Marina Brown

home

authors

marina-brown

One of the most important aspects that separate good, knowledgeable sports coaches from the ones who win championships year after year is that the repeat winners understand they need to see and treat their players as individuals. They know what motivates one player to excel, whether it’s getting in their face and coming down hard or providing soft guidance and support, will cause another to fail miserably and they adjust accordingly.

As former New York Giants Head Coach and Super Bowl winner 

, “Look, coaching is about human interaction and trying to know your players.”

What works in the world of athletics also works in the real world, especially when it comes to motivating members to improve their own health. You can’t settle for blanket solutions or approaching everyone with the same set of tools. To be truly effective, you must understand the individuals with whom you’re working.

That’s why having population health analytics that identify high-risk members, no matter how sophisticated they are, isn’t enough. You need to be able to get below the data to understand what will get members motivated and activated, as well as what will prevent them from following a program, if you hope to succeed at a higher level.

It would be easy if you could follow football legend 

 when he was asked how he got to be such a great motivator of players: “Motivation is simple. You eliminate those who are not motivated.”

But health plans don’t have that option. Managed care leaders must meet their members where they are and work with them to change any negative behaviors impacting their health to positive ones. Not just temporarily but in the long term.

Top 4 Ways Healthcare Executives Can Be Better Leaders

One of the most important ways care managers of health plans can do that is to have regular, meaningful conversations with the members in their care using motivational interviewing and other in-depth techniques. Care managers need to discover what is important to members and how better health might impact it.

For example, a member who has difficulty walking due to diabetes or obesity may want to dance at her daughter’s wedding or throw a football in the backyard with his grandson. The care manager who can develop a strategy based on those personal, concrete goals will be far more likely to have success motivating that member than one who talks in the abstract about being healthy in “the future.” Especially since humans are wired with a “

” that normally places our short-term desires (e.g., eating a big, delicious bowl of ice cream) ahead of our future needs (walking, not losing a foot, etc.).

Yet it takes more than simply talking to gain the full picture.
	Some people will avoid the truth so they don’t have to make changes. Others will sincerely state things they 

This is where in-home visits for the highest-risk members can be a game-changer for health plans. A nurse, care manager, or even unlicensed staff member who walks into the member’s home can see exactly how they live to gain a better understanding of who the member is.

Something a professional can do is take note of the surrounding neighborhood to help fill out the social determinants of health (SDoH) picture. Members who live in “

” will find it far more difficult to adhere to a healthier diet no matter how motivated they are. Understanding the inherent barriers to activation will help ensure plans of care are designed to overcome or avoid them.

To date, adoption has been slow due to costs in areas other than in Medicaid programs. But as healthcare in general recognizes the value of understanding the SDoH and other environmental factors that contribute to member health, the pervasiveness of face-to-face, in-home visits is expected to grow.

Once this non-clinical information has been gathered, health plans can work with members and their providers to help develop care pathways members will embrace rather than resist or avoid entirely. For example, the mother who has trouble walking but wants to dance at her daughter’s wedding can be shown how purposeful walking over a very short distance for a few days can lead to progressively longer walks, and ultimately lead to dance lessons or practice sessions at home.

Then, once the behavioral change has been implemented for that specific, member-driven goal, it will be far easier to carry forward as a matter of habit. This, in turn, can lead to slowing, stopping or even reversing disease progress, depending on the condition. When that happens, emergency department visits, inpatient stays, and unplanned readmissions are likely to be reduced, lowering the cost of caring for that member while improving member health and satisfaction overall.

Perhaps most important, the health plan will become an active partner in the member’s health instead of just a deduction on his/her paycheck or a place to send monthly checks. This relationship-based approach will help build member loyalty and gives health plans something to compete on other than price.

Analytics and population health management, by their nature, are about working with huge numbers. However, you can’t forget the human element behind those numbers.

As any successful professional coach can tell you, coaching people on an individual basis and determining what motivates them rather than using a single, cookie-cutter approach, isn’t easy. But it’s well worth the effort, because it enables you to make a real difference. It’s like women’s basketball 

 has said, “Coaching is the great passion in my life, and the job to me has always been an opportunity to work with our student athletes and help them discover what they want.”

Approach your members in that way and the dividends will be enormous.  

Marina Brown is vice president of clinical programs for eQHealth Solutions, a population health management and healthcare IT solutions company that touches millions of lives each year. The organization has more than 30 years of experience working with payers, providers and government entities on increasing quality outcomes and optimizing payer and provider networks. She can be reached at 

Articles

How health professionals who use a coach’s mentality and ability to care for a patient can better impact their lives in the long-run.

Opinion: Applying Lessons of Great Coaches to Motivate Members in Healthcare

With the transition to value-based care and shared risk, helping members become and remain as healthy as they can be is critical to achieving clinical and financial success. The biggest “X factor” in this equation, however, is the members themselves.

If they are not willing, active participants in their own care, health plans are going to find it very difficult to move the needle on member health-no matter how many other processes and how much more technology they put in place.           

Here are five ways to drive greater member activation and participation in their own care:

One of the challenges health plans face in getting members activated is that they are used to doing everything for their members. While that certainly gives them a measure of control and ensures important actions (such as making a follow-up appointment with a primary care physician (PCP)), it also does little to change member thinking or behavior-either today or in the long term.

To really get members actively participating in their own care, case managers and care coordinators need to move from acting like a hotel concierge to being more like a teacher. In other words, when they are on the phone or chatting in a portal, rather than saying, “Let me call your doctor for you,” they should be saying, “I want you to call your doctor, and here is what I want you to do.”

For example, if a member with chronic heart failure (CHF) calls and repeats problematic symptoms, the case manager can tell them to call the PCP’s office and ask to speak with the doctor. They can tell the doctor that the patient is experiencing symptoms such as a two-pound weight gain, swollen feet, and difficulty breathing.

By taking this approach, members take charge of their care rather than having it imposed on them, and the clinicians are able to ask follow-up questions directly of the member. Members also gain a greater understanding of what led to the current situation so those behaviors can be avoided, rather than managed after the fact, in the future.

Finally, if the case manager isn’t around when members call, those members will know what to do and are more likely to stay out of the ED and/or avoid an inpatient visit.

2. Create a personal connection with the member

Health plans are frequently the villain in media discussions about the high cost of healthcare. One way to change that perception is by building personal relationships with members-especially the 

 of healthcare. People are far more likely to take advice from someone they have a relationship with-rather than a cold, faceless company-so creating that personal connection is essential to improving member activation.

Wherever possible, health plans should work on creating more face-to-face interactions with their members. These can be live, in-home visits to ensure everyone involved understands the context of the member’s care challenges, supplemented by video virtual visits. The idea is to put a face with a name and voice, look into the member’s eyes, and create a trusted relationship that is more likely to result in the member taking the action(s) the case manager recommends. It also offers many opportunities for “teachable moments” that will help change behaviors over the long term.

Yes, this approach can be costly upfront. But when weighed against the long-term value-such as avoiding blindness or amputation of a limb for a person with diabetes, or even reducing the number of ED visits in a year from five to two-the program can quickly pay for itself.

3. Understand the concept of motivational interviewing

When case managers are speaking with members, any questions should be open-ended rather than yes/no. That’s where they can elicit much of the most valuable and helpful information. Wherever possible, case managers should first seek out the member’s knowledge level to establish the bar of where to begin. For example, if they ask members “Do you know what diabetes is?” most likely members will answer yes. But case managers still don’t know based on that response what the member’s level of understanding is.

Instead, they should ask members to tell them what they know about diabetes. This question will provide a much clearer understanding of where they are in comprehending the disease process and show what gaps they have so you as case managers can begin at a level that will be interesting, relevant, and valuable to the members.

Understand how activated and motivated the member is already

If a person with diabetes doesn’t understand, or chooses not to understand, they have an issue that must be addressed, no amount of case management is going to convince them they need to monitor their diet, check their blood sugar regularly, or lose weight.

The first step is getting them to acknowledge the issue. On the other hand, a member who already has a willingness to address these issues will require a different approach. Health plans need to meet their members where they are.

5. Be mindful that some members won’t follow through

Just because a case manager told a member to make a call to their doctor and say X doesn’t mean it will always happen. After offering the instructions, case managers should be trained to say they will call back in a half hour or an hour to see how the call went. The follow-up will be in the context of helping. It’s also designed to create accountability to help make sure the call happens. Case managers should also call the physician’s office and tell them to expect a call from the member, and follow up there if they can’t reach the member again.  

Creating this higher level of member activation offers multiple benefits. It has certainly resulted in 

reduction in ED visits and inpatient stays

, and helped lower the length of stay when an inpatient visit is warranted. It can also help halt or slow disease progress, and in some cases even reverse it, depending on the condition and the comorbidities involved.

 as well. Members feel like they’re being heard and gaining a level of control that wasn’t available to them previously. Providers are happy because better educated members are giving them more specific information that enables them to determine the true source of issues and get members the care they need faster.

Getting there isn’t easy. Yes, it requires an investment of time, money, and personnel. But mostly it requires a changing in thinking, at the individual and organizational level.

Start making the changes now, and you will find it is worth it in the long run. 

Marina Brown is vice president of clinical programs for 

, a population health management and healthcare IT solutions company that touches millions of lives each year. She can be reached at 

How to drive greater member activation and participation in their own care.

Marina Brown

Articles

Opinion: Applying Lessons of Great Coaches to Motivate Members in Healthcare

5 Keys to Improving Member Activation