population against the composition of our behavioral practitioner network and also through annual Participant Satisfaction Surveys, which showed that African American and other minorities were less satisfied with appointment access. Since 2002, CBH has taken many steps to improve access and care for diverse participants:

In 2002, we:

• Began voluntary collection of practitioner racial or ethnic identity, sexual orientation, substance abuse recovery status, religion, veteran status, and disability information to supplement language, gender, and age information already collected as part of the standard credentialing process.

• Enhanced data allowed staff nationwide to assist callers by searching for practitioners in particular zip codes against diversity criteria. Language Line (telephonic translation service) was in use.

• Aggressively recruited practitioners with diverse backgrounds, languages, and other diversity characteristics.

• Implemented web based access for behavioral care, expanding the diversity information available to participants as they selected their practitioners.

In 2003:

• An open access model was adopted, allowing participants to begin routine treatment with network practitioners without the need for prior authorization.

In 2004 and 2005:

• Web based Practitioner Self Introductions were created and actively promoted through outreach calls, newsletter articles, mass e-mail communications, and at practitioner continuing education events. A photograph and self-description of treatment approach and practice setting could now be made available to assist participants in matching diversity needs or preferences.

And in 2006:

• CBH moved to required submission of the Practitioner Self Introduction for all practitioners upon initial credentialing and contracting into the network.

The Results

Increases in Behavioral Network Count By Select Criteria

	2001	2002	2003	2004	2005	2006	Increase 2001 to 2006
African American	441	523	597	690	725	800	81.4%
Spanish Speaking	1132	1391	1626	1879	1978	2081	83.8%
Jewish	1394	1481	1653	1814	1872	1901	36.37%
Gay/Lesbian	434	518	590	680	715	730	68.2%

Dramatic increases were achieved in the number of practitioners identified as African American, Asian American, Cuban American, Latin American, Mexican American, and Pacific Island Descent. A goal of 50% increase was also achieved for those identified as Gay/Lesbian and Bisexual. In terms of religion, the same goal was achieved for Buddhist, Christian, Hindu, and Moslem faiths. An improvement of 50 percent or greater was also achieved for those speaking Chinese, French, German, Spanish, and Sign Language. In addition, the goal was achieved for those identified as being in substance abuse recovery.

Annual Participant Satisfaction Survey responses provided by African American and other Non-Caucasian members found significant increases in satisfaction with Urgent access to care from 2003 to 2006 (z=2.15, p-value=0.031). Improvements in Routine access to care for the same time periods were also achieved (z=1.81, p-value=0.070). Significant improvements were also seen in the satisfaction with the practitioner’s ability to listen carefully, possibly suggesting improved cultural sensitivity (z=1.79, p-value=0.074).

An additional survey utilized by CBH to measure member satisfaction includes a question that asks participants to rate whether they were able to see a practitioner who met their special cultural, ethnic, and linguistic needs. The percentage of participants responding “Fantastic,” the highest response option, showed significant improvement from 2004 to 2006 (z=2.64, p-value=0.008). CBH also monitors utilization of the web based practitioner search and online access. The number of participants using the practitioner search capability tripled from 3043 (2004) to 9174 (2006). The number of behavioral practitioners who submitted the Practitioner Self Introduction for the web also showed dramatic improvement, from 1282 in 2005 to 6670 in 2006, and reaching 8571 year to date in 2007.

Impact of the Initiative

Implementation of these strategies has required substantial commitment, but CBH plans further enhancements over time because of the clearly demonstrated improvement to member satisfaction and access to care.

Other Featured Articles:

ASSESSING SUICIDALITY

CIGNA WINS MULTICULTURAL AWARD

INSURANCE IDENTIFICATION CARDS

INCREASING CBH REFERRALS

MEET THE EMPLOYEE ASSISTANT CONSULTANT TEAM

PRACTITIONER SELF INTRODUCTIONS

ONLINE COACHING PROGRAM 

HEALTH INFORMATION RATED POSITIVELY

ANNOUNCEMENTS

Practitioner Connection Home | CIGNA Behavioral Health Home | Legal Disclaimer

©2007 CIGNA