Immigrants left in the lurch again

Kay Lazar in the Boston Globe tells a sad story. Several weeks ago, Governor Patrick and his administration pushed through a plan to help assure that legal Massachusetts immigrants would continue to receive coverage under the state's landmark health care access bill. This was a gutsy move, staving off prejudice and xenophobia, and many of us joined in thanking him for his political courage.

Now, in ways the Governor and his folks could never have anticipated, the insurance company that is providing that coverage has decided to limit the network of physicians and other providers these patients can see. Kay's story outlines this problem. Here are more details that apply to BIDMC and the community health centers affiliated with us.

But the same points apply to Cambridge Health Alliance and Boston Medical Center, the major "safety net" networks in Eastern Massachusetts. CeltiCare’s refusal to negotiate in good faith with key providers that serve this population is jeopardizing and severing thousands of primary care physician/patient relationships and also separating patients from their specialty practitioners.

I summarize some information provided to me by Ediss Gandelman, our Director of Community Benefits:

Over the years, BIDMC has worked tirelessly over the years to ensure that the patients served in our affiliated community health centers have seamless, high quality and culturally competent access to primary care, and to tertiary and specialty services when needed. In downtown Boston, the Fenway, Brighton, Chinatown, Quincy, Roxbury, Dorchester and beyond, BIDMC built these affiliations to prevent poverty, fear and isolation from serving as barriers to responding to the persisting unmet medical needs of these communities.

Given the challenge of administrative burdens and delays in access to care for both primary and specialty care appointments, these community-based affiliations have resulted in timely, efficient and meaningful access to needed care in the appropriate setting for our community health center patients. This is the result of a decade’s worth of effort and investment to ensure that our health centers have electronic health records, and a seamless connection to BIDMC for the real-time sharing of needed laboratory and essential clinical information for their patients.

In short, we BIDMC have created an integrated care delivery system that – for our affiliated community health center patients – means timely, efficient, safe, and linguistically and culturally appropriate care and communication between the community health centers’ and BIDMC clinicians. (Paul's note: This integration is at the heart of recent policy standards set forth by the state. It is also what is visualized in pending federal legislation.) It crucial to minimizing opportunities for medical error and ensuring high quality care to these patients.

These patients deserve no less.

Immigrants, many of whom have never benefited from a relationship with a primary care physician or a specialty physician, are especially vulnerable to a disruption of this caring relationship—that hard-earned trust will not transfer easily (or at all) to a new provider in an unknown care delivery system. The medical literature is replete with data about how the
patient/physician relationship impacts health outcomes, including adherence to treatment protocols and keeping medical appointments. Being able to continue care with trusted providers and institutions is critical to the health of these patients.

Another element that affects continuity of care and quality and safety is the institutional support for culturally and linguistically diverse patients. BIDMC has invested deeply in its Interpreter Services department with 47 staff interpreters and more than 54 additional free-lancers. With our health center partners we have also invested significantly in other programs that facilitate access. (For example, Latina and Chinese Cancer Patient Navigators provide compassionate care for vulnerable patients finding their way through a complex medical system). Chinese labor coaches work hand in hand with obstetricians in delivering more than 300 Chinese babies annually, and our Latino mental health team provides invaluable care to the newly arrived who are most prone to depression.

These support systems are not easily replicated and are essential to providing culturally responsive care to CeltiCare members.