Mayo Clinic Announces Video Storytelling Campaign with Hispanic Patients and Doctors

ROCHESTER, Minn. — Mayo Clinic has announced the launch of a global storytelling campaign for the Hispanic community. Historias Mayo shares the stories of some of Mayo’s inspiring Hispanic patients and doctors.

[MULTIMEDIA ALERT: Video of Dr. Noseworthy is available on the Mayo Clinic News Network.]

“The legacy and history runs deep between Mayo and the Hispanic community,” says John Noseworthy, M.D., president and CEO of Mayo Clinic. “Historias Mayo celebrates and deepens that bond. It reflects our commitment to meeting the health care needs of Hispanic patients and communities worldwide.”

As a result of the international travels of Mayo’s founders Drs. William and Charles Mayo, patients from Latin America began traveling to Rochester, Minnesota, for care at Mayo Clinic in the early 1920s. Today, Mayo continues to treat thousands of patients from Latin America every year, and an ever-growing number of U.S. Hispanic patients.

“Our founders understood the value of diverse talents, backgrounds and beliefs in providing the best care to patients — and that core belief persists today at Mayo Clinic,” explains Dr. Noseworthy.

Historias Mayo reflects Mayo’s recently enhanced investment in engagement with Spanish-speaking audiences globally through community collaborations around patient care, research and education. Historias Mayo also complements Mayo’s growing influence in Hispanic social media (www.twitter.com/ClinicaMayo and www.facebook.com/MayoClinicEspanol) and its recently redesigned Spanish webpages at www.mayoclinic.org/espanol.

Historias Mayo launches with six stories:

Adrián Fernandez, Mexico’s beloved car racing champion, gives Mayo Clinic unfettered access during his 24 hours of Le Mans race in France. This video captures the intensity Fernandez faces as an elite athlete, and he reveals how Mayo Clinic has been by his side throughout his career.

Newlyweds Johanna Iturrino, M.D., and Benjamin Zendejas, M.D. are two young physicians completing their training at Mayo Clinic. They give an inside look at what it means to be Mayo Clinic residents, while sharing their heartwarming love story. Dr. Iturrino also discusses her very personal journey as a multiple sclerosis patient.

Another video follow Mayo Clinic neurologist Zbigniew Wszolek, M.D., to Bogotá, Colombia, to meet and treat the first patient in Latin America to be diagnosed with Perry syndrome, a rare genetic and fatal neurological disorder. The story documents the patient’s daughters, her Colombian neurologist and the Mayo doctor as they connect to begin their journey toward a cure for her disease.

Mayo Clinic neurologist and psychiatrist Daniel Drubach, M.D., plays classical flamenco guitar while telling his passionate story from childhood in Argentina to becoming a physician at Mayo Clinic. He weaves a ribbon between the mind, the brain and music.

Mind-body alignment plays a role in treatment of complex conditions at Mayo Clinic, and pulmonologist Roberto Benzo, M.D., an Argentine-born physician, describes how he improves patient outcomes through meditation and mindfulness practices.

Venezuela’s championship fencer Carmen Militza Perez is now Mayo Clinic’s Carmen Terzic, M.D., Ph.D. She is currently leading the world in development of adult stem cells designed to repair damaged cardiac tissue. She discusses how her past competitive spirit has driven her to a career in medicine with a goal to improve patients’ quality of life.

New patient stories will be shared on Historias Mayo throughout 2013.

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About Mayo Clinic

Mayo Clinic is a nonprofit worldwide leader in medical care, research and education for people from all walks of life. For more information, visit www.mayoclinic.org and www.mayoclinic.org/news.

Journalists can become a member of the Mayo Clinic News Network at http://newsnetwork.mayoclinic.org for the latest health, science and research news and access to video, audio, text and graphic elements that can be downloaded or embedded.

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A sobering new U.S. Senate report indicates that nearly 57 million people in the U.S.—about one in five—live in areas where they do not have adequate access to primary healthcare because of a shortage of providers. This shortage is most pronounced in rural and low-income areas, and it means more emergency-room visits, less access to preventive care, and less chance of someone establishing a relationship of trust with a healthcare provider.

Access to primary care has repeatedly been shown to have a strong impact on health disparities: One study from 2005 showed that access reduced deaths among Blacks four times more than among whites—even after controlling for education and income. Findings such as this usually point to the value primary care provides in terms of early detection and treatment of conditions such as hypertension and diabetes, and in terms of the ability to be screened for cancers, such as colon cancer, which are more likely to be treatable if discovered early.

As the shortage intensifies, the Association of American Medical Colleges reports that, while there has been a decrease in Black men applying to, accepted to, and entering medical school overall, among all people who do apply, Blacks expressed a greater interest in primary-care fields than other demographic groups.

Blacks and Latinos are also willing to practice medicine in underserved areas more than any other group. Yet the gap will not be closed any time soon if the percentage of medical-school graduates does not better reflect the U.S. population: Over the past two years, the percentage of white entrants to medical school exceeded all other racial and ethnic groups by a substantial amount—57.1 percent in 2010 and 57.5 percent in 2011—while Black and Latino entrants were less than 15 percent of the total. Consider that Blacks and Latinos together are almost 30 percent of the U.S. population (and increasing rapidly, especially Latinos), and the gap seems even greater.

Further, these percentages of graduates are not necessarily even translating into similar percentages of practicing physicians. Blacks represent 14 percent of the U.S. population and only 4 percent of physicians, according to U.S. Census data and the American Medical Association Physician Masterfile, as reported by Kaiser Permanente. Meanwhile, Latinos represent 16 percent of the population and 5 percent of physicians.

In June 2012, Kaiser Permanente took a substantial step to close this gap: The organization expanded its relationship with National Medical Fellowships and contributed $1 million to support medical students through education and training programs. NMF is a not-for-profit organization that seeks to increase the pipeline of doctors, nurses and physician assistants from underrepresented groups by providing scholarships to medical students and by offering service learning programs to students in the health professions.

Cleveland’s University Hospitals is strongly committed to such efforts and has seen impressive results through its David Satcher Clerkship, a national model for recruiting Black and Latino medical students. Since the program’s inception in 1991, UH has increased its Black and Latino representation from 3 to 10 percent. The hospital’s Henry L. Meyer III KeyBank Faculty Minority Fellows Program is another of UH’s efforts to develop medical staff to provide culturally competent care.

The Mayo Clinic’s Minority Medical Student Career Development Programs are designed to help train students in meeting the needs of a diverse patient population. Mayo’s College of Medicine Diversity in Education Blog provides students a place to connect with each other and with those outside Mayo Clinic who are interested in working or receiving medical training there.

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By Debby Scheinholtz, Vice President of Consulting, DiversityInc

With new rules that went into effect Oct. 1 as part of the Affordable Care Act, hospitals now have financial incentives for improving quality of care and patient satisfaction while keeping readmission rates low. Engaging patients is essential to improving these metrics.

How are hospitals utilizing their diversity resources to boost patient engagement? Here are some best practices.

Cross-Cultural Communication

Mayo Clinic has a cross-cultural communication program that is required of new physicians. Physicians complete a four-hour training that includes participating in scenarios in the Mayo Clinic Multidisciplinary Simulation Center, where actors portray patients from different cultures in common clinical situations. Dr. Onelis Quirindongo-Cedeno, the physician champion for the training, says the program is “an opportunity for physicians to discuss what is culturally competent care, what is cultural humility, and explore their own biases and assumptions.” The program includes instruction on how to work with medical interpreters, and how to elicit health and healing beliefs from patients.

• One goal is to get physicians to understand the broad aspects of cultural differences, says Dr. Quirindongo-Cedeno. “Sometimes you think about cultural competency or cross-cultural care when someone looks different from you, but we want to teach [physicians] about the overall aspects of culture that involve religion, sexual orientation and disability.”
• One simulation might involve a Latino patient who is diabetic and wants to use some complementary therapy, such as tea or herbs, to try to control the diabetes rather than take the prescribed medication. The physician will go into this simulated situation, interact with the patient actor and then receive feedback from a group of physician observers.

Results: The latest data show that 90 days after completing the program, at least 85 percent of physicians say that participation has improved the quality of patient care they deliver.

Health Literacy

New York’s North Shore–Long Island Jewish Health System, a group of 16 hospitals, includes several locations in Queens, one of the most ethnically diverse regions in the world, with a population representing more than 100 nationalities and speaking more than 170 languages. Dr. Jennifer Mieres, Senior Vice President, Office of Community and Public Health and North Shore-LIJ’s Chief Diversity Officer, heads the Office of Diversity, Inclusion and Health Literacy, which has implemented several web-based programs to increase understanding of various cultures and also to educate employees about health literacy.

• A web-based health-literacy course is available to all employees for continuing-education credit and has been used by more than 2,700 people to date. “It’s case-based, and it focuses on the importance of communication and health literacy in getting patients to be a 50/50 partner in their health,” explains Dr. Mieres. Tactics include using plain language rather than medical jargon; using the “teach-back” method to encourage patients to explain back what the medical professional has just explained to them; and the implications of nonverbal communication such as facial expression, gestures, contact/touching and personal space.

Results: At all system hospitals that measured HCAHPS scores on the question “During this hospital stay, how often did nurses explained things in a way that you could understand,” scores rose from 68.6 percent to 73.1 percent in less than one year.

Patient-Centered Care

Cleveland Clinic was one of the first academic medical centers to establish an Office of Patient Experience, and it was the first to appoint a Chief Experience Officer, Dr. James Merlino. He says the hospital has invested heavily in “activities that align our workforce around our patients.” Last year, Cleveland Clinic put all 43,000 of its employees through half-day training.

• Each session included people from different backgrounds, departments and locations.“We had conversations around what our mission, vision and values are; what it means to put patients first; how everyone in the organization contributes to that. We talked about expected service behaviors: how we want to treat each other—with respect—and we want to make sure that we’re treating patients appropriately,” says Dr. Merlino.
• It took a year to put the entire employee population through the program, which cost $11 million.

Results: Since the training was implemented, patient complaints have significantly declined and caregiver engagement has significantly climbed. In 2012, Dr. Merlino says, caregiver engagement was in the 57th percentile, “which is the highest ever. We have been steadily increasing since 2008.”

Simplifying Patient Communications

Cleveland Clinic recently redesigned its discharge packet. Every patient gets a patient-friendly discharge summary without medical jargon. A nurse sits down with each patient and goes through the discharge summary and a checklist of followup care, says Dr. Merlino.

• Staff members also call patients after discharge to check in on them. “It’s been great for patients because there’s this gap—they get great care, they don’t quite understand what they’re supposed to be doing when they get home, they get very nervous, and things slip through the cracks,” Merlino says. “But really taking time, stopping, going over everything—it’s had a great impact.” He adds that Cleveland Clinic’s Patient Relations department is brought in when a patient might be reluctant to follow a care plan due to cultural beliefs. “You can’t just assume one size fits all,” he says. “You have to be sensitive to those disparities.”

Results: For its HCAHPS patient-satisfaction score on the discharge process, Cleveland Clinic is now in the 95th percentile nationally.

Resource Groups

Mayo Clinic’s 18 resource groups, known as MERGs (Mayo Employee Resource Groups), are called upon to improve cultural competency and impact patient engagement, says Dr. Sharonne Hayes, Director, Diversity and Inclusion.

• A group of representatives from MERGs at Mayo’s Rochester, Minn., location have been brought together as Mayo initiates its Destination Medical Community initiative, a joint effort between Mayo and the city of Rochester to welcome patients and their families who are traveling to use Mayo’s services. The MERG members “will make not only Mayo but also Rochester a better community for those patients who come in, and will help us better meet the needs of our diverse patients,” says Dr. Hayes.
• Mayo also has a transcultural patient-family advisory council (PFAC), “One World,” which wascreated to give a voice to those who might not be heard in other circumstances, often because of language and cultural barriers. While PFACs are a commonly used practice, says Dr. Hayes, Mayo did not have diversity of patient representation across all subspecialties.

Results: Efforts like these likely contribute to Mayo Clinic’s high HCAHPS score for “Willingness to Recommend.” This measure averaged 70 percent nationally; the score across Mayo Clinic’s four main hospitals (two in Minnesota, one each in Arizona and Florida) averaged more than 85 percent.

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Those organizations are most ready for the influx of an estimated 32 million new consumers, most of them lower-income Blacks and Latinos, and the need to care for them on a sustainable basis emphasizing wellness as opposed to constant crisis management. The critical factor in their business strategies, they tell us, is the ability to offer culturally competent healthcare and connect on a large scale to the communities they serve while being more cost effective.

“Our assessment is that the Supreme Court decision on health reform will accelerate existing trends in healthcare and the marketplace,” says Dr. Patricia Simmons, executive medical director for Health Policy at the Mayo Clinic. Those trends include consolidation of facilities, new organizations that combine hospitals and insurance companies, increased accountability for metrics-driven results, and a strong focus on community outreach.

Successful implementation of diversity-management initiatives is giving organizations such as Kaiser Permanente, Eli Lilly and Company, WellPoint, Mayo Clinic, University Hospitals, Blue Cross Blue Shield of Michigan, Health Care Service Corporation, Blue Cross Blue Shield of Florida, Massachusetts General, Cleveland Clinic and the Henry Ford Health System a competitive edge in the new world of expanding affordable healthcare.

“Healthcare reform challenges diversity and inclusion to keep and expand our place at the table,” says Linda Jimenez, chief diversity officer at WellPoint.

Diversity Management Connects to Community

In interviews with DiversityInc, these 11 organizations tell a similar story, with minor variations depending on their business model. All have been long-time diversity leaders, appearing either on The DiversityInc Top 50 Companies for Diversity list or The DiversityInc Top 5 Hospital Systems list (and one company is on The DiversityInc Top 10 Regional Companies list). All anticipate (and are already seeing) an influx of new patients/customers, mostly from lower-income families, predominantly Latino and Black.

They stress the need to offer culturally competent healthcare and to emphasize wellness prevention and disease management instead of frequent, costly trips to emergency rooms and urgent-care sessions. All are looking at ways to serve far more people, operating more efficiently and streamlining costs. Several of the hospital systems are worried that Medicare funding might not cover their increasing treatment costs.

The resounding sentiment from leaders in these organizations is that their long-term commitments to culturally competent care through diversity-management initiatives have left them in a better strategic position to improve market share. They point to the importance of resource groups in reaching the community and promoting health education. They cite diversity training for customer-facing employees and the need for an employee and leadership base that represents the communities they serve.

Here is an industry-by-industry look at their changing business models and how critical diversity management is to their sustainable success. 

The Affordable Care Act emphasizes preventive care, to save costs by helping more low-income Americans take care of themselves before expensive and life-threatening diseases such as diabetes, cancer, AIDS and high blood pressure develop and to minimize the damage of these diseases in those who already have them. The law specifically calls for investments in community health teams, community health centers and expanded initiatives to increase racial and ethnic diversity in healthcare teams.

Cost Containment: Hospitals

The dilemma for hospitals is how to provide more access while lowering costs at the same time.  “It really requires a lot of innovation to reduce costs, and no one’s figured out how to do it,” says Jeff Davis, senior vice president of Human Resources at Massachusetts General, No. 5 in The DiversityInc Top 5 Hospital Systems.

“It’s clear that the new normal in healthcare will involve getting paid less to do more,” says Oliver Henkel, chief external affairs officer at the Cleveland Clinic, No. 3 in The DiversityInc Top 5 Hospital Systems. “There will be more patients with access to healthcare, but private and government insurers will pay hospitals and doctors less and less to care for patients. Therefore, we have to drive efficiencies and cost containment to be able to accommodate the increased demand for healthcare.”

There are healthcare models in place, however, that offer best practices in increasing the prevalence of care to underserved communities without adding employees.

Kaiser Permanente, which has both hospitals and health insurance, has made eliminating healthcare disparities through community outreach a key part of its mission for decades.

“Many in the industry are trying to move toward an accountable care model and there will be more people in the marketplace trying to compete on that basis (alliances between insurance, hospitals and physicians). We’ve been in that business for over 60 years,” says Christine Paige, senior vice president of Marketing and Internet Services at Kaiser Permanente (No. 3 in the DiversityInc Top 50).

The difference now is in volume and the impact of having a substantial number of people entering the market in a short period of time, she says. To that end, Kaiser has been expanding its system capabilities through more bilingual employees, increased communications and more personalized experiences for patient populations through more detailed electronic health records. Kaiser Permanente shared its bilingual program at DiversityInc’s Innovation Fest!

University Hospitals, located in the greater Cleveland area, is moving toward an accountable care organization (ACO) to address the changing marketplace. ACOs rely on metrics and cost-care reductions for assigned groups of patients by making hospitals and doctors directly accountable to the patients and the insurance companies for the quality and efficiency of the healthcare delivery. ACOs were piloted with Medicare patients and now, under the Affordable Care Act, will be used for Medicaid patients as well.

“We are facing a doctor shortage in Ohio,” says Dr. Eric Bieber, chief medical officer for University Hospitals, No. 2 in The DiversityInc Top 5 Hospital Systems. “We can handle it but we need to be efficient and do what’s right for the patient. We now have an integrated delivery system that helps us touch more patients with our primary-care physicians—and not in the emergency rooms.”

At the Mayo Clinic, the hospital is working on creative reimbursement models for insurance companies to “control costs and increase value and make care more affordable,” says Dr. Simmons. Mayo Clinic is also working on improving relationships with other hospitals and medical institutions to provide better access. For example, an affiliate-practice network from various medical institutions sends physicians to treat patients at local affiliates and helps patients stay in their communities. Mayo Clinic is No. 4 in The DiversityInc Top 5 Hospital Systems.

The Henry Ford Health System in Detroit last year bought a Medicaid health-maintenance organization (HMO) so it can offer Medicaid patients comprehensive care. “Hospitals need to better provide care. It’s really about how we can survive financially when more people have insurance,” says CEO Nancy Schlichting. But she worries that the act, as it stands now, isn’t giving hospitals enough funding for the addition. “The population is the same; it’s just how we pay for them. We’re advocating very hard for the expansion of Medicaid funding.”

Henry Ford, she says, now receives more than $200 million a year in uncompensated healthcare, but under the act as it stands now, that amount is cut to $30 million. “It’s really how we can survive financially,” she says. “When people have insurance, as they now will, they won’t wait to go to the doctors. We don’t need to change our operations, just our payment system.” Henry Ford Health System is No. 1 in The DiversityInc Top 5 Hospital Systems.

At Massachusetts General, the situation is a little different because the state has had universal healthcare in effect since 2006 and 97 percent of state residents already have health insurance, according to Davis.

“We adjusted to meet access demands but are still trying to increase the number of primary-care physicians, nurses and physicians’ assistants. Nationally, the first few years of the law will be all about access. It will require a lot of innovation to reduce costs,” he says. He believes the increase in ACOs will allow more people community access.

Cost Containment: Insurance Companies

For the health-insurance companies, the Affordable Care Act literally turns the landscape upside down. In addition to providing insurance for millions of low-income Americans, they can no longer deny care to those with pre-existing, and often expensive, conditions.

For these organizations, the urgent business shift is in focusing on consumers rather than business sales. And cost-savings are critical. “Right now we know that we have to do a lot of work to be a viable player in the consumer market,” says Jon Urbanek, senior vice president, Sales and Marketing for Employer Markets, Blue Cross and Blue Shield of Florida (BCBSF), No. 6 in The DiversityInc Top 10 Regional Companies. “Our focus is on significantly improving our consumer capabilities. At the same time, we’re the leader in the group market and we’ve got to maintain a significant presence there.”

BCBSF has addressed this in the long term by investing in retail centers throughout Florida that will put 90 percent of the population within 30 minutes’ drive of a center. In addition to selling health insurance at the centers, there will be free wellness and screening facilities as well as culturally competent health coaching. The organization also is putting much more health information online, as well as having bilingual call centers. “The information has always been out there, but it’s been in 10 different places in language you can’t understand, and there’s nothing like the ability to see it simply and in one place,” says Urbanek.

Like the hospitals, the insurance companies are often combining efforts to be more efficient. WellPoint, Health Care Service Corporation and Blue Cross and Blue Shield of Michigan (all part of the Blue Cross Blue Shield network) now have a joint effort to create a private exchange with a defined contribution approach to give employers information on managing their healthcare offerings.

These efficiencies enable them to focus more on healthcare disparities, says Carolyn Clift, chief diversity officer at Health Care Service Corporation (No. 19 in the DiversityInc Top 50). “We can offer the providers training. We can help them help us determine if they have a language capability they have not included before in a directory … these plans were in place before the Affordable Care Act started to take fold. As a result of the ACA, we’re moving more steadily to implementing more of these programs and projects so we can reach the broad diverse audience.”

Kirk Roy, vice president of National Health Reform at Blue Cross Blue Shield of Michigan (one of DiversityInc’s 25 Noteworthy Companies), notes that the act has direct regulations requiring insurers to communicate in a culturally and linguistically appropriate manner. To meet this requirement, the organization partnered with a translation service and now can communicate in more than 100 languages.

Innovation: Pharmas 

For pharmaceutical companies, the challenge to stay competitive is in new drugs that reach the increasingly diverse population. And that requires innovation, which all of the drug firms say requires diversity of thought, experience and background.

“The firms that are already there understand the benefit of a holistic diversity-management approach that makes them better run, have better leadership, have better creativity, better innovation, better productivity and better bottom-line impact,” says Shaun Hawkins, chief diversity officer of Eli Lilly and Company (No. 29 in the DiversityInc Top 50).

While drug manufacturers were relatively untouched by the Affordable Care Act’s specific regulations, they will be strongly affected by expanding rebates for Medicare and Medicaid that will enable more patients to have access to more drugs. That will create a rise in sales volume and patient demand, especially for the influx of new people who are insured.

Because health-insurance companies are looking to cut costs, pharmaceutical companies also will have to demonstrate more cost/benefit of their products. For a company like Eli Lilly, which has had a strong focus on clinical trials aimed at Blacks and Latinos, the emphasis is on developing drugs that effectively prevent and treat the diseases so prevalent in these populations: diabetes, obesity and high blood pressure.

“We are an innovation-based company in an innovation-based industry, focused on breakthroughs for the next round of diseases and how they impact race, ethnicity, gender and age,” Hawkins says.

Solutions: Diversity-Management Resources

For the hospitals, resource groups are an increasingly valuable means of connecting to the increasingly multicultural patient base. A critical part of that is the role they play in community education.

At University Hospitals, for example, the resource groups are working with Black and Latino community leaders to conduct prevention screenings and health-education screenings. They recently partnered with corporate and other Cleveland-area healthcare organizations to support a cultural arts fair called Fairfax, primarily aimed at Blacks. The resource groups helped the hospital bring in a team of nurses and health professionals to conduct screenings and encourage them to interact with primary-care physicians.

“Trust is often an issue in the community. The resource-group employees often live in those communities as well,” says Donnie Perkins, chief diversity officer at University Hospitals.

Increasing the level of cultural-competence training is a high priority for the hospitals as well. While Kaiser Permanente has been a leader in this area for years, other hospitals increasingly recognize the importance of this to the new marketplace.

“We are training clinicians to understand what health means and that preferences vary by culture,” says Dr. Sharonne Hayes, director, Office of Diversity and Inclusion, Mayo Clinic. “The idea is that we are treating diverse populations and each individual in them. The tendency is to treat populations as market segments – we are customizing care to the culture and then further to the individual.”

Cultural-competence training is key for healthcare providers, notes Clift. “We have already required all of our internal clinicians to complete cultural-competency courses. Training is around attitudes and how patients actually may have trust issues with providers,” she says.

Jimenez has a good example from WellPoint: Its Latino resource group, SOMOS, has been encouraging healthcare providers to emphasize family care as opposed to individual care. Latino parents, she says, will go out of their way to provide preventive care for their children but are far less inclined to do it for themselves. WellPoint is No. 34 in the DiversityInc Top 50.

The Affordable Care Act also requires hospitals to increase the racial and ethnic diversity of doctors, nurses and other healthcare professionals.  Hawkins notes that having a workforce representative of the new marketplace is a big plus for Lilly as it expands its clinical trials. “The patient population we serve is more likely to connect with customers from a sales standpoint,” says Hawkins.

Deep relationships with community organizations developed by companies that are diversity leaders is paying off in efforts to promote wellness and connect with the expanded patient base. Lilly has worked with organizations such as the National Council of La Raza and the Urban League on wellness programs in areas such as depression.

The end result for these companies is the diversity-management strategies that they have put in place are helping them negotiate this brave new world of healthcare accountability and expanded patient populations. Diversity management is critical to their very survival, they all say.

“Everyone is realizing how important diversity and inclusion is in the course of business,” says Health Care Service Corporation’s Clift.

–Barbara Frankel, with Robyn Heller Gerbush and Stacy Straczynski

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