Kyung Hee Choi recalls feeling close enough that she could have reached out to touch the airplane that zipped past her 25th floor Wall Street office window on Sept. 11, 2001, before it struck the second tower of the World Trade Center.
“It was truly a life-changing moment,” said Choi, who soon left her job and turned her sights to community service.
That career move has dramatically affected the provision of healthcare to Bergen County, N.J.’s, Asian-Americans, who face numerous obstacles to good healthcare.
“There are big language barriers and culture barriers,” Choi said. “On top of that, understanding the U.S. healthcare system is very, very difficult—even English-speaking people sometimes have a hard time understanding how this healthcare system works.”
Culturally sensitive care can be good for both patients and the provider.
Prior to 9/11, the first-generation American immigrant from South Korea had been living out her dream of working in New York as a managing director for global firm J.P. Morgan Chase. Along the way, Choi said she never forgot the help and support she received from colleagues and others when she first moved to the U.S.
After 9/11, she felt it was time to give something back. The next year, Choi retired from J.P. Morgan and joined the boards of several not-for-profit organizations in and around her community of Bergen County, including the board of the now-former Pascack Valley Hospital, in Westwood.
“Sitting on the board I noticed that the hospital really wasn’t reaching out to the Asian community,” she said, even though the community was growing swiftly. The state has the fourth-largest Asian-American population in the U.S., ballooning 1,400% to more than 725,000 people in 2010, up from 48,000 in 1970, according to federal census data analyzed by the state.
New Jersey is not the only part of the U.S. where the Asian population is growing. Throughout the U.S., Asian-Americans are the fastest-growing racial or ethnic group, increasing 72% from 2010 to 2015, according to the Pew Research Center.
In Choi’s home of Bergen County, Asian-Americans account for more than 14% of the population, and the county is home to more than 60% of the state’s Korean population. In one of the county’s boroughs, Palisades Park, Korean-Americans make up more than 51%.
With such a large proportion of Korean-Americans within the hospital’s patient population, Choi suggested Pascack Valley target that community. Choi proposed the hospital start there since she herself was very familiar with the Korean immigrant community’s health needs. Cultural and language barriers made it difficult for many to navigate the local healthcare system to get routine checkups, causing many to visit emergency departments after their conditions grew severe.
Choi began by recruiting Korean-American doctors and nurses who could provide care that was more linguistically and culturally in tune with the intended population. That marked the beginnings of the Korean Medical Program, which Choi said she wanted to benefit both the community and the hospital by establishing a go-to healthcare site for Korean immigrants.
After ongoing debt problems and years of declining admissions led Pascack Valley to close in 2007, Choi moved the program to nearby Holy Name Medical Center in Teaneck, which had been running a less ambitious form of a clinic targeting Korean-American patients since 2002. (Pascack Valley reopened in 2013 as Hackensack University Medical Center at Pascack Valley.)
“She was very successful, and her program was very different from ours,” said Michael Maron, president and CEO of Holy Name Medical Center. “Ours in its origins was just a clinic to treat mostly the uninsured and needy in that population, but it was not real total population health management.”
Following the move to Holy Name in 2008, the program quickly grew from 35 physicians to 90, serving a population of more than 45,000 patients.
Since that time the program has been renamed Asian Health Services and expanded to include specialized medical programs for Chinese, Filipino, Indian and Japanese ethnic populations. Choi is vice president of the program.
Now in its 10th year, the program has about 280 Asian-American physicians who work in concert with more than 250 church and community groups and more than 900 private donors to provide a medical home for more than 250,000 Asians in the New Jersey and New York area.
Adapting menus and reading materials
Patients who come to Holy Name under one of the programs can access services with the help of a bilingual care coordinator. During hospital stays, patients are served food from their native culture and have access to television and newspapers in their native language.
Part of those efforts require educating clinicians and other healthcare staffers on some of the subtleties of Asian culture. Some of those cultural norms can include offering warm water instead of cold, providing a bowl of rice and soup as opposed to a sandwich, and referring to a patient by their surname instead of by their first.
A serious faux pas in the healthcare setting is writing a patient’s name in red ink, the color traditionally used in some parts of Asia to signify a person is dead. “Can you imagine if you came to the hospital and the nurse picks out red ink and begins to write your name?” Choi asked. “That is not a good thought.”
Providing culturally tailored amenities is just one part of what the program offers patients. Maron said the program has been effective because of the systemwide commitment toward culturally sensitive care from Asian and non-Asian clinicians alike. “What we learned is that there is an incredible amount of science and an incredible amount of enhanced, high-quality, cost-efficient care that can be delivered when you tune in to ethnic segmentation of the population,” Maron said. (See sidebar, p. 23.)
Dr. Hee Yang said when he began participating in Asian Health Services 10 years ago, the goal was to provide culturally sensitive care to a population whose health needs were often ignored. But he discovered that providing care with such an approach let clinicians practice some of the truest forms of population health management.
“We basically started a program to see if we could help people,” said Yang, chief medical officer for the Asian Health Services program at Holy Name. “But an interesting thing happens along the way when you do something like this, when you start centralizing a minority group in a region, you begin to see subtle differences in medical issues.”
Choi said Holy Name has reaped the benefits since becoming known as the area’s go-to health site for Asian-Americans. The hospital as well as its three satellite sites attract 50,000 patient visits a year through Asian Health Services. Over the past several years, the program has helped more than 7,000 patients obtain coverage through the Affordable Care Act’s health insurance marketplace.
Maron agreed the program has been financially positive for the hospital, but acknowledged problems existed before the ACA due to bad debt the system had to carry to treat first-generation immigrants, many of whom were uninsured. The situation improved somewhat when New Jersey opted to expand Medicaid to all low-income adults.
Over the years, Maron said, the program has helped the hospital recruit ever-more talented Asian clinicians, making it an attractive healthcare destination for all members of the community. “For many of them, their reputations have grown so their practices now are probably half Korean and half the rest of the population,” Maron said. “That for us is just another great growth story—when you put the people first, the dollars end up following.”
Maron said the Asian Health Services program has already influenced how the hospital delivers care to other ethnic groups. Recently, the hospital formed a Patient-Centered Cultural IQ Committee to develop a pilot program that packages the methodology of Asian Health Services in order to share the model with other providers.
In recent years, representatives of three area hospitals have visited Holy Name as they study adopting a similar model to serve their Asian-American populations, and Illinois and California providers have called seeking information.
Choi said she never aspired for Asian Health Services to go beyond its initial goal of helping her community, but feels its success has shown a potential path other healthcare providers can take to better manage the health of their minority patient populations.
“We want to become the national leader in culturally sensitive care,” she said.