Offering Healthcare Coverage Plans to Hispanics Carlos H. Assante, MBA Regional Director of Business Development UnitedHealthcare Latino Health Solutions Compass Resources, Inc Provider No. 3591 CE Course. No 38094 (2 CE Hrs) January 20, 2012 Albuquerque, NM
Objectives To obtain a general understanding of the U.S. Hispanic market and the issues surrounding offering healthcare coverage plans to the growing Hispanic workforce and their employers. To understand Hispanic cultural, social and religious customs and practices as they relate to health and healthcare coverage plans. To enhance your ability to communicate effectively with Hispanic business owners (or non-hispanic business owners that employ a large number of Hispanics) for the purpose of offering healthcare coverage plans to Hispanics. Compass Resources, Inc. 2
Objectives (cont ) Understanding the importance of bilingual (English-Spanish) communications. To learn how to address potential hesitations that Hispanic workers may have relevant to enrolling in healthcare coverage plans. To learn key strategies for assisting Hispanic business owners (or non-hispanic business owners that employ a large number of Hispanics) to implement a successful healthcare coverage plan. Compass Resources, Inc. 3
U.S. Hispanic Population Demographics
The Changing US Demographics Compass Resources, Inc. 5
The Changing US Demographics Census 2010: 50 Million Latinos Hispanics Account for More Than Half of Nation s Growth in Past Decade Pew Hispanic Center, March 2011 Compass Resources, Inc. 6
The Changing US Demographics Pew Hispanic Center, March 2011 Compass Resources, Inc. 7
U.S. Hispanics - Demographics U.S. Hispanics are the largest minority Hispanics are a highly diverse market. Each Hispanic group (Puerto Rican, Cuban, Mexican, etc.) is distinctly different and possesses its own customs and idiosyncrasies. Top 3-Hispanic Countries based on the size of Hispanic population worldwide: 1 st : Mexico 2nd: U.S.A. (The United States is the fastest-growing Spanish-speaking country in the world.) 3 rd : Colombia Source: U.S. Census Bureau, <http://www.census.gov/press- Release/www/releases/archives/population/010048.html> and <http://www.census.gov/press- Release/www/releases/archives/population/007910.html> and http://www.census.gov/press- Release/www/releases/archives/population/001720.html US Pop. Projections 2005 to 2050 PEW Hispanic Center, Feb 2008. Compass Resources, Inc. 8
U.S. Hispanics - Demographics Hispanics account for 56% of the population growth in the U.S. in the last decade 2000-2010 As of 2010 there were approximately 51-million Hispanics in the U.S. That is approximately 16.3% of the total U.S population. If population trends continue on their present course, by the year 2050, Hispanics will represent 32% of the nation s population and 55% of the workforce. In New Mexico 46% of the population is Hispanic, or over 953,403 people. Younger Age: Hispanics are more than a decade younger 27.5 yrs. vs. non-hispanics 41 yrs Mix of Native-born in U.S. and Foreign Born 60% of Hispanics are U.S.-born 40% are Foreign-born Source: U.S. Census Bureau, <http://www.census.gov/press- Release/www/releases/archives/population/010048.html> and <http://www.census.gov/press- Release/www/releases/archives/population/007910.html> and http://www.census.gov/press- Compass Resources, Inc. 9 Release/www/releases/archives/population/001720.html US Pop. Projections 2005 to 2050 PEW Hispanic Center, Feb 2010.
U.S. Hispanic Population Overview: Facts & Figures *U.S. Census, Public Information office, May 2010 ** U.S. Census Bureau, March 2004 ***Map source: U.S. Census Bureau, U.S. Interim Projections by Age, Sex, Race, and Hispanic Origin. Release Date: May 11, 2004 Compass Resources, Inc. 10
U.S. Hispanic Population Overview 450 400 350 300 250 200 150 100 50 0 1970 1980 1990 2000 2010 2020 2025 2050 6.4% 12.3% 22.9% 35.4% Total Population Hispanic Non-Hispanic Hispanic Population as a % of Total US Population 1970 1980 1990 2000 50.5 2010 2020 2025 2050 Total Population 203.2 226.5 249.4 275.3 299.8 324.8 337.8 403.7 Hispanic 9 14.6 23.7 33.9 51.9 74.5 86.9 143.1 Non-Hispanic 194.2 211.9 225.7 242.1 247.9 250.4 250.1 260.6 In 2011, approximately 16.3% of the U.S. population (1 out of 6 individuals) is of Hispanic descent. Compass Resources, Inc. 11 Sources: Strategy Research Corporation: 2000; and the U.S. Census Bureau, Population Estimates, Middle Series
Percent Distribution of the Hispanic Population by State, 2010 Approximately 62% of Hispanics Live in 4-States: CA, TX, FL & NY Source: US Census Bureau, 2010 Compass Resources, Inc. 12
Percent Distribution of Hispanics by Country of Origin, 2010 Source: US Census Bureau, 2010 Compass Resources, Inc. 13
U.S. Hispanic Population Overview: Facts & Figures Source: Pew Hispanic Center, March 24, 2011 Compass Resources, Inc. 14
U.S. Hispanic Population Overview: Facts & Figures Hispanics spend $926 billion a year on goods and services. Buying power is growing faster than non-hispanics Hispanics are more than decade younger (27.5 yrs.) than non- Hispanics (41 yrs). Approximately 23.1% of Hispanics are younger than 17 years old Fertility rates of Hispanics are higher than the natural replacement level Sources: Pew Hispanic Center, 2010. Compass Resources, Inc. 15
U.S. Hispanic Population Overview: Facts & Figures The U.S. Hispanic Labor Force The U.S. Hispanic labor force is the fastest growing segment of the labor force, even in non-hispanic owned businesses There are approximately 14.8-million Hispanics in the workforce Immigration continues to drive the growth: 9 of 10 new Hispanic workers are foreign born Desire for affordable product with full benefits and Spanishspeaking doctors. If a very limited network improves affordability, Hispanics are receptive. Despite high employment rates, a significant proportion of the Latino population is uninsured and does not benefit from either private or public insurance. US. Census, Public Information office, May 2011 Compass Resources, Inc. 16
We Speak Spanish / Hablamos español 89% of Hispanics learned to speak Spanish first. 50% of U.S. Hispanics speak Spanish most frequently at home. * 70% of Hispanics are Spanish-dominant or Bilingual. Many Hispanics prefer information in Spanish especially when dealing with complicated issues such as healthcare, health insurance and finances. Source: Retrieved on October 25, 2007 from A U.S Hispanic Market Primer, www.hispanicmarket.com. *Minority Business Development Agency. Compass Resources, Inc. 17
Percent of People 5-YRS and Older who Speak Spanish at Home, 2007 Compass Resources, Inc. 18
Hispanic Market Impact The impact of Hispanics on the American culture, population and everyday life is undeniable. Example* Salsa now outsells ketchup Tortillas outsell white bread The better we understand the Hispanic market, the more successful we can be in serving their needs and selling health insurance to them. * Source: Wall Street Journal Ketchup Versus Salsa by the Numbers Sept. 20, 2007 Compass Resources, Inc. 19
Video Hispanic Market Overview Welcome to the New America Source: Telemundo, May 2010 Compass Resources, Inc. 20
Hispanic Values and Beliefs Compass Resources, Inc. 21
Faith / La Fe A large number of Hispanics are Catholic (approximately 70%) Today many practice other religious faiths Many Hispanic traditions are based on religious beliefs and practices Family gatherings are often centered around religious events and religious customs Compass Resources, Inc. 22
Religious Affiliations Pew Hispanic Center and the Pew Forum on Religion & Public Life Compass Resources, Inc. 23
Hispanics Tend To Be Spiritual People Latinos believe in fate and destiny. This affects the way they view health and healthcare. Regardless of their religious tradition, God is an active force in everyday life. Most Latinos pray every day. Latinos who identify with a religion believe in miracles and divine healing. Source: PEW Hispanic Center, Changing Faiths, Latinos and the Transformation of American Religion 4/25/07 Compass Resources, Inc. 24
Hispanic Religious Traditions Quinceañeras - Fifteenth Birthday Celebration Bautismo -Baptism Comunión -Communion Confirmación -Confirmation Día de los Santos Reyes -Three Kings Day Día de la Candelaria - Candlemas Semana Santa - Holy Week Ash Wednesday Holy Thursday, Good Friday, Holy Saturday, etc. Easter Día de los Muertos - Day of the Dead Día de Nuestra Señora de Guadalupe (honoring patron saint of Mexico) Las Posadas - Christmas-time processions La Navidad -Christmas Compass Resources, Inc. 25
The Family / La Familia The Hispanic family unit is very strong. The familia is the primary reason for living, working and celebrating. The familia is usually several generations. The familia may be divided in one or more countries. The familia may include both biologically- and non-biologically-related individuals Compass Resources, Inc. 26
Respeto: Respect Culturally, in general, Hispanics have a hierarchy for social respect. Four social heads of the community are highly respected and factor into decision making for both the individual and the family: El Medico: The Doctor El Padre: The Priest La Abuelita: The grandmother El Juez: The Judge Compass Resources, Inc. 27
Friends / Amigos Friends can be synonymous with family. Friends can be compadres, comadres, community leaders, etc. Friends are trustworthy sources of information and advice. If we reach the opinion leader we reach their circle of family and friends. Compass Resources, Inc. 28
6 Degrees of Separation? Background: In the 1960 s Stanley Milgram showed that any two randomly chosen individuals in the U.S. are linked by a chain of six or fewer first name acquaintances known as 6 Degrees of Separation. Hispanic consumers tend to be a loyal and close knit group there is a likelihood of fewer than 6 degrees because of family and community ties. Source: Milgram s Small World Experiment Compass Resources, Inc. 29
6 Degrees of Separation Hispanics often feel that it is a small world and are more comfortable when they recognize a common bond with the other person. Hispanics look for the connection that they have with others. Hispanics place emphasis on Word of mouth Relationships Friends and family as reliable sources Referrals from family or friends A convinced Hispanic shares and convinces many. Beware: this also applies to negative experiences with products or services. Compass Resources, Inc. 30
In General Terms, which Group is Latino? A 1. Group oriented 2. Believes in fate and destiny. 3. Follows advice from trust-worthy friends and family 4. Loyal to brands and products 5. Shows respect by not looking directly into your eyes B 1. Individual strength 2. Tolerant of religious differences 3. Relies on research, facts, experience 4. Likes to try new and improved products & brands 5. Confident, assertive. Looks you in the eye Compass Resources, Inc. 31
Issues Affecting Hispanics Understanding of the Healthcare System in the United States Compass Resources, Inc. 32
Hispanics Perspectives on Health Health is important: a healthy family is highly valued Hispanics worry more about healthcare than non- Hispanics 1 The health of the income earners in the family is critical to the well-being of the entire family. In Hispanic families, women make 80% - 90% of the health care decisions. Hispanics place great emphasis on their children s health and wellbeing. Many Hispanics do not fully understand how health insurance works in the U.S. Yet, they need it and want it Compass Resources, Inc. 33 1 A study conducted by the Rockefeller Foundation titled American Worker Survey (Feb. 2007)
Confused by the US Healthcare System Many Hispanic s first contact with the healthcare system was in their country of birth, where workers do not need to make a conscious choice of medical plans The employer pays a social security contribution for each employee (according to their salary). The worker does not pay any money. Employers do not offer their workers a choice of plans or premiums A social security card DOES equal medical care A recent immigrant to the U.S. may erroneously think that because they see a Social Security amount deducted from their paycheck that they already have medical coverage Compass Resources, Inc. 34
The Alternatives to Health Insurance In Latin American countries, the majority of Hispanics have access to over-the counter medications and medicine prescribed by their pharmacist. Some Hispanics have faith in homeopathic medicine. Traditional home-remedies are passed on through the generations. Compass Resources, Inc. 35
Hispanic Health Disparities Diabetes Hispanics born in the year 2000 face a 2 in 5 risk for diabetes. Compared to non-hispanic whites, Hispanics are more than twice as likely to have diabetes. Cholesterol Screening 1/3 and 1/2 Hispanics not screened in past 5 years Accidental Injuries Third leading cause of morbidity and mortality among Hispanics and are primarily work-related. HIV Hispanics have the second highest rate of HIV infection in the U.S. AIDS Latinos represent nearly one in five (19%) people in the US Sources: American Heart Association, 2009; US Department of Health and Human Services, Office of Minority Health, 2009; American College of Chest Physicians, 2007; National Council of La Raza (NCLR), 2009; The Common Wealth Fund, 2003; US Census Bureau, 2008; US Department of Health & Human Services, 2006. Compass Resources, Inc. 36
Health Disparities: Other Factors Access to Healthcare Hispanics have higher uninsured rates across all age groups when compared to non-hispanic whites and non-hispanic African Americans. This is especially true for foreign-born Hispanics. Nationally, approximately 33% of Hispanics are uninsured In New Mexico, approximately 26% of Hispanics are uninsured Language & Communication Barriers Even when insured, primarily Spanish-speaking Hispanics experience more difficulties when accessing care than do primarily English-speaking Hispanics, non-hispanic whites, and non-hispanic African-Americans. Compass Resources, Inc. 37
Health Disparities: Other Factors Pew Hispanic Center & Robert Wood Johnson Foundation, August 2008 Compass Resources, Inc. 38
Hispanic Health Paradox The Good News.. Latinos in the U.S. tend to have significantly better health and mortality outcomes than the average population despite generally low socioeconomic status. Recent studies suggest, this is primarily true for the following: Lower infant mortality Mental Health Asthma (with the exception of Puerto Ricans) High Blood Pressure However, the longer someone remains in the US (acculturation) the worse their health becomes. Compass Resources, Inc. 39
Lower Infant Mortality Despite the fact that Latinos are less likely to access early prenatal care, they are more likely to have good outcomes at birth. Despite barriers to prenatal care, the rate for Hispanics (6.9%) was lower than the rate for the overall population, about half the rate for non- Hispanic Blacks (14%), and similar to the rate for non-hispanic Whites (7.3%). Tomas Rivera Policy Institute August 2007 Compass Resources, Inc. 40
Hispanic Businesses Today, there are approximately 3-million Hispanic-owned businesses in the US. Hispanic-owned firms are the fastest growing segment of US small businesses In New Mexico, there are approximately 37,000 Hispanic Owned Businesses Latina-owned businesses are the fastest growing segment of Hispanic-owned small businesses Sources: US Census Bureau, last revised August 9, 2007 US Hispanic Chamber of Commerce, 2009 Annual Report Compass Resources, Inc. 41
15-MINUTE BREAK
Hispanic Business Owners Video Let s meet some Hispanic business owners. As you listen to the video, think about: What are they concerned about? What do business owners need? Compass Resources, Inc. 43
Video: Talking Candidly about Health Insurance with Hispanic Business Owners Compass Resources, Inc. 44
Let s Discuss 1. What kind of concerns did you hear? 2. What do these business owners need? Compass Resources, Inc. 45
Key Strategies for the Broker to Help the Business Owner
#1 Know the Spanish-language and cultural capabilities of the health insurance companies that you represent Seek companies that have culturally appropriate and linguistically accurate programs, services and materials. Companies that have: Bilingual customer service Bilingual websites Bilingual health education materials and disease management programs Enrollment materials in Spanish Plan summaries in Spanish Investigate and research: What is the depth of the carrier s capabilities? Do these companies offer quality, comprehensive materials? Are the materials valuable, useful and relevant to the audience? Compass Resources, Inc. 47
#2 Make it easy for the employer to educate the employee Utilize documents that are bilingual, simple and easy to understand Offer your assistance and expertise at open enrollment Supply the open enrollment meetings with health education flyers on topics relevant to the Hispanic community (diabetes, heart disease, cancer and others) Stage the dissemination of the information. Develop a health information calendar. Compass Resources, Inc. 48
#3A Learn your client s language preference Speak the language that the owner is comfortable speaking If you do not speak Spanish, consider taking a Spanish-speaking employee to visit the client. The Spanish-speaker should address the business owner and employees in the respectful form of you USTED (formal) and not TU (informal) Compass Resources, Inc. 49
#3B Learn your client s language preference About three in ten (30%) Hispanics report problems communicating with their health-care providers due to language barriers* Language comfort level is key to understanding terms of agreements and benefits especially when discussing sensitive issues like healthcare Reaching out is more than a simple translation of documents and hosting a web site Spanish capabilities should be available across all points of service Direct translations can often be meaningless, incorrect, confusing or ineffective beware of Spanish-language software translators Wrong use of Spanish-language could be offensive or ineffective: Example: Stretch Your Healthcare Dollars was incorrectly translated into Spanish as Increase your Healthcare spending Source: * Pew Hispanic Center, 2002 National Survey of Latinos Compass Resources, Inc. 50
#4 Communication styles Understand cultural differences Eye contact: Hispanics consider not looking directly into your eyes a sign of respect. In contrast, Anglos consider looking into people s eyes a sign of assertiveness, confidence and truthfulness Understand their position Focus on the relationship with the business owner and convey to him/her that you consider them an important long-term customer Compass Resources, Inc. 51
#5 Understand the community and get involved Every community has its own distinct personality Familiarize yourself with the neighborhood and the people Every community has a special need Volunteers are always needed Find out what are the key organizations in the Hispanic community Hispanic Chambers of Commerce Hispanic-based professional organizations and associations Hispanic-based community agencies & organizations Build long-term relationships How can you support Hispanic individuals and organizations? How can you be recognized as part of their community? Compass Resources, Inc. 52
#6 Relational vs. Transactional Hispanic relationships tend to be more personal. This is paramount to a successful business relationship. Face-to-face meetings should be treated as a relationship and not simply as a transaction Relationships are built on trust Establishing trust leads to a loyal and long term relationship You build trust by understanding and respecting the Hispanic customs and values You build trust by fully understanding the customer s needs -- especially when those needs are different from the general market needs. Compass Resources, Inc. 53
#7 Emulate other successful brokers Look at what brokers in Hispanic communities offer their customers They get involved in the community They go beyond providing Spanishlanguage materials They respect the Hispanic culture They attend Hispanic Chamber events even if they are not Hispanic According to the article titled Serving an Underserved Market While most Hispanics are not likely to respond to standard industry pitches they are a receptive audience to health insurance products Source: Serving an Underserved Market, Joe McKendrick, October 3, 2005 Compass Resources, Inc. 54
Understanding Hispanic Workers Hesitations to Enrolling in Health Insurance Coverage
Worker s Hesitation #1: It is not worth the money Preventive healthcare and regular checkups save money in the long-run Paying the full amount at the time of an emergency is an unexpected financial burden Your health is much more valuable If you think of medical insurance as a monthly pre-payment plan you will not have to worry about unforeseen large medical expenses Compass Resources, Inc. 56
Worker s Hesitation #2: I cannot afford a benefits package If you, the family s money-earner, get sick, (and do not have health insurance) you will: have to take time away from work, and pay out-of pocket for medical care.all of this when you are not earning a paycheck At a minimum, cover yourself to protect the economic welfare of your family. Compass Resources, Inc. 57
Worker s Hesitation #3: I don t understand how the health insurance system works in the U.S. We understand that each country s healthcare system is different. That is why some insurance carriers have developed educational tools and resources to help explain, in simple terms, how to use the health plans. Keep in mind that: Worker s may not be familiar with employer-sponsored health insurance and the concept of shared costs Not all Hispanics understand or read English Compass Resources, Inc. 58
Worker s Hesitation #4: I pay for medical care only when I need it It is more cost effective to have health insurance as opposed to not having Health coverage relieves the stress of having the worry Will I have enough money to pay for emergency medical care? When you make a large purchase (a home) do you pay the entire amount in cash? Most likely not. Shouldn t you apply the same principle to healthcare? Remember that: It is important to demonstrate actual costs for emergency room visits or a short hospital stay compared to a monthly insurance premium Encourage employees to realize what a great benefit it is to have their employer share their health care costs with them. Show examples to demonstrate how their employer is sharing costs with employee. Your employer pays X and you only pay Y Compass Resources, Inc. 59
Conclusion
Key Learnings Approximately 50.5-million Hispanics live in the U.S. The US Hispanic workforce is growing rapidly Hispanics culture, beliefs and customs play a significant role in how Hispanics view their health and health insurance coverage Many Hispanics prefer Spanish (verbal & written), especially when it relates to sensitive issues like healthcare. Some Hispanics do not understand the healthcare system in the U.S. and how to use it appropriately. However, health and wellness programs that promote literacy through the use of culturallyrelevant, bilingual resources and services are key. Many Hispanics may be uninsured or under-insured Hispanics experience health disparities that affect their health and well-being (e.g. diabetes and accidental injuries) Some Hispanics may have certain hesitations to enrolling in health insurance coverage; however, through proper education these hesitations can be addressed. Compass Resources, Inc. 61
GRACIAS!