Language Access in Community Centers: Improving Care With Medical Translation with Louis D. Simmons

Eyal Heldenberg (00:10) Hi, everyone. Welcome to Care Culture Talks. My name is Eyal Heldenberg. I'm the CEO of No Barrier, an AI medical interpreter for healthcare providers. This podcast is about language accessibility and cultural competency. Happy to have a dear guest in the podcast, Louis Simons. How are you today?

Louis D. Simmons (00:30) I'm doing well. You all on yourself?

Eyal Heldenberg (00:33) All good, all good. Perfect. So maybe we'll start with just a quick intro. could you kind of guide us through your journey in healthcare?

Louis D. Simmons (00:43) Well, again, thank you so much, y'all, for inviting me to the podcast. I look forward to sharing my experiences as well as this very interesting topic. My journey into healthcare is that I have been a part of the healthcare community for over 15 years. I began as a administrative fellow at Emory Healthcare, and then from there, I decided to focus.

my attention on acute care operations. And so I started in the perioperative and endoscopic space for over three and a half years for Emory hospitals in Atlanta, Georgia. From there, I decided to progress in my career and wanted to gain more experience in the physician group practice arena. So for over 10 years, I've been focused on the physician group practice management side of healthcare. And so I also began that journey at Emory healthcare.

specifically Emory School of Medicine and then had an opportunity to also work on the Emory Healthcare side for a multi-specialty clinic. And then from there I migrated to work for community health systems, one in Athens Regional.

more specifically Athens Regional Health System as the Assistant Director of Practice Operations. And then I moved from there to join Morehouse School of Medicine and be a part of their faculty practice plan, Comoros Health Care, still doing multi-specialty physician group management and then had a wonderful opportunity that I couldn't resist to come to where I am today, which is Whiteford, Inc. We are a nonprofit based in Atlanta, Georgia, more specifically the Edgewood area. And we are

a organization that has been practicing for over 30 plus years and we've been practicing in a couple of spaces. One space we have a Early Learning Academy and then that we have operated for a number of years and then also we have what's called a Fairly Qualified Health Center operation where we have five clinical care sites that are deemed Fairly Qualified Health Centers or also known as Community Health Centers and three of those are currently within school-based health centers.

environments and so we partner with both the Atlanta Public Schools as well as KIPP Metro Atlanta. So for over 15 years I've had the opportunity to lead in both acute care and physician group settings as well as been able to manage areas like revenue cycle management, project management, financial analysis, financial budgeting. So my focus has always been operations for each of the entities that I work for.

And that is a nutshell for me.

Eyal Heldenberg (03:30) Amazing, Perfect.

So maybe we'll hone on this community centers experience. I think it's called, you know, also the safety nets across America. There is kind of a known knowledge that these specific segments serve a really diverse patient population. Can you guide us through like what are the unique challenges

Louis D. Simmons (03:36) Mm-hmm. Mm-hmm.

Mm-hmm.

Yes, so we are a what's called, as I said earlier, Community Health Center. And so we are under the umbrella of the what's called the HRSA 330B program, which funds federally qualified health centers. And those centers are either what's called lookalikes or, you know, community health centers. And what we do is, is we actually serve in what's called

medical underserved areas.

so what we do is that we provide services to a community that's deemed a medically underserved community. And that could be based on not having specific providers in their area to enable community members to receive the care that they need when they need it. Or also what's called medical services underserved populations. So you may be in a population

where you are considered to be a medical underserved population based on the service the types of services that are needed are not available so these community health centers serve as a access point

for patients, particularly patients who are what's considered low income compared to what's called the federal poverty level guidelines every year. So specifically for community health centers, more so what's called federally qualified health centers that we are, we have to provide what's called a sliding fee discount program, which means any person that is 200 % or below the federal poverty level, we are required to provide reduced services on fee for the services that we provide.

So for our center, what makes us unique is that we provide medical data of AVL services in one location. What also makes us unique too is that we not only accept commercial insurance plans, but we also have this unique sliding fee program which is specific and required for community health centers. Now the other piece that is important to note that you mentioned is that we are a part of the safety net.

umbrella and that is true. So we serve collectively, federally qualified health centers across the country, which there are, you know, thousands of them, over a thousand of them across this country. I think the last number I remember was over 1,400. And we also provide services in a year to over 30 million Americans. And so when you think about it from that perspective, we serve a number of

patients a year and these individuals receive quality care from these community centers. So that's also what makes us unique is because not only do we provide care to low income individuals, but just like private health institutions, we provide care to all that will come to us. But in particular, we're known to have a sliding fee count program. So therefore we are a clinic that can cater to and is really

developed to support persons who are 200 % or below the priority profile level. So that's how we are integral into the safety net umbrella because we provide that access point that a patient may not otherwise have. With that said, we also are what I like to call a connector to specialty services because as a further qualified health center, you are required to provide primary care services and that could be in the form of a internal medicine physician or family medicine physician.

pediatrician or a OB-GYN physician. It could also mean it could be provided by what's called a mid-level or associate provider, which is a nurse practitioner or a physician assistant or certified nurse midwife.

So when you think about it from that perspective, it's really creating a primary care pipeline for patients to receive care and then that primary care unit then links them with specialty care when needed. So yes, we are considered part of the safety net umbrella and we provide exceptional care, I think, to anyone who needs health care, but also we do it in the privacy and background of their own community.

That's why we also here at our organization refer to this as place-based care. We want our community members who live in the community, we want them to come and receive care at our health center so that where they live and play, they can also receive quality health care from qualified health care providers and from a very supportive staff.

Eyal Heldenberg (08:40) Yeah, I I read in LinkedIn that the FQHC got into a very efficient level comparing to other, may I say private, private operations.

Louis D. Simmons (08:54) Yes, I think, we have learned and historically, I believe, community health centers have learned to be efficient, but they've also been.

Also, from a governmental perspective, we are assessed on an annual basis based on specific criteria. That could be what's called universal clinical quality measures that we have to where, you know, we have to report annually to the federal government, specifically HRSA, which is the Health Resource and Service Administration, through a program called...

the uniform data system reporting that we have to report on over 16 measures now because of change. They added two more this year, which are related to substance use disorders. But we have to report every year on measures such as diabetes management, hypertension management, cervical cancer screening, HIV screening. Now, this is not different from other measures that we have to report to specific payers like HEDIS measures,

et cetera. But we also have to report from a Federal Tort Claim Act perspective in order to receive medical malpractice coverage from the federal government. We also have to report on our specific programs such as our quality assurance program, our risk management program, our claims management program, because they want to make sure that the program is ensuring that they are credentialing and privileging all of their providers and staff as appropriate, that they are

enacting and are sustaining a quality and robust clinical risk management program and also similarly a robust quality assurance and improvement program as well to ensure that we're providing quality patient care. So because we are required to report those things, it also allows us to ensure that we are evaluating ourselves appropriately to see if we are providing quality care to our patients.

And that's also a way for HRSA to assess and compare and contrast to not only other federally qualified health centers, but also to through the nation and comparatively, and the nation, if we are providing quality care. The other piece of that is every three years, similarly to joint commission, which, they, they do it on a multi-year basis. they evaluate hospitals and they also do clinics. for us.

We have a similar accreditation process that is every three years. As a matter of fact, we are slated to have our own upper side visit, which is what it's called, for our organization in June. And that specific evaluation reviews 19 areas of your entire organization. That's everything from your needs assessment that you're supposed to every three years and asking the question, do you use that data to inform the services that you provide?

to looking at board composition, board authority, and conflict of interest, as well as clinical staffing, et cetera. And that is important because similarly to Judge Wong Commission, they too want to make sure that there is an assessment in place to evaluate each entity to ensure that they are and are being cognizant of the appropriate...

processes and procedures that they need to have in place in order to continue to provide quality patient care, as well as to create positive patient experiences and also thoroughly to have a assessment to provide information to the health center on ways to improve. So I think because of all those things, I think it has been assessed, as you said, in studies that federally qualified health centers or community health centers or even the lookalikes that we're able

to provide and sustain providing quality patient care. and to be very efficient because we've had to for various reasons. And a lot of organizations, we are not resource rich, but we've learned various ways on to how to be efficient and lean. Even this organization that I'm a part of, we are lean and that's not uncommon.

in a number of community health centers. And also too, because I think we, and because I believe that as a part of being a member of the community of our FQHCs, we are highly connected to our communities. So I think that's the other benefit too, from a perspective of our engagement and our intention, because we are so focused on ensuring that our community has the services it needs when it needs it. That helps us to be more

engaged as well as it helps our performance and so that's why I also think that you have an opportunity

to receive quality care because we try to be very connected. And so to have the ability to have all your services in one location like oral health care, in our example, we have medical, dental, behavioral services. So we were able to provide that one patient all those services in one location. In comparison, they would have to go to multiple locations from a private care perspective. They have to go to another area for

they have to go to another area for primary care, they have to go to another area for mental health services. So to be able to do that in one location as well as to do it in real time because that's what we sometimes have to do. And we call those warm hand offs to other services. That is one of the hallmarks, I think, of a federally qualified health center, that happens. that does not happen.

in a vacuum that really happens in a coordinated fashion. And so from that perspective, that's already providing a model that's different when you compare it to being in an academic medical center or a private environment most of the time. So I think that's the other advantage of being a part of an FQHC.

Eyal Heldenberg (15:02) Perfect. So I think let's go over language barriers.

Louis D. Simmons (15:07) I think they can definitely be impacted by the level and types of care that a person receives. From a Federally Qualified Health Center perspective, there are various types of programs that are supported by the Federally Qualified Health Center. We happen to be a part of what's called a 330 grant, and a part of the 330 grant, there's different funding models. So there's a Federally Qualified Health

Center, is term 330B. There's also 330H, which is specifically for homelessness. And then there's 330, I think it's H, which I believe is for...

or I think it's 330 I's for public housing and then 330 H is for seasonal or migratory workers. So you have specific models that the 330 program, which is an act, 330 program funds.

And in each of those models, it's a little bit different, right? So when we talk about language barriers, cultural barriers, let's just even think about, which we are not, the model of having a health center that specifically supports seasonal or migratory workers. In that environment, you're definitely going to have potential language barriers, which means that you also have to supportive interpretive services in order to support the clients that come and see you. And so with that said,

And

if they did not have that service of medical interpretation available for the provider and for the patient, then of course specific medical information would be lost and therefore it would limit the provider's ability and impact the provider's ability as well in medical decision making.

And because based on that medical decision making leads to decisions that he or she will have to make related to the care of that patient. And then on the patient side, based on.

what is found through various tests and evaluations and assessments. They will then have decisions to make based on that information. And if the barrier then is language or even cultural, because that's what I think it's very important too that we remember when we're delivering care and even for non-clinical interactions, meaning

when we talk about patients coming to the health center, they're interacting with persons at the front desk who are not clinical and then they're going through their journey through the visit, it's very important to make sure that we are being very sensitive to...

to various persons in the community who may have cultural or language implications that we need to be aware of. So going back to the migratory seasonal worker example, in that community, there are definite cultural, language, and social aspects that we as providers have to take into account. Same thing as the Federally Qualified Health Center related to us, are comparatively, we are one of the smaller FQHCs in

our state of Georgia and also nationally. And so for us, you we have less than 20 % of our patients who are identified as limited English proficiency speaking patients. But with that said, we are required to provide language interpreter services. But not only to that community, when we talk about language, we need to also talk about disability as well, because for persons who are blind or deaf, we also have to provide those services. So from that perspective,

It's very important for health centers to document instances where their patients need support. And one of those supports is around language barriers. The other support is around disability barriers. And so that could be vision or deaf. And then the other piece of that is providing culture comments and care. And so it's very important for providers and staff to be trained in providing culture competent and care.

Because we know through, and as you're aware, through when we look at the data on chronic disease results, as you are aware, African Americans and the Hispanic or Latino or Latino populations, our...

statistics are some of the worst when we look at various disease states. And that can be diabetes, hypertension, maternal health. You know, those specific indicators show that African Americans and Hispanic or Latina

persons have higher rates of incidences of those disorders. But when you look at the outcomes and when you see that those same individuals have individuals who are taking care of them that understand cultural competencies and that understand how to partner with them on their health care journey, their outcomes get better. And so that...

And we know that that's the case, right? Because there's other studies that show that those persons who are taken care of by persons that look like them ethnically and culturally behave the way that they do, there's a deeper connection between that provider and that patient, which leads to potential better outcomes because of that connection. definitely language barrier, cultural barrier is very important in the practice of medicine.

Eyal Heldenberg (20:57) Yeah, totally agree on that. One of the, I would say, bad practices is to bring family members and kind of bypass, know, a provider could get by with what's in the room. I wonder what's your position on that, if you have your stories around that or, yeah.

Louis D. Simmons (21:12) Mm-hmm.

Mm-hmm.

Mm-hmm.

Well, I think, you know, historically, you know, organizations have used

in certain instances, and I've been witness of it too, that sometimes the patients will want to use a family member or a friend who speaks in their same language to serve as their interpreter. You know, there are instances where that happens. There's also instances where we have staff who are bilingual or some even trilingual who will also assist, and all those things are helpful. I think where we have to be careful is

you know, we need to make sure that those individuals who are interpreting that we have a mechanism in place where we train them on really medical interpretation. And I say that because I've had instances where, you know, what was supposed to be communicated to a patient was not. And then that led to different medical decision-making errors, in my opinion, that could have been avoided if the patient

Eyal Heldenberg (22:15) Hmm.

Louis D. Simmons (22:25) understood completely why they were coming to receive care. And so because in this example, the patient did not, they were unaware of what type of medical services

services they were coming to have to be provided to them. you never want a patient to present to an institution and not know completely and be fully aware and engaged about what services are about to be delivered for them. And I know the case where that was not the case for this one patient. And unfortunately, the family member who was accompanying them didn't communicate clearly.

what they were coming to that institution for. So with that said, it's always been important to have in my opinion in a certified medical interpreter, and that could still be a staff member of that clinic. I also believe, that for documentation purposes, it's also helpful to even document that exchange with the patient.

because sometimes when there is a third party and they're trying to interpret for them, it's also good to have something documented that's show about something, it is best practice to document that conversation. if we ever need to go back to that exchange, the information is there. And it's also important to, I think, to have a third party there because sometimes information can get lost in translation.

And it still can between two people. I think the benefit of having a medical interpreter, particularly specifically, is that we can actually keep the dictation.

We need to if there's any discrepancy related to what was communicated between the doctor or provider and the patient. And I think that's important because It definitely allows us to ensure that whomever is giving the interpretation has been trained to do so, understands the

medical terminology understands the nuances and medical interpretation in order to provide the best experience for both the provider as well as for the patient in particular that they're trying to communicate.

on behalf of to ensure that both parties understand what medical needs are warranted for that patient. And then it also enables the medical provider in their best judgment to provide the best medical decision-making based on the information that's been communicated. So I think there's benefits in having a third-party medical interpreter, in my opinion, for those reasons.

I think as we, from a patient population perspective, as you know, we are becoming more more culturally diverse. And so I think it's even going to become more more important that we have a basis for and a grounding for training individuals in the medical interpretation space.

Eyal Heldenberg (25:20) Yeah, I totally agree. A medical translator, especially on site. I would say this is the golden standard. I would say that the second will be video interpreter over phone because video would get to see, you get to see face, but we're going to talk about it. And maybe question like from your experience, what would be the best way to train

Louis D. Simmons (25:31) Mm-hmm.

Eyal Heldenberg (25:39) and prepare your staff to work effectively across those language and cultural barriers around professional development and things that other clinics should look into.

Louis D. Simmons (25:52) Yes, I definitely think clinics should look into how to provide culturally competent care. think clinics should also explore the benefit of maybe having staff certified as medical interpreters, not only from a non-clinical and clinical perspective, but even we don't even think about this sometimes, is even from a billing perspective, to have a person who is bilingual or

who knows how to communicate to a patient about their payment that is needed or about their medical bills, I think is very important. But I also think it's important too when we talk about those additional services that we provide to patients like care coordination or connecting them to specialists. So really trying to think about how do we provide Coaching Conference in care throughout

not only the in-person or virtual patient visit, but also patient engagement after the visit, right? And that's both in writing as well as in-person or virtually. So for me, one of things that programs can do is they can bring in persons to talk about cultural competent care. What does that look like? What does that look like at different roles? Because it is going to be different when we talk about how does it look for a front desk person? How does it look

for a phlebotomist, how does it look for a nurse, and how does it look for a provider. It is just going to be different. not only having that type of training, but also status neutral training, To really think about making sure that all persons understand throughout the patient interaction continuum how to provide what's called status neutral care to everyone. The other piece that I would also advocate for, not only having training for

for

staff, not only front desk staff and clinical staff, but also providers on medical interpretation. Because I think it's a different experience when you know that your provider speaks two or more languages and you can specifically coordinate schedules to allow providers who are bilingual, trilingual, to be able to write care to that population. And so now you're building somewhat of a pipe.

when that's somewhat your building a pipeline for those patients. So I think those are the various ways that you can educate your staff as well as to provide professional development for them to attain some sort of certification in medical interpretation because I think it's very important. And then the other piece I would say that would be great is that you begin to poll your patients who are considered limited English.

preventive speaking patients to really gauge and understand.

what their needs are and ask them questions around what can we do to improve your experience with this and whether that be by services or whether that be by how we engage with you or how we communicate with you. That's important too because just like we survey patients in our practice, we survey patients after every visit about their experience. I think it is helpful to also survey, you know, cohort of patients like LEPs just to get additional information about

we can provide that patient population a better experience giving their additional need of making sure that we provide adequate, limiting-use, proficiency-speaking services, i.e. translation services, so that they can understand the type of health care needs that they may have.

Eyal Heldenberg (29:44) Maybe going back a bit on the medical translation part. It's kind of an old problem. think we have medical translation in the last, I don't know, 40 years or so. I wonder how was the technology changed throughout the years from your perspective to cover those gaps?

And what innovations have you found most promising throughout the years?

Louis D. Simmons (30:13) Well, in my over 15 years experience, you know, I've seen medical interpretation go from having in-person medical interpretation where, you know, we had to request a medical interpreter and then we had to cover out of the two or four hours of that medical interpreter's time and they would come to the hospital and regardless if it was two hours or four hours of time, we would still be charged for that time and then of course the hourly rate.

So we will be charged with hour rate plus the transportation piece of at least two or four hours, depending on the contract. And then I've seen that evolve to telephonic interpretation and then video interpretation, which I think is great because you can do either verbal or American Sign Language for those patients who need it. And to me, that's a game changer. The other piece I've seen too is that from a telephonic perspective,

we've been able to provide also three-way medical interpretation communication. So when a patient calls us in particular, we're able to, from a patient appointment scheduling perspective, if we notice that the patient is limited English proficient, then we can actually connect them to our telephonic interpreter. And then it's a three-way call now, then the interpreter, the...

patient staff member and the patient are all on a three-way call trying to complete this one function of patient registration, patient appointment scheduling, et cetera. So from that perspective.

What we have is now we have the ability for the patient to be seen and heard, right? And so for me, I've seen that evolve from that in-person individual coming to the organization and sitting with the patient and then speaking to the patient and the provider as they walk through the various paperwork that's involved as well as having the

ability to communicate between the two during the visit about the medical care that's needed or in medical decision making and so that's evolved from that point to now having it be telephonic and now having the video interpretation. think those are wonderful game changers, particularly the video because now with

the expansion of telehealth and even for us, in our organization, particularly for behavioral health, behavioral health for us, 50 % of that patient visit population is telehealth. And so that's big, and I think you'll notice in the health industry related to telehealth, engagement, behavioral health, or mental health is one of the service lines that has the highest adoption of telehealth.

encounters, if you will. And from that perspective, we can now, if needed, have

even on a telehealth basis, we can also request interpreters. So I think, you know, the video piece has allowed us to grow along with telehealth in order to make sure that, you know, LEP patients are getting the same type of care from an access perspective as our non-LEP patients. And that's important because that means that we are providing consistent care to both groups, regardless of their ability to speak.

the national language. And think that's important because at the end of the day, what we want for our patients is we want them to have the best version of what they feel like is optimal health for themselves. And so by doing these things, we're hoping that it aids them in that journey.

Eyal Heldenberg (34:09) Yeah, totally agree. think also the COVID period gave a lot of boost to the video component. Maybe it was kind of overlooked, but now it's kind of obvious.

Louis D. Simmons (34:14) Mm-hmm.

Yes.

Well, I think when COVID hit, we were converting to telehealth. And I can tell you the organization I came to prior to this organization, we had two clinics and we decided to convert one to in-person and another, we decided to do telehealth. And I think too, some of the billing and payment practices from insurers, particularly CMS also opened the door to providing more telehealth services given that telehealth service payment and

Eyal Heldenberg (34:36) Mm.

Louis D. Simmons (34:51) billing rules were changed for that period. And some have maintained, some of them have not. So I think because of COVID and because of the implications COVID provided from the ability of patients being able to see another provider opened the door, I think, to expanding the use of telehealth. Because as you know, before COVID, telehealth adoption was not as great as it was

during the COVID period. So with that said, I think that because of the changes in health plan, health payer billing practices and payment practices, it actually enabled telehealth to spawn into multiple environments. And that's medical services, behavioral services, and even done on certain parts of the country. So with that said,

it's very important to have as you're expanding in telehealth the ability to connect with your limited English proficiency speaking patients. And one of those ways is making sure that you provide that same translation service benefit when they're doing telehealth because even during that time it was very important as well. Don't have any data around the

Well, I haven't seen any data yet around the...

the quantity and also the effectiveness of having translation service or what the effectiveness of providing language interpretive services during the COVID period. I haven't seen any data about that and then if it was consistently used. If patients who are considered LEP when they did receive care, did they do it by telehealth in person? And if it was telehealth, what was the experience? I haven't really seen any data on that.

I wouldn't be surprised if there was data on it, because I'll be curious to see that. Because during that period, we had to pivot to that. And so I think that you're right that because of COVID, really spawned evolution of telehealth. And I think it's great. Now that we're not necessarily past COVID, but what you've seen sustained from the COVID experience.

related to service offerings, the highest service that utilizes telehealth is still behavioral health, mental health services that you still see. So that has been able to retain itself. It still has been impacted, but still when you do comparatively, that's one of the services that has been able to maintain the telehealth engagement of patients.

Eyal Heldenberg (37:47) Yeah, I agree on that. Maybe last question from your experience. What advice would you give to healthcare leaders who are just beginning to address language barriers in their organizations?

Louis D. Simmons (38:02) A couple of things that I would offer to those organizations is, one, first evaluate your patient population and determine if, well, one, what needs that group require from you. As you know from a regulatory perspective,

if you receive funding from the federal government in any pathways such as research, re-enumeration, you are supposed to provide.

language and derivative services to patients at no cost. So most organizations and most private practices who opt in to receiving Medicare services, even Medicaid services, or who have specific funding from the federal government, they are required to do so. most, as I said, organizations and

that receive that type of funding are already required to do so. So that's one. And if they're not...

Then, and that's part two of this is then it's helpful to assess and this is even if you're not receiving funding is for all organizations is to see in your patient population. What is your limited English proficiency speaking patient population? Do you know what that is? And if you do, what data do you have that reflects that patient population?

Is

it, you have patient visit data? Do you have patient satisfaction data? Because if you do, then from a recommendation perspective, I would utilize that data to talk about how do we provide more clinically competent and supportive care to this population? What is the percentage of patients that are LEP? What are the various languages?

Are we seeing being spoken by our patients? And then what types of communication should we be providing to them both written and verbally to assist them in their health literacy, right? Thirdly, what I would ask the organization to do is to look at your human resource capital and evaluate who on your team, both provider and staff, are bilingual, trilingual.

and then think about giving them professional development if they so choose to look at the opportunity to maybe become a medical interpreter. So when you have patients come in, you have designated persons who are subject matter experts on medical interpretation.

and they can be advocates for your LEP patients. And this could range from persons who are referral coordinators to, you know, patient informant schedulers to providers themselves. And because what you end up doing then is you're now creating a community of individuals that can assist this specific population. And lastly, what I would say as a recommendation is that you evaluate these things on a routine basis. And that could be every year,

you know, at least every year in my opinion, because things change. And you also need to strategically think about when you are opening other clinics or other sites or other services, who is the target population of those services, of that site, and also reviewing if you're going to have a need for increased LEP services for that target population, target service.

if so, make sure that you incorporate the level of services that are needed for that population to make sure you're providing consistent, culturally competent and quality care across your organization. So those are the four things that I would say. And the last thing I would say is have a champion for LEP patients, but not only that, have a champion for promoting quality

quality care from a culturally competent perspective. And sometimes, you know, having that person could inform how we communicate to certain target populations, because we want to make sure that we're communicating in a very supportive, thought-provoking, as well as informative way. And maybe having a designated person to serve in that capacity would be helpful when we talk about how we communicate with our patients.

how we engage with our patients, what does that look like, even based on the service because and I will be specific and say

One of the two other service lines like family medicine and peach, know, we deal with the family. So how are we communicating with the parents of a potential patient who could be, you know, first generation Americans and they have a grasp of English, but how do we engage that parent or guardian or parents?

or guardians on understanding the care that's being provided to their relative. So with that said.

think having a point person that understands how to provide these types of arrangements for a patient, I think is very important. So really having an advocate for this would be helpful. And that same person could also be the same person who looks at these activities across the entire system, which I think is important because you want to make sure that you're providing consistent

you know, care and activities for patients who no matter where they seek care in your ecosystem, that their experiences are identical.

Eyal Heldenberg (44:21) Yeah, those are great tips. All right, Luis Simons, it was pleasure to have you in Care Culture Talks and thank you so much for sharing your experience and your tips.

Louis D. Simmons (44:31)

Thank you so much, Eyal It was great being here and I enjoyed having this conversation and I look forward to hearing what other people thought about the experience. But I thank you so much for having this podcast and really talking about this ever increasing important topic.

Eyal Heldenberg (44:50)

Thank you.