How to drive greater member activation and participation in their own care.
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:
1. Teach members to do for themselves
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 5% who account for 50% of the cost 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.
Related: Value-Based Care: Lessons Learned
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.
4. 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 better health outcomes, including a documented 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.
It can result in higher member and provider satisfaction 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 eQHealth Solutions, a population health management and healthcare IT solutions company that touches millions of lives each year. She can be reached at firstname.lastname@example.org.