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Effective CMS Marketing for Multilingual Healthcare Materials
The Centers for Medicare & Medicaid Services (CMS) administer critical programs for residents of the United States in need of free or low-cost health plans. These programs are particularly critical for individuals with limited English proficiency (LEP) — in 2021, nearly 20% of the nation’s population with LEP were enrolled in Medicaid and State Children’s Health Insurance Programs had LEP. Likewise, 23% of children enrolled in Medicaid had parents who spoke English “less than very well,” back in 2019. As important as these programs are for millions of LEP patients across the nation, their effectiveness ultimately hinges on their ability to connect with and enroll eligible residents. That’s why it’s particularly important that CMS marketing strategies utilize multilingual content — after all, it’s hard to make your message resonate with an audience if they can’t understand the very words you’re using. LEP patients often report difficulty understanding their eligibility for CMS programs. Similarly, many LEP individuals are completely unaware that these programs exist in the first place, due to the prominence of English-language marketing that is simply inaccessible. Multilingual CMS marketing strategies can help with all of this. From creative content like informational videos and brochures to more run-of-the-mill content like SMS messages and letters addressed directly to patients, it’s absolutely critical that Medicare and Medicaid providers connect with people in the language that they speak. In this blog post, we’ll take a look at the different approaches you can take when developing a multilingual CMS marketing strategy. While these approaches differ slightly, the end result is the same: CMS marketing campaigns that resonate with people no matter what language they speak. Depending on the resources and budget available to you, you can either craft the marketing content directly in your target languages or you can create content in English first, working with a trusted language service provider to translate the content into your target languages. It may be daunting to craft marketing content in a language you don’t speak — but using this approach allows you to develop marketing campaigns that are authentic and tailored specifically to your target communities. Creating content directly in the target languages requires you to work with a wide range of professionals: in-language copywriters, SEO specialists, marketers and designers, to name a few. By leveraging AI tools, you can easily generate content briefs in the target language and send them off to content specialists who will develop whatever you need — blogs, social media posts, scripts, etc. — in the languages you need them in. By eliminating the need for a translation step, you can ensure that your CMS marketing materials are culturally and linguistically appropriate, without having to wonder if something got lost in translation. That said, there are a handful of trade-offs to this method. To start, contracting marketing professionals in several different languages can get costly. Depending on the number of target languages you’re working in, you also risk fragmentation across different languages — for example, your Spanish content may end up being visually and tonally quite different from your Chinese content. When you work with a language service provider to translate English source material, the provider handles all of the hiring work on their own — if you choose to create content directly in the target language, all of the work of searching for, vetting, and hiring marketing professionals will be placed on your organization. Consider how much time and money your organization has to put toward these materials before opting to go with this approach. You’re likely to find that it’s cheaper and less labor-intensive to create English materials and translate them. If you don’t have access to content marketing professionals who work in your target languages, you can instead develop English-language marketing materials in house before commissioning translation or localization from a language service provider. If you go this route, there are two different approaches you can take: Either you can create content using your brand’s standard tone and voice, or you can use plain language, which will help streamline the translation process and make your content more easily understandable. Below, we’ll take a look at the pros and cons of these two options. This is likely to be the easiest approach for healthcare providers. Your marketing team can simply craft their content as normal, adhering to your standard branding, style, and terminology. Once the content’s been drafted, you can send it off to your language service provider and request the translation services needed. Maintaining your brand voice in the target language will likely require your language service provider to transcreate — rather than simply translate — your content. Though they are closely related processes, transcreation goes a bit deeper than translation. Transcreation attempts to mimic the tone and feel of the original documents, so transcreation specialists have to take into account several additional elements beyond the text itself, such as SEO, local culture, copywriting best practices, design, etc. In the end, this will yield a final product that closely aligns with your brand’s style, while also making sure that the content resonates with LEP individuals. However, transcreation is a more complex process than plain translation. Your language service provider will have to spend more time focusing on your brand’s voice and style, which means you should anticipate a longer turnaround time on projects and potentially higher costs to complete. The term “plain language” refers to writing that is concise and easy to understand on the first read. Standards of plain language might differ quite a bit from your brand’s standard voice and tone, but it can be worth it in the long run to sacrifice your branding a bit for plain language content. Plain language tends to be easier to translate and doesn’t usually require . That means language service providers can typically provide you with a quicker turnaround time on marketing materials that have been written in plain language. This means that it’s particularly suitable for healthcare content under strict regulatory deadlines, such as notices of action and member letters that must be translated and delivered within 72 hours. But using plain language isn’t just about lowering costs and reducing turnaround time on your translations. Health literacy rates in this country are low — 36% of adults in the US have basic or below basic health literacy rates. Plain language breaks down complex medical concepts into small chunks that readers can easily understand. By explaining things in clear, concise language, you make medical information more accessible, enabling patients to understand your message and improve their health literacy. Plain Language Guidelines: Translation Begins with the Source Multilingual marketing strategies are the key to connecting with individuals with LEP. When it comes to programs like Medicare and Medicaid, it’s important that healthcare providers make an effort to engage individuals in all languages so that they can understand their eligibility for free or low-cost healthcare services. Here are a few different approaches to developing multilingual CMS marketing content for LEP patients: No matter which approach you select, the end product will be a CMS marketing campaign that effectively reaches patients with LEP. At Avantpage, we’ll gladly assist you in developing a multilingual marketing strategy. Whether you need translation, transcreation, or web localization, we can help — contact us today at [email protected] or (530) 750-2040 to get started.
Browse our most recent blogs covering topics surrounding health equity, language access, and improving social determinants of health through culturally competent care.

AI Interpreting: Is it ready for the healthcare sector?
Artificial intelligence (AI) is transforming many industries, including language services, like interpreting, and the healthcare sector. Working at the intersection of these areas, we see our clients struggling to figure out how best to benefit from exciting developments in automation and AI-powered technologies without compromising interpreting and translation quality. At Avantpage, we’re supporting healthcare organizations by implementing AI carefully, safely, and transparently to optimize business processes and translation workflows. Tools like machine translation can greatly enhance the work of human translators and there are ways that human interpreters can leverage AI to support their job as well. But while Avantpage embraces AI in certain aspects of language access, we encourage our clients to carefully consider the implications of services that offer to entirely replace linguists with AI interpreting technology. These offers of a service that’s faster and cheaper are understandably appealing when you’re on a tight budget. But are there more risks than benefits in a highly regulated industry where patient experience and outcomes are the top priorities? The National Council on Interpreting in Healthcare¹ recently published their “Guidance for Healthcare Organizations Evaluating the Potential Use of AI-generated Interpreting,” where they highlight many areas for organizations to ask deeper questions. We consider some of these here, highlighting five core concerns for health plans and hospitals considering an exclusively AI-interpreting model. A crucial part of language access planning is understanding which languages you need to provide. The core languages spoken in your patient communities should be easy to identify. But how will you offer support to a patient who needs an interpreter in a less common dialect or a language of lesser diffusion? It is important to remember that AI models are only as good as the data used to train them. If that data is limited (eg. for indigenous languages or other less common languages and dialects), you cannot rely on the same level of accuracy as a commonly spoken language such as Spanish. If you are using an AI interpreting model, does your provider have a backup solution for languages that are not available through AI? And on the topic of Spanish, can the AI tool pivot to provide a Spanish speaker from Puerto Rico versus one from Mexico, to match the needs of an individual caller? These are important questions to consider when considering an AI interpreting provider. As mentioned above, it is important to consider whether an AI interpreting service has been trained using sufficient data to provide accurate output for your members or patients. But the quality assurance questions don’t end there. Human interpreters are required to meet certain qualifying criteria. These include proof of subject-specific training, nationally recognized credentials, field experience, continuing education, and adherence to the National Code of Ethics. Years of experience (Avantpage requires a minimum of 3 years) have taught interpreters to self-monitor and to constantly look out for subtle misunderstandings between the parties. If a human interpreter identifies a communication issue, such as a cultural misunderstanding or a moment of unintelligible speech, they can intervene before it becomes a larger issue. How does an exclusively AI-generated interpreter guarantee the same level of nuanced expertise and service quality? Has the AI been trained with terminology that is specific to the healthcare industry? Does the service offer an opportunity to switch to a human interpreter if it becomes apparent that a quality issue is developing on the call? Distinct from quality assurance, quality control is about monitoring performance and improving a service to maximize quality and outcomes for patients. When it comes to written translation, tools with AI features learn and improve through detailed feedback from human linguists. If you are considering an exclusively AI interpreting model, find out how the tool will learn from mistakes. Will there be an opportunity for your staff, patients, or human interpreters to give feedback, and will that be incorporated into the model’s improvement? How does a user submit a complaint, how will errors be tracked, and who is ultimately responsible should a serious error occur? Will the service be spot-checked and monitored from the quality perspective, to be sure that patients and providers are receiving the level of quality they deserve? If you use a service like this, are you complying with federal regulations surrounding quality and AI, such as those outlined in Section 1557 of the ACA? Anyone who works in healthcare in the United States understands the importance of the Health Information Portability and Accountability Act (HIPAA) and, in the European Union, the General Data Protection Regulation (GDPR). When a health organization contracts with a language services provider such as Avantpage, that LSP must show that they offer translation and interpreting services that align with these regulations. This includes HIPAA training for staff and interpreters, secure and encrypted phone lines and servers, and many other data security measures that are monitored through annual audits. AI interpreting models work by recording conversations, converting them to text, translating them, and then voicing them in the target language. If an AI interpreting service is recording patient data, where is it being stored and for how long? What measures are in place to prevent a breach? Are patients aware that they are being recorded, and is there an option to opt out of this and be routed to a human interpreter on a non-recorded line? Addressing the factors above is an important part of building patient trust, which is arguably one of the most crucial factors when it comes to providing quality care and improving health outcomes. You want your members and patients to feel that you care at every turn in their journey with your organization. As the National Center for Interpreting in Health Care stated in their guidance¹, “qualified human interpreters often play a crucial, but understudied role not only in ensuring effective communication but also in building empathy and trust in healthcare settings, aspects of care that AI will not be able to fully replicate.” Where can you carefully implement AI within language services without eliminating the human approach? Can you be sure that your patients are not affected by unchecked racial biases, which can be unwittingly introduced in an AI interpreting tool by virtue of its limited training? If you do decide to offer AI interpreting services, is there an option for your patients to opt out and reach a human interpreter without any delay or other impact? Avantpage is excited about the progress in this field and we have been incorporating AI-powered processes into our workflows for some time. By asking questions such as those suggested above, healthcare organizations can make informed decisions about the extent to which they are willing to replace human steps with AI. To learn more about how we provide meaningful language access by combining AI with human expertise, contact our team today.

Avantpage and EmTex Offer Seamless MDR Compliance Solutions
In the dynamic landscape of the life sciences industry, collaboration can be key to overcoming complex challenges and delivering exceptional results. Recently, Avantpage Life Sciences and EmTex Life Science joined forces to address an MDR compliance challenge presented by TEAC Europe GmbH, a leading medical imaging solutions manufacturer. This collaboration exemplifies the power of strategic partnerships in providing comprehensive, one-stop solutions tailored to the needs of our clients in this highly regulated sector. TEAC Europe GmbH approached Avantpage Life Sciences with a specific request. They needed their most recent Instructions for Use (IFU) translated into five languages, but also needed support with the crucial step of checking MDR compliance with EU standards. As the source text is written at TEAC’s headquarters in Japan, ensuring MDR compliance with Medical Devices Class 1 EU regulations is essential. TEAC typically conducts MDR compliance checks in-house but, in this instance, requested that Avantpage include the task in the project scope. Given the crucial nature of both MDR compliance and linguistic accuracy, Avantpage leveraged their partnership with EmTex Life Science to tackle this challenge head-on. EmTex Life Science, a provider of medical writing and communication services based in Belgium, brought over two decades of experience in regulatory medical writing to the table. Their EU regulatory compliance specialists meticulously reviewed the English text against EU Medical Device Regulation (MDR) standards, ensuring that the content met the necessary requirements. Once the English text received the MDR compliance stamp of approval from EmTex Life Science, Avantpage’s team of expert linguists translated the IFU into five languages: French, German, Italian, Spanish, and Turkish. As subject-matter experts in the field, Avantpage’s teams ensured linguistic accuracy and cultural nuances were preserved throughout the translation process. In addition to translation, Avantpage’s graphic design team played a crucial role in the project by reformatting the translated files, ensuring consistency and readability across all languages. The result was a set of IFUs that not only met MDR compliance standards but also provided clear and accessible instructions to end-users in diverse linguistic markets. Beyond delivering the translated IFUs, Avantpage went the extra mile by creating a post-project glossary for use on future TEAC Europe GmbH projects and updates. Avantpage Life Sciences was delighted to partner with EmTex Life Science on this MDR compliance project as our respective company offerings are the perfect complement to one another. Both companies are trusted partners for the life sciences industry, and both are focused on what we know we do best. Avantpage’s linguists are experts in clinical trials, pharmaceuticals, medical devices, and biotech, and the company is ISO-certified. EmTex Life Science brings a wealth of expertise in medical writing and communications services to the table, with writers specializing in preclinical, clinical, pharmacokinetics, pharmacodynamics, and quality of life. Through their EmTex Academy, they also offer professional courses within the life science industry, further demonstrating their commitment to excellence and knowledge sharing. Client testimonials speak volumes about the success of the collaboration between Avantpage and EmTex Life Science. Andreas Koller, Sales and Marketing Manager at TEAC Europe GmbH, praised the seamless experience and expressed confidence in Avantpage’s continued support in navigating complex regulatory landscapes. “This was the first time we worked with a different vendor and also the first time we asked an external partner to check MDR compliance. Things were very smooth with Avantpage, who will soon begin assisting with the complex IFU update process.” – Andreas Koller, Sales and Marketing Manager at TEAC Europe GmbH In conclusion, the partnership between Avantpage and EmTex Life Science exemplifies the power of collaboration in the life sciences industry. By leveraging each other’s expertise, these two industry leaders provided TEAC Europe GmbH with a comprehensive MDR compliance solution that addressed their unique challenges and exceeded expectations. As the life sciences landscape continues to evolve, partnerships like this will play an increasingly vital role in driving innovation, compliance, and success for clients worldwide.

5 Ways Language Access Can Improve Your CMS Star Ratings
Every year, the Centers for Medicare & Medicaid Services (CMS) release a series of star ratings that patients can use to evaluate the quality of the services that a Medicare Advantage health plan offers. As a health insurance provider, it’s important to make sure your CMS star rating is in tip top condition. CMS star ratings help patients identify high-quality Medicare health plans, with a five-star rating indicating excellence. If your rating falls below this threshold, not only will patients be less likely to select your plans, but you could face penalties and fines from the CMS. The CMS calculates its star ratings on a scale of 1 to 5 based on the following factors: If your CMS star ratings slip or you’re simply looking for new ways to improve your services, it might be a good idea to look into improving your language access plan. Patients with limited English proficiency (LEP) make up a significant proportion of Medicare recipients, and as such, it’s important to make sure you’re serving them effectively if you want to boost your star rating. By offering a diverse range of language access services for LEP patients, you can improve their overall experience with your organization, thereby increasing your CMS star ratings. Although language access is not factored directly into your CMS star rankings, improving language access can help you perform better on the other measures that the CMS uses to calculate your star rankings. In this blog post, we’ll take a look at how your agency can improve its language access services and, in turn, boost your CMS star rating. Nearly 10% of the United States’ population has LEP, meaning that they are unable to effectively understand or communicate in English. Research suggests that immigrants — particularly those with LEP — are more likely than their U.S.-born counterparts to be enrolled in Medicare services. And given that the number of older individuals with LEP is projected to grow significantly over the course of the next 40 years (by 2060, experts predict the number of older LEP immigrants will grow to 22 million, up by 15 million from 2018), it’s important to make sure that you’re able to serve this population just as well as you’re able to serve English speakers. Patients — regardless of the language that they speak — need to be able to understand their health status and communicate effectively with their healthcare providers and insurance agencies. By offering language access services that improve your organization’s transparency, outreach, and communication with consumers, you can contribute to improved health outcomes for the country’s growing population of individuals with LEP. Effective CMS Marketing for Multilingual Healthcare Materials A Guide to Finding a Medicare Translation Agency Fast Print & Mail Translations for Health Plans While the CMS won’t take your language access measures into account when developing star ratings, high-quality language access is likely to improve your performance on the measures that they do factor into their star ratings. In recent years, CMS star ratings have been on a downward trend — more and more providers are performing worse than they have in past years. And that could be because many of them aren’t well-prepared to meet the needs of their patients with LEP. Let’s take a look at the different factors that go into your CMS star ratings, and how improving language access can help you improve your score on each. The CMS looks at the mortality rates of patients enrolled in a specific plan when determining their star rankings — the lower your mortality rate, the higher your star rating will be. LEP appears to be a factor that can increase mortality rates — according to a report published in 2016, LEP “was associated with a 31% increased odds of mortality” among patients with sepsis, even after accounting for illness severity, comorbidities and other factors. While it depends on the type of healthcare issue patients face, making sure they are well-informed about their plan and comfortable seeking out the treatment they need, you can lower the overall mortality rate of your plan. In the case of LEP patients, translating important medical information and offering interpretation services as needed will empower patients to make informed choices about their healthcare. This measure looks at the rate of serious complications patients can potentially face when seeking treatment, such as surgery site infections or catheter-induced urinary tract infections. Language access may not directly impact this measure, but you should be able to effectively communicate the level of risk patients might face. Additionally, making sure interpreters are available and present either in person or remotely can ensure patients are knowledgeable about the health procedures they’re undergoing, allowing them to make decisions accordingly. If patients frequently have to return to the hospital after surgeries or health emergencies like heart attacks and stroke, your CMS star rating will go down. Patients with LEP have been shown to have particularly high readmission rates when compared to patients who speak English. If you’re looking to reduce readmission rates, it’s a good idea to look into whether or not your readmission rates are higher for your LEP patients. If it is, working with a language service provider to improve your language access could be a good first step to improving this measure. In 2017, researchers found that access to interpreters had a significant impact on lowering the readmission rates for patients with LEP, from 17.8% to 13.4%. CMS star ratings also take the patient reviews into account — if patients aren’t satisfied with the care they’re receiving, it could take your rating down a notch. While it’s true that language access can be a matter of life or death in certain situations, it’s also an important way to make patients feel more comfortable, regardless of the severity of their health situation. LEP patients who have access to high-quality language access services may be more likely to report a positive patient experience, which could give your rating a well-needed boost on this measure. The longer it takes to give patients effective care, the lower your star rating is likely to be here. And wait times tend to be much longer for patients with LEP than for English-speaking patients: A 2022 study found that folks with LEP spend an average of 31.9 minutes in the waiting room, while English speakers wait just 21.8. On this measure, interpreters can play a particularly important role — if patients with LEP regularly have to wait for a long time to receive interpreting services, it could delay their access to effective care, ultimately hurting your star rating. Work with a language service provider to make sure interpreting services are available on standby so that you can get them access to an interpreter as soon as possible. Your CMS star ratings are an important way for patients to understand the quality of care they’re receiving. In order to avoid penalties and fines, it’s important to aim for a five-star rating; considering the unique needs of LEP patients, language access is likely to play an important role in reaching that perfect score. If you’re looking to improve your language access services and boost your CMS star ratings, Avantpage is here to help. We know how important language access is for LEP patients and are proud to provide specialized translation, interpreting, and localization services for healthcare providers. Contact us today at [email protected] or (530) 750-2040.

The Positive Impact of Diversity and Immigrants
Diversity, which includes differences in race, ethnicity, sexual orientation, religion, language, geography, gender, and more, is crucial to the US, as the US was founded on the idea that all people are created equal. In addition, diversity provides new ideas, experiences, and perspectives, and people can learn from each other. From a business and organizational perspective, diversity leads to better problem-solving due to having different ideas, resulting in better business decisions and higher-performing outcomes. Josh Bersin of Forbes states, “Companies that embrace diversity and inclusion in all aspects of their business statistically outperform their peers.” In addition, companies with a diverse workforce are 35% more likely to achieve more financial gains than those without a diverse workforce. Immigrants are a big piece of the diversity pie. Supporting immigrants is important for humanity, supporting our economy, and foundational to our country. Immigrants contribute to our economy in many ways, including labor force, business, and population growth. Some cities in the US are making strides in making diversity, and immigration specifically, a part of the way they operate. We’ll look at some things that the city of Cleveland, Ohio is doing to promote diversity and ways in which organizations can expand and improve language access as support for immigrants. Immigrants contribute to local economies in a variety of ways; these are just some of the many ways. The city of Cleveland is working towards diversity through many actions. Here are some ways in which the city is working towards diversity. Cleveland, Ohio is one of the over 300 non-profits and local governments that have partnered with Welcoming Network, “a network and a movement driven by the conviction that communities make better decisions when residents of all backgrounds, identities, and perspectives are meaningfully engaged.” Have key influencers and stakeholders get involved with non-profits, committees, boards or other initiatives to inspire and encourage diversity. For example, three Cleveland representatives out of a nationwide board of 23 individuals are on the Board of Directors for non-profit Creating Healthier Communities: Kevin Clayton, the Vice President of Diversity, Inclusion and Engagement for the Cleveland Cavaliers; Alan Nevel, SVP of Metro Health System; and COO Teleange Thomas of JumpStart. Look for grants that promote equity in Social Determinants of Health (SDOH) among immigrant populations. For example, in Cuyahoga County, the Beulah Park-Euclid Beach Connector Trail will be built thanks to funds from the Outdoor Recreation Legacy Partnership (ORLP) program. The trail will be built along the lakefront of Lake Erie for nearly half a mile to provide a trail for underserved communities. This funding from the ORLP program will continue to expand our communities’ connections to urban green spaces, where children can play, families can connect, and a love and appreciation for the outdoors can be nurtured.” Cleveland has a program called Landed: Stories of Newcomers that captures the stories of immigrants, first-generation Americans, and other newcomers living in Northeast Ohio to try to mend the divide between people in the community. It showcases people from other countries through a podcast where they talk about their experiences. The Cleveland Language Access Service (LAP) Plan, which is a plan to ensure equal and effective access to city services for Limited English Proficient residents, followed other successful city LAPs. These LAPs included Minneapolis’ Minneapolis in Any Language guide, Chicago’s Bridge the Language Gap guide, and other resources such as www.lep.gov. These cities have invested a lot into language services and realized the benefits. Language access is one of the important things you can provide to immigrants to promote equity. And while language access is a cost, it’s also an investment in your local economy. In working with a language service provider, you can strategize how to maximize the process. To expand and improve language access, consider the following ideas. Supporting diversity benefits communities, businesses, and organizations. As observed through the example of Cleveland, diversity can be viewed and accomplished in many ways. To provide language access for immigrants and other limited English proficient individuals, work with a professional language service provider. For more information about language services, contact us at [email protected] or (530) 750-2040. We’re here to support efforts to increase diversity.