2. Mary
I am a part of all that I have met – Tennyson
Institute for the Future > role of consumers &
technology
LifeMasters > application of activation and
motivational interviewing in disease
management call centers decreased HC
utilization by 11%
StayWell > health coaches have an advantage
in engaging members
3. Improving Member
Engagement
From Case Management Team:
We need to improve engagement with members
Case Managers don’t like “selling” themselves
We want to improve member’s health by ensuring
access to the services available
The value of case management not clear to the
member or to case managers
Current results:
Short interactions
Missed opportunities
No connection made with the member
4. How to improve CM results
Revisit the value of case management from
the case manager’s perspective
Introduce Motivational Interviewing
Meet the member where they are
Learn how to listen, collaborate and connect with
the member
5. Objectives for training
Describe the core skills of motivational interviewing
and the concept of engagement as they apply it to
the case management process
Demonstrate basic motivational interviewing
techniques and an understanding of how to engage
members in assessment, goal setting and achieving
plan of care
Practice specific techniques to increase member
engagement to facilitate assessment, goal setting
and achieving plan of care
Demonstrate skills to utilize effective responses
designed to reduce member resistance, allowing
facilitation of goal setting and continued member
engagement with the plan of care
6. Process for developing and
conducting training
Learn about the context for case management
How are staff trained?
What are they measured on?
What do they think works and why?
Develop customized training
Provide training
Train-the-trainer
Clinical: 3 modules trained in August
2 virtual 2-hour trainings over 2 weeks, 1 onsite 4-hour
training
Non-clinical: 2 modules trained in September
2 virtual 2-hour trainings over 2 weeks
Post-training evaluation
7. Success Metrics
CM staff’s ability to articulate an understanding of the
case management program
CM staff’s comfort with ability to engage members as
measured by pre- and post-training assessments
Effective communication with members as measured
by member surveys
Efficient process for staff that doesn’t increase
perception of workload burden as measured by pre-
and post-training assessments (i.e. revisiting the
process, not just piling more on top)
Long-term measures of success
Fewer “one and done” cases, fewer incidences of “lost
contact”
Greater member satisfaction with case management
services
8. Context of Case
Management
Why do people choose to be case managers?
What helps them connect with their members?
What are the barriers to connecting?
9. Motivational Interviewing
Collaborative, person-centered form of guiding
to elicit and strengthen a person’s motivation
for change – Bill Miller
Goal: give the staff tools to draw the member
out and support the member’s own motivation
for change in the context of an appropriate
care plan
10. Spirit of MI
Collaborative > a partnership, not top down
Evocative > the member has the resources
within herself to make a change
Honors autonomy > Case Manager can’t make
choices for the member
11. Principles of MI
Support self-efficacy
Express empathy
Roll with resistance
Develop discrepancy
12. MI Techniques
OARS
Open-ended questions
Affirmative statements
Reflective statements
Summary statements
Listening for change talk
Desire: Why would you want to make this change?
Ability: How would you do it if you decided?
Reason: What are the three best reasons?
Need: How important is it? and why?
Commitment: What do you think you’ll do?
14. Keys to success
Training is the first step in a journey
Evidence supports ongoing coaching and
management support will make or break the
sustainability of the change
Supporting infrastructure is key
Performance evaluation and measurement must
adjust to continue staff growth in skills
15. MI is a big change
Change is hard
Congratulations on taking this first step
This is a marathon, not a sprint
16. Value
To member: greater self-efficacy, help when
they need it and ultimately better quality of life
To staff: job satisfaction, more efficient process
and time well spent
To Corporation: more appropriate use of
services, improvement in the health of the
member population
Revisit to include make sure non-clinical is covered? Here’s how long I’m going to talk
We are all lifelong learners. What I’ve learned along the way after my Masters in Public Health IFTF Role of the consumer and technology research. Demographic and economic changes create long-term trends that effect healthcare and how consumers engage with it. Consumer demands are changing HC. Internet, mobile, health games, LifeMastersMI and activation and resultsDirect experience w translation of research into practiceAward winningLong road, staff quotes:StayWellWellness approachBackground in health coaching, personal training gave an advantage nurses didn’t have. They are trained to work with the motivation the member has, not push their ideas onto the member.
Value being clear to case managers and to the non-clinical staff translates into clear articulation of the value for the member.
For this project, we’ve devised strategies to improve member engagement. These won’t all get the same weight and time in the training because we don’t have a large amount of time with the staff, currently the clinical staff training is 8 hours. These are all strategies that can be expanded over time. This may just be the first step in your continued efforts to improve engagement .
As a result of this training, participants will be able to:Constraint: Stress basic MI given that normal intro to MI is a 16 hour course and we have half the time
Successful training, with WellPoint’s integration of techniques, will result in the following:
The evaluation process of the context for case management will allow us to step back and look at the big picture of what’s being asked of the CM staff. We want the end result to not be just piling more on top but rationalizing their interaction with the member to make it as efficient and productive as possible. We’ll customize the training to the WellPoint-Anthem context. Case Management is an incredible valuable service to members. We want CM staff to have pride in what they do and feel good about how WellPoint is supporting them to do their jobs well.
That definition is very different from how most CMs are trained as nurses. Nurses are trained to listen but then to educate and direct. MI is going to be a big change for CM staff. Care plans might change. If they’re going to be successful and from the member’s perspective, then they can’t be put upon the member by the CM. If care plans are more successful, then CM staff will be more effective and successful and feel better too, assuming that the collaboration with the member ends in an appropriate. Beware of the pendulum swinging too far in the other direction and staff losing the ability to guide the member/come along side.
Example of exercise
Example of exercise Support self-efficacy: pt has the resources they need to succeed, draw it outExpress empathy: see the world through their eyes, how would you respond?Roll with resistance: a helper wants to direct, and tell the pt why they should do x, y, z. when CM takes up the argument for change, the only side available to the pt is the argument against changeDevelop discrepancy: btwn how you want your life to be vs. how it currently is, btwn values and day-to-day behavior Most people come in to a treatment situation ambivalent about making a change. Meet a helper who is fixer. Stop go back, you should do this insteadFixer makes arguments for change. Client says no, it’s not that bad. When you take resp for good arguments, but you leave the bad arguments for the client. Client talking self out of changing.
Example of exercise
Image of overlapping studies of MI
This isn’t full MI. this is just putting your toe in the water.
I looked for a before and after picture to illustrate the size of the change. It’s reminiscent to me of learning a new language. When you start, it’s about key concepts and some vocabulary. Being immersed in it and continuing to practice it is the best way to really take it in and incorporate it into who you are and how you interact with the world. you are there when you don’t have to think about it, when it just comes to you. When you dream it.
So what does this all result in? Member > positive self-efficacy, lower depression, more likely to get help, more likely to experience better health
