Appendix H
Contra Costa Health Plan Language Assistance Database and Ethnicity Categories

Contra Costa Health Plan (CCHP), founded in 1973, is sponsored by the county of Contra Costa, California. It is the only county run health plan in California, and it was the first federally qualified county sponsored HMO in the United States. Today, CCHP serves approximately 85,000 people, including public and commercial members. The plan is licensed by the California State Department of Managed Health Care and the provisions of California SB853 apply for determining the language needs of its membership.

CCHP has developed, in collaboration with other health plans, a set of race, ethnicity, and spoken and written language categories applicable to its service population (see following pages). After analysis of its membership needs, CCHP determined that there were 15 detailed ethnicity and language categories that would be most frequently used by its members at different sites. Initially, a top 10 list was compiled, but it was apparent that the top 10 list at each service site was not the same; by developing the top 15 list, the top 10 categories at all sites were covered. To further increase interoperability among parts of the health system, CCHP is trying to promote the top 15 categories into the data collection systems of all county health centers and the Contra Costa Regional Medical Center. A need remains, however, to crosswalk the CCHP codes to different codes used at the state level (e.g., for hospital discharges).

The top 15 ethnicities and languages are visible on drop down menus for selection by staff and the system has the capacity to access the full list if an individual self-identifies with a category not included in the top 15. For example, if a member services representative types the letter “e,” English will pop up from the top 15 list, but if the patient speaks another language starting with “e,” a second keystroke brings up other language choices beginning with “e” such as Estonian (see entry screen and training instructions on the next page). Additionally, they have helpful features such as allowing population of those fields for other family members at the same time. The CCHP phone script for member services staff has evolved over time from a lengthy explanation of the need for these data for quality improvement to simply request for verification; collection of the data takes practice and monitoring. Collecting these four variables (i.e., race, ethnicity, spoken language, and written language) takes, on average, one minute and thirty seconds per call. To ensure that the race, ethnicity, and language data are being collected, production metrics regularly report on the number of records fully completed by member services staff, which is reviewed by the member services manager.

CCHP collects ethnicity separately from race and avoids aggregating detailed ethnicities to OMB race categories whenever possible. To ensure compliance with HEDIS reporting requirements and minimize redundancy in data collection, CCHP automatically populates a variable on the individual’s Hispanic ethnicity based on his or her responses to the language, race, and detailed ethnicity questions.



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Appendix H Contra Costa Health Plan Language Assistance Database and Ethnicity Categories Contra Costa Health Plan (CCHP), founded in 1973, is sponsored by the county of Contra Costa, California. It is the only county run health plan in California, and it was the first federally qualified county sponsored HMO in the United States. Today, CCHP serves approximately 85,000 people, including public and commercial members. The plan is licensed by the California State Department of Managed Health Care and the provisions of California SB853 apply for determining the language needs of its membership. CCHP has developed, in collaboration with other health plans, a set of race, ethnicity, and spoken and written language categories applicable to its service population (see following pages). After analysis of its membership needs, CCHP determined that there were 15 detailed ethnicity and language categories that would be most frequently used by its members at different sites. Initially, a top 10 list was compiled, but it was apparent that the top 10 list at each service site was not the same; by developing the top 15 list, the top 10 categories at all sites were covered. To further increase interoperability among parts of the health system, CCHP is trying to promote the top 15 categories into the data collection systems of all county health centers and the Contra Costa Regional Medical Center. A need remains, however, to crosswalk the CCHP codes to different codes used at the state level (e.g., for hospital discharges). The top 15 ethnicities and languages are visible on drop down menus for selection by staff and the system has the capacity to access the full list if an individual self-identifies with a category not included in the top 15. For example, if a member services representative types the letter “e,” English will pop up from the top 15 list, but if the patient speaks another language starting with “e,” a second keystroke brings up other language choices beginning with “e” such as Estonian (see entry screen and training instructions on the next page). Additionally, they have helpful features such as allowing population of those fields for other family members at the same time. The CCHP phone script for member services staff has evolved over time from a lengthy explanation of the need for these data for quality improvement to simply request for verification; collection of the data takes practice and monitoring. Collecting these four variables (i.e., race, ethnicity, spoken language, and written language) takes, on average, one minute and thirty seconds per call. To ensure that the race, ethnicity, and language data are being collected, production metrics regularly report on the number of records fully completed by member services staff, which is reviewed by the member services manager. CCHP collects ethnicity separately from race and avoids aggregating detailed ethnicities to OMB race categories whenever possible. To ensure compliance with HEDIS reporting requirements and minimize redundancy in data collection, CCHP automatically populates a variable on the individual’s Hispanic ethnicity based on his or her responses to the language, race, and detailed ethnicity questions. 221

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222 RACE, ETHNICITY, AND LANGUAGE DATA CONTRA COSTA HEALTH PLAN’S LANGUAGE ASSISTANCE DATA BASE MEMBER SERVICES STAFF TRAINING The collection of Spoken/Written Language, Race and Ethnicity is meant to be at the end of a call; after a member has been helped with the issue they called about. Add this step to your conversation at the end of the call as a verification process. This sentence has been shown to be effective: “We are verifying that we have the most accurate information about our members on file.” Then proceed to ask the four questions listed below. Notice that the top 15 (most frequent) are at the top of the list; the complete list follows at the bottom. At the end, ask if the information applies to all family members. If it does check all family box in left corner of the screen, if it does not enter the family members individually. Quick tips: Tab—will move the cursor to the next field. Example: from Spoken Language to Written Language. Pressing a letter: Example “S” will take to the cursor to Spanish in the top 15 list, by pressing S again will take you to Samoan, then Sangho and so on….

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22 APPENDIX H

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224 RACE, ETHNICITY, AND LANGUAGE DATA TABLE H-1 Language Assistance Data Base (LADB), based on CDC Race/Ethnicity Codes and ISO Language Codes by Otilia Tiutin, Manager of Cultural & Linguistic Services Race Code Race Description (For mixed race use boxes, can choose up to 3 categories) R5 White/Caucasian E1 Hispanic or Latino R3 Black or African American R2 Asian R1 American Indian or Alaska Native R4 Native Hawaiian or Other Pacific Islander R9 Other Race RZ Unknown/Not Provided EY Decline to state Ethnic Code Ethnicity Description Top 15 in Order of Frequency 21089 European 00017 American 21352 Hispanic/Latino 21485 Mexican 21782 Latin American 20560 Black 20586 African American 20479 Vietnamese 20297 Asian Indian 21212 Iranian 20362 Filipino 21295 Arab 20412 Laotian 20347 Chinese 00016 Russian

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22 APPENDIX H Ethnic Codes and Description in Alphabetical Order 21261 Afghanistani 20602 African 20586 African American 21386 Andalusian 00017 American 21295 Arab 21667 Argentinean 21097 Armenian 20297 Asian Indian 21196 Assyrian 21394 Asturian 20677 Bahamian 20305 Bangladeshi 20685 Barbadian 21428 Belearic Islander 20313 Bhutanese 20560 Black 21675 Bolivian 00005 Bosnian 20610 Botswanan 00029 Brazillian 20321 Burmese 20339 Cambodian 21634 Canal Zone 21451 Canarian 20925 Carolinian 21402 Castillian 21410 Catalonian 21550 Central American 21626 Central American Indian 20883 Chamorro 21519 Chicano 21683 Chilean 20347 Chinese 20974 Chuukese 21691 Colombian 21568 Costa Rican 21766 Criollo 21824 Cuban 00000 Decline to state 20701 Dominica Islander 20693 Dominican 21840 Dominican 21709 Ecuadorian 21204 Egyptian 21105 English 20628 Ethiopian 21089 European 21014 Fijian 20362 Filipino 21113 French 21436 Gallego 21121 German

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226 RACE, ETHNICITY, AND LANGUAGE DATA 20875 Guamanian 20867 Guamanian or Chamorro 21576 Guatemalan 20719 Haitian 20022 Hindi 21352 Hispanic/Latino 20370 Hmong 21584 Honduran 20388 Indonesian 21212 Iranian 21220 Iraqi 21139 Irish 21279 Israeili 21147 Italian 20487 Iwo Jiman 20727 Jamaican 20396 Japanese 20966 Kiribati 20404 Korean 20933 Kosraean 00013 Kurdish 21527 La Raza 20412 Laotian 21782 Latin American 21238 Lebanese 20636 Liberian 20529 Madagascar 20420 Malaysian 20495 Maldivian 20891 Mariana Islander 20909 Marshallese 21006 Melanesian 21485 Mexican 21493 Mexican American 21535 Mexican American Indian 21501 Mexicano 20859 Micronesian 21188 Middle Eastern or North African 00026 Mixtec, Mexican Indian 20644 Namibian 20792 Native Hawaiian 20503 Nepalese 21048 New Hebrides 21592 Nicaraguan 20651 Nigerian 20438 Okinawan 00002 Other Ethnicity 00030 Other Latino 20446 Pakistani 20917 Palauan 21246 Palestinian 21600 Panamanian 21022 Papau New Guinean 21717 Paraguayan

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22 APPENDIX H 21725 Peruvian 20941 Pohnpeian 21154 Polish 20784 Polynesian 00014 Portuguese 21808 Puerto Rican 00027 Punjabi, India 00016 Russian 20958 Saipanese 21618 Salvadoran 20800 Samoan 21162 Scottish 20511 Singaporean 21030 Solomon Islander 21659 South American 21758 South American Indian 21378 Spaniard 21469 Spanish Basque 20453 Sri Lankan 21253 Syrian 20818 Tahitian 20354 Taiwanese 20461 Thai 20735 Tobagoan 20834 Tokelauan 20826 Tongan 20743 Trinidadian 00001 Unknown 21733 Uruguayan 21444 Valencian 21741 Venezuelan 20479 Vietnamese 20750 West Indian 00025 Yao, Mien 20982 Yapese 20669 Zairean

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22 RACE, ETHNICITY, AND LANGUAGE DATA TABLE H-2 Spoken Language Codes (ISO) Language Code Language Description Top 15 EN English ES Spanish VI Vietnamese FA Farsi LO Laotian AR Arabic TL Tagalog 12 Cantonese RU Russian KM Cambodian KO Korean 14 Mandarin PA Punjabi BG Bulgarian PL Polish Spoken Language Codes and Description in Alphabetical Order AB ABKHAZIAN OM AFAN,OROMO AA AFAR 15 AF-MAAY AF AFRIKAANS SQ ALBANIAN,SHQIP 01 AMERICAN SIGN AM AMHARIC AR ARABIC HY ARMENIAN,HAYEREN AS ASSAMESE 16 ASSYRIAN NEO-ARAMAIC AY AYMARA AZ AZERBAIJANI BA BASHKIR EU BASQUE,EUSKERA 17 BEHDINI BN BENGALI,BANGLA DZ BHUTANI,BHUTANESE BH BIHARI BI BISLAMA BS BOSNIAN BR BRETON BG BULGARIAN MY BURMESE,MYANMASA BE BYELORUSSIAN KM CAMBODIAN,KHMER 12 CANTONESE CA CATALAN 19 CHALDEAN NEO-ARAMAIC CH CHAMARRO

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229 APPENDIX H CO CORSICAN HR CROATIAN,CROAT,HRVATSKI CS CZECH DA DANISH 21 DINKA NL DUTCH,NEDERLANDS EN ENGLISH ET ESTONIAN FO FAROESE,FAEROESE FA FARSI,PARSIAN,PERSIAN FJ FIJI,FIJIAN FI FINNISH,SUOMI 22 FLEMISH (DUTCH) 23 FORMOSAN FR FRENCH FY FRISIAN 24 FUJIAN 25 FUKIENESE FL FULA, FULAH GL GALICIAN KA GEORGIAN,KARTULI DE GERMAN EL GREEK KL GREENLANDIC,KALAALLISUT GN GUARANI GU GUJARATI,GUJERATI HT HAITIAN CREOLE/FRENCH CREOLE 26 HAKKA HA HAUSA 27 HAWRAMI HE HEBREW,IWRITH HI HINDI 28 HMONG (BLUE/GREEN) 03 HMONG (WHITE) 29 HUNANESE HU HUNGARIAN,MAGYAR 30 IBO IS ICELANDIC,ISLENZK 04 ILACANO (ILOKO) ID INDONESIAN,BAHASA,INDONESIA IU INUKTITUT IK INUPIAK GA IRISH,GAEILGE IT ITALIAN JA JAPANESE,NIHONGO JV JAVANESE,BAHASA JAWA KN KANNADA KS KASHMIRI KK KAZAKH RW KINYARWANDA KY KIRGHIZ,KYRGYZ RN KIRUNDI KO KOREAN,CHOSON-O 31 KPELLE

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20 RACE, ETHNICITY, AND LANGUAGE DATA KU KURDISH,ZIMANY KURDY 32 KURMANJI LO LAOTIAN,LAOTHIAN,PHA XA LOA LV LATVIAN,LETTISH LN LINGALA LT LITHUANIAN MK MACEDONIAN MG MALAGASY MS MALAY, BAHASA MALAYSIA ML MALAYALAM MT MALTESE 14 MANDARIN MI MAORI MR MARATHI MH MARSHALLESE (EBON) 33 MENDE 06 MIEN 34 MIXE 35 MIXTECO-ALTA 36 MIXTECO-BAJA MO MOLDAVIAN MN MONGOLIAN NE NAPALI NV NAVAJO, NAVAHO NO NORWEGIAN 37 NUER OC OCCITAN OR ORIYA PS PASHTO,PUSHTO PL POLISH PT PORTUGESE PA PUNJABI,PANJABI QU QUECHUA RM RHAETO-ROMANCE,ROMANSCH RO ROMANIA,RUMANIAN RU RUSSIAN SM SAMOAN SG SANGHO GD SCOTS GAELIC SR SERBIAN,SRPSKI ST SESOTHO TN SETSWANA 38 SHANGHAINESE SN SHONA SD SINDHI SI SINGHALESE SS SISWATI SK SLOVAK SL SLOVENIAN SO SOMALI ES SPANISH SU SUDANESE SW SWAHILI SV SWEDISH,SVENSKA

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21 APPENDIX H TL TAGALOG TG TAJIK TA TAMIL 39 TARASCO TT TATAR TE TELUGU TH THAI BO TIBETIAN,BODSKAD TI TIGRIGNA 40 TIO CHIU OR TEOCHEW TO TONGAN (LANGUAGE OF TONGA) TS TSONGA TR TURKISH TK TURKMEN TW TWI UG UIGUR UK UKRAINIAN UR URDU UZ UZBEK VI VIETNAMESE CY WELSH WO WOLOF 41 WU XH XHOSA YI YIDDISH,JIDDISCH YO YORUBA 42 ZAPTEC ZA ZHUANG ZU ZULU 8 Unknown 3 Unable to contact 98 DECLINED TO STATE 99 OTHER

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22 RACE, ETHNICITY, AND LANGUAGE DATA TABLE H-3 Written Language Codes (ISO) Language Code Language Description Top 15 (most frequently used) EN English ES Spanish VI Vietnamese FA Farsi LO Laotian AR Arabic TL Tagalog 12 Cantonese RU Russian KM Cambodian KO Korean 14 Mandarin PA Punjabi BG Bulgarian PL Polish Written Language Codes and Description in Alphabetical Order AB ABKHAZIAN OM AFAN,OROMO AA AFAR 15 AF-MAAY AF AFRIKAANS SQ ALBANIAN,SHQIP AM AMHARIC AR ARABIC HY ARMENIAN,HAYEREN AS ASSAMESE AY AYMARA AZ AZERBAIJANI BA BASHKIR EU BASQUE,EUSKERA 17 BEHDINI BN BENGALI,BANGLA BH BIHARI BI BISLAMA BS BOSNIAN 02 BRAILLE/ALTERNATIVE FORMAT BR BRETON BG BULGARIAN MY BURMESE,MYANMASA BE BYELORUSSIAN KM CAMBODIAN,KHMER 12 CANTONESE (SIMPLIFIED) CA CATALAN 19 CHALDEAN NEO-ARAMAIC CH CHAMORRO ZH Chinese- simplified characters

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2 APPENDIX H 20 Chinese- Traditional characters CO CORSICAN HR CROATIAN,CROAT,HRVATSKI CS CZECH DA DANISH 21 DINKA NL DUTCH,NEDERLANDS DZ DZONGKHA (BHUTANI,BHUTANESE) EN ENGLISH ET ESTONIAN FO FAROESE,FAEROESE FA FARSI,PARSIAN,PERSIAN FJ FIJI,FIJIAN FI FINNISH,SUOMI 22 FLEMISH (DUTCH) 23 FORMOSAN FR FRENCH FY FRISIAN 24 FUJIAN 25 FUKIENESE (traditional characters) FL FULA, FULAH GL GALICIAN KA GEORGIAN,KARTULI DE GERMAN EL GREEK KL GREENLANDIC,KALAALLISUT GN GUARANI GU GUJARATI,GUJERATI HT HAITIAN CREOLE/FRENCH CREOLE 26 HAKKA (traditional) HA HAUSA 27 HAWRAMI HE HEBREW,IWRITH HI HINDI 28 HMONG (BLUE/GREEN) 03 HMONG (White) 29 HUNANESE (traditional characters) HU HUNGARIAN,MAGYAR 30 IBO IS ICELANDIC,ISLENZK 04 ILACANO (ILOKO) ID INDONESIAN,BAHASA,INDONESIA IU INUKTITUT IK INUPIAK GA IRISH,GAEILGE IT ITALIAN JA JAPANESE,NIHONGO JV JAVANESE,BAHASA JAWA KN KANNADA KS KASHMIRI KK KAZAKH RW KINYARWANDA KY KIRGHIZ,KYRGYZ RN KIRUNDI

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24 RACE, ETHNICITY, AND LANGUAGE DATA KO KOREAN,CHOSON-O 31 KPELLE KU KURDISH,ZIMANY KURDY 32 KURMANJI LO LAOTIAN,LAOTHIAN,PHA XA LOA LV LATVIAN,LETTISH LN LINGALA LT LITHUANIAN MK MACEDONIAN MG MALAGASY MS MALAY, BAHASA MALAYSIA ML MALAYALAM MT MALTESE 14 MANDARIN (TRADITIONAL) MI MAORI MR MARATHI MH MARSHALLESE 33 MENDE 06 MIEN 34 MIXE MO MOLDAVIAN MN MONGOLIAN NE NAPALI NV Navajo, Navaho NO NORWEGIAN 37 NUER OC OCCITAN OR ORIYA PS PASHTO,PUSHTO PL POLISH PT PORTUGESE PA PUNJABI,PANJABI QU QUECHUA RM RHAETO-ROMANCE,ROMANSCH RO ROMANIA,RUMANIAN RU RUSSIAN SM SAMOAN SG SANGHO GD SCOTS GAELIC SR SERBIAN,SRPSKI ST SESOTHO TN SETSWANA 38 SHANGHAINESE (traditiona charactersl) SN SHONA SD SINDHI SI SINGHALESE SS SISWATI SK SLOVAK SL SLOVENIAN SO SOMALI ES SPANISH SU SUDANESE SW SWAHILI SV SWEDISH,SVENSKA

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2 APPENDIX H TL TAGALOG TG TAJIK TA TAMIL 39 TARASCO TT TATAR TE TELUGU TH THAI BO TIBETIAN,BODSKAD TI TIGRIGNA 40 TIO CHIU OR TEOCHEW (verify character style) TO TONGAN (LANGUAGE OF TONGA) TS TSONGA TR TURKISH TK TURKMEN TW TWI UG UIGUR UK UKRAINIAN UR URDU UZ UZBEK VI VIETNAMESE CY WELSH WO WOLOF 41 WU (traditional) XH XHOSA YI YIDDISH,JIDDISCH YO YORUBA ZA ZHUANG ZU ZULU 8 Unknown 3 Unable to contact 98 DECLINED TO STATE 99 OTHER NOTE: For more information on CCHP’s LADB project, call Otilia Tiutin at 925-313-6063 or email otiutin@hsd.cccounty.us. Information about CCHP can be found at www.contracostahealthplan.org.

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