Increasing Influenza Immunizations Among Spanish-Speaking Medicare Advantage Beneficiaries Through Care Navigator Outreach and Teletalks

SCAN built trust among its Spanish-speaking members by recruiting Spanish-speaking care navigators to conduct outreach to encourage them to receive the flu vaccine and by holding a telephonic town hall with a Spanish-speaking physician. By relying on staff who speak colloquially and accurately about the vaccine, SCAN helped its members make more informed and confident decisions about their care. How does this build trustworthiness?  Communication in a patient’s primary language shows you “know me” and respect me.

How It Works

Care Navigation
The Care Navigation program is designed to promote positive health outcomes by increasing health literacy and access to services and resources. We recruited two Spanish-speaking Care Navigators to focus solely on increasing flu vaccination rates among our Spanish-speaking members. These Care Navigators were given outreach lists of Spanish-speaking members who had not consistently received the flu vaccine in the past. They called each member and had conversational and factual discussions about the flu vaccine and the importance of getting vaccinated, especially during the COVID-19 pandemic. Care Navigators tracked member intent to receive the vaccine, discussed potential barriers, and worked with members to make sure they were making the best decision for themselves. From October 2020 through December 2020, the Care Navigators reached out to about 2,600 Spanish-speaking SCAN members.

Teletalks
Alongside our individual outreach, in October we also held a telephonic town hall event (“teletalk”) hosted by a Spanish-speaking SCAN employee and Dr. Ilan Shapiro, a Spanish-speaking physician who serves as Medical Director of Health Education and Wellness for AltaMed, one of SCAN’s provider partners. Dr. Shapiro is an advocate for health promotion and education who has done extensive work to promote health equity.

Somewhat to our surprise, some 3,000 Spanish-speaking SCAN members joined the teletalk. As a fluent Spanish speaker and native of Mexico, Dr. Shapiro was able to discuss the flu virus, the flu vaccine, and the importance of staying healthy during the COVID-19 pandemic in a way that resonated with members.

Skills and Competencies

The practice is reliant upon cultural competency and Spanish fluency, health education, and trust-building. We’ve learned through experience with this practice that it requires staff who can speak both colloquially and accurately about medicine and healthcare, in a way that builds trust and instills confidence in members as they make decisions about their care.

Origins

According to the CMS Office of Minority Health’s “2019 Racial, Ethnic, and Gender Disparities in Health Care in Medicare Advantage” report, Hispanic Medicare enrollees receive their annual flu vaccinations at a rate of 65.9%, while their White counterparts receive the vaccine at a rate of 75.1%. For the 2019/2020 flu season, SCAN Health Plan internal data showed Hispanic enrollees receiving their flu vaccine at a rate of 62.2% and White enrollees receiving theirs at a rate of 65.4%. For members who speak Spanish as their primary language, the vaccine rate was just 58.32%.

In 2019, a SCAN employee suggested that part of the reason for the low rate of vaccination was the cultural competency of our outreach. For example, she noted that members frequently use the term “la gripe” to mean flu, while SCAN materials generally use the term “la influenza.” Moreover, “la gripe” can also mean the common cold. How can we appropriately communicate the virus’s severity and the vaccine’s effectiveness, we asked, without having common language to do so? We realized that simply translating English documents into Spanish wasn’t working.

Effectiveness

Our key objective with this initiative is to provide our Spanish-speaking members with health education that meets their needs—that is, to meet them where they are and use their language to answer their questions and their concerns about the flu and the flu vaccine.

Because the program is new and we are still in the middle of the 2020-21 flu season, we don’t have precise data with which to document the effectiveness of our initiatives. However, we do know that at the point of this writing—just halfway through the flu season—our flu vaccine rate among Spanish-speaking members is already at 56.23%. What’s more, we’ve received a good deal of feedback from members in these programs who have told us how much they appreciate our outreach efforts.

Scalability

Teletalks can be presented to several thousand members at a time and can be recorded for archival purposes. Also, teletalks are quick (this one lasted around 30 minutes), so several can be held in a relatively short period of time.
A consideration for scaling the Care Navigator program is to ensure the staff have adequate time to spend with each member they’re contacting. It is important that the calls feel conversational and not rushed. It is also important to have staff whose Spanish fluency is strong enough to instill trust, while delivering accurate information.