health literacy perspective how does one navigate such a complicated system to even get to health care? Health literacy issues also affect members’ abilities to share their health information with providers, to engage in self-care and chronic disease management programs, and adopt healthy behaviors.

MetroPlus members are at significant risk for health literacy issues and challenges in their health care. The membership is made up of a diverse population whose members speak multiple languages; at least 30 percent of the population does not speak English and many have a limited education. To address language issues, MetroPlus has about 100 customer service staff who speak 13 different languages and who are available Monday through Saturday, from 8 a.m. to 8 p.m. The automated telephone line is available in five different languages and additional languages are supported through a contracted telephone line service. The Web site is available in only English, Spanish, and Chinese, but work is under way to expand the number of languages.

Sites also have language cards that allow the member to point to the language he or she uses. Member newsletters, which are mailed four times a year to all members, are published in English, Spanish, Chinese, Bengali, and Haitian Creole. There are many other materials used by case managers from marketing information, to basic health information materials that are available in multiple languages. A company is employed to translate the material into different languages, but prior to publication those translations undergo quality review by MetroPlus staff who are fluent in the language. Materials also are reviewed before publication in print and on the Web by a member advisory committee. It is interesting to note that approximately 70 percent of the time the quality review results in changes to the material. The materials are written in simple, plain language at a fourth grade reading level.

Case management programs are offered to persons with chronic disease in the areas of behavioral health, asthma, diabetes, prenatal care, complex transplant, and HIV. Each of these has nursing staff, social work staff, or support staff who speak multiple languages so that there is an opportunity to telephonically case-manage individuals in their own language. There is also a health screening and initial health assessment for all Medicare members conducted in the appropriate language and this has a health literacy component. Finally, there are also some pilot programs, primarily in HIV, that have patient navigators.

In the future, Saperstein said, MetroPlus will continue the programs already established and will also create and identify quality health education materials written at varying literacy levels, in various formats and in multiple languages. There will also be further analysis of the impact of language and literacy barriers on the clinical outcomes of the member



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