Displeased with the Affordable Care Act’s lack of solutions to improve care for immigrants, New York City is taking the matter into it owns hands and fashioning answers others might emulate.
The metropolis, with the largest foreign-born population in the United States, announced plans this fall to roll out a web of primary care and preventive services to capture uninsured illegal immigrants who are excluded from federal and state support. “Direct Access” will launch as a pilot program this spring at an estimated cost of $6 million, targeting a population of 1,000 in several soon-to-be announced neighborhoods across New York.
Last year alone, the city spent some $400 million providing care to immigrants, which was often delivered in emergency departments, notes Ramanathan Raju, M.D., president and CEO of the NYC Health + Hospitals. The new approach will focus on delivering culturally competent care in the community, to be coordinated among the corporation’s 11-hospital system.
“Our major push is to give them geographically convenient access. They should not have to take two buses and walk three miles to get to a clinic, so we need to make sure that they’re strategically located,” Raju says.
The creation of Direct Access comes at the recommendation of a task force convened by the city last year to better understand the immigrant care conundrum. That follows in the footsteps of such efforts previously in San Francisco and Los Angeles. Comprising everyone from the Caribbean Women’s Health Association to the Hastings Center, the group unearthed a series of hurdles to care for this population. Lack of provider capacity, inadequate linguistic competency among providers and little understanding of coverage options were a few. NYC plans also include expansion of health literacy education, support for providers who are serving immigrants and bolstering interpretation services.
One of the biggest barriers to seeking care can be a lack of trust, fearing that they may be persecuted for their citizenship status, those involved note. That’s why it’s important to involve groups who have tight bonds with the community, whether a foreign consulate or a local church. Health navigators and translators are one key piece of better coordinated care for immigrants, notes Francesca Gany, M.D., an internist and chief of the Immigrant Health and Cancer Disparities Service at Memorial Sloan Kettering Cancer Center, which was part of the task force.
“I think reaching out with groups that are already entrenched in the community and trusted is going to go a long way toward overcoming those barriers,” she says. “These groups speak the language of the community, understand the culture and the fears, and they know how to establish trust.”
The success of Direct Access in its first year will be judged on a series of factors including such things as how quickly patients get an appointment, how well diabetes is controlled and how easy access is. Raju is optimistic that it will exceed expectations and serve as both a model to other hospitals on how to improve immigrant care, and a wake-up call to the feds in addressing the issue legislatively.
“I think we simply cannot give different treatment for different people,” he says. “If coordinating the delivery of care is the future in this country, then everyone should get it, irrespective of immigration status.”