One of the emerging issues in the American healthcare system is the combination of value-based care and patient communication. Since there are more than 25 million Limited English Proficiency (LEP) individuals in the US, healthcare organizations need to ensure communication delivery as well as compliance with the increasing metrics in value-based care settings. Language access in regard to its healthcare correlation has never been more crucial.

What Is Value-Based Care in an Evolving Healthcare System?

Value-based care represented a genuine innovation in both the processes of care delivery and assessment of its effectiveness. Unlike the traditional fee-for-service models that emphasize volume of services, value-based care focuses on better results and patient satisfaction. At its core, the model focuses on four essential principles:

Achieving Better Health Outcomes for the Patients Through Focused and Wholesome Care Better Patient Experience & Engagement Overall Reduction in Cost Better Efficiency in Case Management

Such a paradigm shift makes it imperative for healthcare givers to be more comprehensive in their approach in addressing patient needs by looking beyond the disease at hand and the barriers to its communication.

Assessment of the Interactions and Impact on Patients with LEP

Immigrant populations, or patients with limited English proficiency, are continuously experiencing challenges within the US healthcare system. One can only imagine the impact on their whole healthcare experience when a patient fails at quite literally all aspects of their treatment, either through accurate reporting of symptoms or understanding of provided instructions. Let us take the example of preventive measures, one of the primary components of healthcare delivery systems, in this instance, based on its value-based orientation. When it comes to LEP patients, they are far less likely than native speakers to seek these preventive services, not because they do not care about their health, but rather because they are unable to understand such phrases as "preventive care" and therefore do not seek help.

Basic communication challenges generate various problems:

Clinical Impact:

• Miscommunications increase medical errors and adverse events which is mostly attributed to language difference
• If symptoms cannot be fully understood, there is a greater chance of them being wrongly diagnosed
• Non-compliance to the medication taken which is usually the result of improper directions provided
• Reduced use of these services, resulting in increased diagnosis at a later stage than normal

Language Barriers and Their Effect on Revenue

The language barriers have an effect on the financial resources of a healthcare organization that goes beyond the mere cost of hiring interpreters. When the language barrier is quite prevalent, the healthcare facilities may incur expenditures in the following areas:

• Durations of appointments that are longer than expected that require more staff time
• Extraneous imaging due to uncertainties in communication
• More use of emergency services
• Increased rates of readmission

What is more troubling is the increased incidence of readmission of LEP patients. The patients do not have the proper knowledge on the rehabilitation plans or the medications that they have been prescribed hence are more likely to suffer from complications that necessitate further interventions. It is even more troubling in a value-based care arrangement, whereby institutions are liable in terms of finances for the outcome of patients.

Avoiding Empirical Challenges and Addressing the Problem Head On

Many centers have come to the realization that LEP patients' demands cannot be met by mere interpretation of words, and thus many more resources are allocated. The majority of language access programs are still staffed by professional medical interpreters who also provide some level of cultural competence. These services may include on-site interpreters for more detailed cases, or remote interpretation service agencies that provide video and telephone-call services for immediate needs.

Traditional interpretation services are the primary means of providing language access, however, advancements in technology, and recently artificial intelligence, has managed to offer new ways of communication with LEP populations.

Managing Value-Based Care Measures of Success

Value-based care models have success indicators with regards to LEP populations for most healthcare organizations:

• Satisfaction and engagement of patients
• Classification of patient's readmission rate against set benchmarks
• Increased utilization of preventive care services
• Reduced numbers of patients visiting the emergency department
• Improved results in managing chronic conditions

Tracking these metrics on a continuous basis allows these organizations to evaluate the success of their language access programs and adjust them to suit the needs of the LEP population better.

The Future

With the transformation of healthcare towards a value-based model, addressing the needs of LEP patients will become even more critical than it is today. The healthcare system of the future relies on our capacity to effectively meet the healthcare needs of all patients, regardless of the language spoken. Institutions that effectively close the loop on communication will not only enhance patient care but also competitive positioning in an ever-tougher healthcare environment.

For LEP populations to receive appropriate assistance, these measures are necessary:

• Policies on language access that are plainly defined and structured
• Quality measures should be regularly and systematically applied
• There is a need for understanding of the needs from both patients and providers
• There is a necessity for continual alignment with the dynamic nature of the patient constituency

Understanding these barriers and prioritizing language access can help them find gaps between technology and clinical practice to achieve value-based care while improving equity in health for all patients.

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