• Achieving Meaningful Healthcare Consumer Engagement

    Dawn Milstead Jan 18, 2016

    Healthcare organizations can improve patient engagement by deploying robust analytics solutions in tandem with a sympathetic personal touch.

    Mrs. Ellen Hughes is 67 and a bit overweight. This fictional patient is an asthmatic who regularly sees her primary care physician but still ends up in her hospital’s emergency department (ED) several times a year. To her physician and her hospital, she is a patient; to her health plan, she is a member; to her employer, she is an employee. These entities all want to intervene to improve her health and the associated costs of caring for her, but with different approaches and areas of focus.

    Mrs. Hughes is likely being bombarded with information and outreach. I can imagine her phone ringing multiple times a week with well-intended but uncoordinated calls from her health plan, her physician, her hospital, and even her employer. Each has little to no insight into what the others are doing, creating redundancy and unnecessary costs in the system and leaving Mrs. Hughes confused, perhaps even frustrated enough to alienate her from the very healthcare system that is working so hard to help her.

    I know we can do better for Mrs. Hughes and the many others like her, and it starts with everyone viewing her as a consumer and coordinating the care and outreach she needs to achieve improved health outcomes. As a clinician, I have observed what countless studies have confirmed: When consumers like Mrs. Hughes are informed, empowered, and engaged in their health, outcomes improve. Health costs also should be affected, which helps all stakeholders in the healthcare delivery system achieve the Triple Aim on behalf of Mrs. Hughes and all consumers.

    Part Technological, Part Personal

    Mrs. Hughes is much more likely to become engaged in her health if clinical interventions are organized and her preferences are used to inform the delivery of those interventions. That’s what today’s advanced analytics and insights platforms help the healthcare delivery system do.

    The most robust analytics solutions aggregate data from multiple sources—claims, clinical, electronic health record, benefits, demographic, even patient-generated data from Fitbits and other wearables—to create a consistent, 360-degree view of the consumer. Equipped with this integrated, more holistic view of Mrs. Hughes, the engagement efforts of the health plan, physician, hospital, and employer can be connected and coordinated.

    But having begun my career as a case manager and led thousands of case managers during my career, I know that the people—and the best practices that have been developed after years of working directly with patients—are just as important as the technology and software.

    The people who engage consumers in their health on behalf of health plans, physicians, hospitals, and employers typically have titles such as case manager, disease manager, care coordinator, and health coach. Each is charged with the same job: engagement and ultimately activating consumers to become involved in improving their own health.

    Honing the Right Skills

    It all begins with creating a unique and individualized relationship with Mrs. Hughes and every other healthcare consumer. As in all relationships, building rapport and trust are critical first steps. Transparency and language matter too. As one of my case managers said best, “Consumers can tell through the phone if I’m smiling when I call them. I also need to let them know who I am, who my employer is, and why I’m calling.” Demonstrating compassion and engaging with patients consistently also are important aspect. When I walk through the section of my office where the case and disease managers work, I often hear the words, “It’s me again.”

    These workers use the following skills daily.

    Listening. The most effective engagement staff begin their conversations with questions like, “How are you doing?” and “How can I help?” They then stop talking and wait for a response, often enduring silence before the truth comes forward. Sometimes it’s important to identify common ground and reveal that they too are human and have struggles—for example, “I have a weakness for sweet potato fries and binge marathons of Real Housewives”—and it always helps to treat the person as a whole being who is much more than a disease or health condition.

    Timing. A recent diagnosis or hospitalization can be a catalyst that erodes common resistance to change. In the case of Mrs. Hughes, a disease manager or health coach is more likely to find her ready for change in the days following an unplanned trip to the ED.

    Motivational interviewing. If I could choose one skill to impart to all those working to engage consumers in their health, unequivocally it would be motivational interviewing. Motivational interviewing is a “directive, client-centered counseling style for eliciting behavior change by helping clients explore and resolve ambivalence.”a It focuses on uncovering a patient’s intrinsic motivations and aspirations, such as being able to walk his daughter down the aisle, play hide-and-seek with his grandson, or avoid another trip to the ED—to push for small steps that ultimately lead to a desirable behavior change.

    Motivational interviewing techniques involve asking patients open-ended questions, providing affirmations of any indication of change, reflecting on patient statements, and summarizing what the patient has said. It may sound simple in theory, but it takes practice with patients to master. Examples of questions to patients may include: “What kind of change makes sense to you?” “Changing your diet would make sense medically, but how does that feel for you?”

    In the words of Dr. Allan Zuckoff, author of the book, Finding Your Way to Change: How the Power of Motivational Interviewing Can Reveal What You Want and Help You Get There,“The big shift in the practice of MI for most practitioners is that you go from telling patients why they should change or how they could change to drawing out from the patient their own ideas about why change would be beneficial to them and about how they might be able to do it.”b

    When case managers, health coaches, and even physicians master motivational interviewing techniques, the results are demonstrable. Patients of providers using motivational interviewing are more likely to use “change talk” in conversations and experience a statistically significant amount of positive outcomes across many measures that are important to achieving benchmarks.c They also are more satisfied patients—the case management program that I oversee has a 96 percent satisfaction rate.

    Using an Artful Approach

    I suspect that many of you wish there were a scientific approach to successful consumer engagement, a precise formula that works every time. If only. Instead, I have found that effective consumer engagement very much is an art—one that depends on a comprehensive view of the consumer created by today’s analytics and insights platforms coupled with people skills and relationship management techniques.

    Effectively engaging Mrs. Hughes and healthcare consumers like her is the heart and the art of meaningful population health management.

    Dawn Milstead, BSN, MBA, is vice president of clinical solutions, Geneia, and is a Six Sigma Black Belt.


    a. Rollnick S., and Miller, W.R., “What is Motivational Interviewing?” Behavioural and Cognitive Psychotherapy, October 1995.

    b. Goldberg, C., “What If Your Doctor Really Listened Instead of Just Telling You What to Do?” WBUR, July 3, 2015.

    c. Keeley, R.D., Burke, B.L., Brody, D., et al., (2014). “Training to Use Motivational Interviewing Techniques for Depression: A Cluster Randomized Trial,” Journal of the American Board of Family Medicine, September-October 2014; and Lundahl, B., Moleni, T., Burke, B.L., et al., “Motivational Interviewing in Medical Care Settings: a Systematic Review and Meta-Analysis of Randomized Controlled Trials, Patient Education and Counseling, November 2013.

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