Assessing the impact of financial incentives on provision of interpretive services in Medicaid

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PROJECT SUMMARY/ABSTRACT Broad access to professional interpretive services is a fundamental first step in improving access to care for people facing language barriers, including individuals whose primary preferred language is not English and those who are deaf or hard of hearing. For too long, the U.S. health care system has produced significant disparities in access, quality, and outcomes for individuals with non-English language preference (NELP). Research demonstrates that individuals with NELP have decreased access to health insurance and experience longer lengths of stay in the hospital, higher readmission rates, poorer management of chronic disease, greater risk of adverse events, and lower satisfaction with their care. Federal policy mandates access to interpretive services but does not mandate that payers reimburse for interpretation, leaving many health care systems ill- equipped to provide care to NELP patients. As part of its commitment to health equity, Oregon’s Medicaid program recently introduced an innovative financial incentive to increase access to interpretive services. The long-term goal of this research is to understand the extent to which financial incentives focused on health equity can change systems, and to characterize the downstream impact of these policies on experiences with and perceptions and quality of health care. Our specific aims, which are the first steps toward attainment of this long-term goal, are to (1) examine changes in the frequency of use of interpretive services among Medicaid members with NELP after implementation of Oregon’s incentive policy for interpretive services, and (2) assess differences in use of interpretive services by setting, type of care, modality of interpretation, interpreter type, and population. This study will use a longitudinal design to understand the impact of Oregon’s language access incentive policy on receipt of interpretive services among Medicaid members with NELP. We will use quarterly reports submitted by Coordinated Care Organizations (CCOs, Oregon’s Medicaid managed care entities) to assess changes in the proportion of members with a documented need for interpretive services who receive these services, the proportion of visits among NELP Medicaid members at which interpretation was provided, and the yearly average number of visits with interpretive services per member with a flagged need. In addition, we will use a comparative interrupted time series (CITS) approach to analyze changes over time in the proportion of flagged Medicaid members receiving interpretive services across different settings, types of care, and populations. Ultimately, better understanding of access to interpretive services is a critical step in efforts to remove structural inequities, enhance quality of health care, and improve outcomes.