Managed Care Moves to the Head of the CLAS 

Implementing Culturally and Linguistically Appropriate Services 

By Brigette Settles Scott, MA


Closing the Gap, Working Toward Our Goal • August 2003


As the U.S. population becomes more diverse, medical providers and other people involved in health care delivery must interact with patients from many different backgrounds. Culture and language are new vital factors in how health care services are 

delivered and received. Today, it is important that health care providers understand and respond with sensitivity to the needs and preferences that diverse patients bring to the health encounter. Providing 

culturally and linguistically appropriate services (CLAS) to these patients has the potential to improve access to and quality of care, and 

ultimately, health outcomes. 

“The system by which health care is delivered and financed must 

be designed to ensure the care is safe, effective, efficient, equitable, 

and tailored to each individual’s specific needs and circumstances,” 

recommends the Institute of Medicine Report, Unequal Treatment: 

Confronting Racial and Ethnic Disparities in Health Care, released 

early last year. 

Once thought of as unrealistic goals or expectations, cultural 

competency programs and initiatives are now being implemented in 

managed care organizations and other health care settings across the 

country. The National Standards for Culturally and Linguistically 

Appropriate Services in Health Care, published by the Office of Minority Health (OMH) in late 2000, serves as a springboard for use by 

providers and others seeking to address cultural issues within their 

delivery systems. 

According to Guadalupe Pacheco, public health advisor at OMH, 

policy makers, accreditation agencies, purchasers, patients, advocates, 

educators, and health care communities use CLAS as a vehicle to 

improve health. “Cultural competence is the ability of health organizations and practitioners to recognize the cultural beliefs, attitudes, 

and health practices of diverse populations, and to apply that knowledge in every intervention—at the systems level or at the individual 

level—to produce a positive health outcome,” said Pacheco. 

“Major HMOs have undertaken CLAS as a vehicle to provide 

appropriate cultural and linguistic care to a diverse population,” added 

Pacheco. “This is the first time these organizations have seen clear 

pathways to culturally and linguistically appropriate services. Before, 

everyone was doing his or her own thing. With CLAS people can 

make improvements by building on these standards.” 

Implementing CLAS 

In partnership with OMH, the American Institute for Research 

(AIR) developed curriculum modules for implementing CLAS. The 

four-year project launched in 2001 is working with family practitioners and plans to pilot test the modules in a variety of health care 

settings. 

The CLAS pilot project will report on guidelines and processes 

for implementing standards in health care organizations, identify potential barriers, and measure impact on providers and patients. 

“In an effort to provide culturally competent care to a multicultural, ethnically diverse population, the pilot project is a way to identify health disparities and deliver case management services, analyze 

members’ health status, educate members about preventive health 

and improve access to early screening, diagnosis, and treatment,” said 

Pacheco. 

In 2002, Alameda Alliance for Health , a managed care health 

plan serving low-income populations throughout Alameda County 

in the city of Oakland and Northern California, was chosen by OMH 

as the first study site for the implementation of the CLAS standards in 

a managed care organization. 

Through more than 1,300 public and private physicians, hospitals, and community clinics, the Alliance provides comprehensive 

medical and behavioral health services to more than 80,000 members—45 percent with a primary language other than English and 87 

percent representing various racial and ethnic minority groups. With 

a racially and linguistically diverse workforce and membership, and 

cultural competency standards already in existence, the Alliance was 

an ideal study site. 

Dr. Juanita M. Dimas, cultural and linguistic program manager, 

said the Alameda Alliance began in 1996 and has always been committed to the culture and health of the population it serves. “Originally chosen as a pilot site, Alameda Alliance is now more of a case 

study since there were a number of similar standards in place,” she 

said. 

“The CLAS standards have been a help in guiding Alameda 

Alliance, but they are our minimum goal. Our systemic approach 

helps to avoid defining cultural competency as the final desired outcome, and instead, desired outcomes are defined as quality of care at 

the member/patient level, provider level, and MCO level,” concluded 

Dimas. 

For more information on the Alameda Alliance for Health, go to 

http://www.alamedaalliance.com

For more information on the Office of Minority Health’s National 

Standards for Culturally and Linguistically Appropriate Services in Health 

Care (CLAS), go to http://www.omhrc.gov/clas

For more information on how to implement a cultural competency 

program in your organization, see page 18.

Managed Care Moves to the Head of the CLAS 

is based on the Summit workshop “Cultural Competence of Health Care Organizations.” 

Office of Minority Health Resource Center U.S. Department of Health and Human Services