Program helps members take control of their health
Program helps members take control of their health
Goal setting, personal responsibility are keys
Involving members in goal setting and getting them to take personal responsibility for their own health are keys to the success of Harvard Pilgrim Health Care’s Health Advance Care Management system, according to Liz Estabrook, RN, manager of care management for the Wellesley, MA-based health plan.
"From the beginning, we try to get the members engaged in the process. We try to get them to take some ownership by looking for the information they need," Estabrook says.
The care managers work with the members to set goals. They may be clinical, such as lowering their hemoglobin A1c level, or personal, such as being able to play golf or spending time with their grandchildren.
"We don’t say Do A, B, C, and D.’ We know that if we go in there with a prescriptive approach, it is likely to turn the person off. Instead, we make suggestions and ask the member if they feel comfortable trying something. We try to make sure the member is ready," Estabrook says.
Members are more likely to meet goals when they help develop them, she adds.
Many of the members don’t understand what their laboratory tests are or why the results matter. They just know their doctor says the results are too high or too low. That’s one reason that setting goals involving lab values don’t always work.
"From the nursing perspective, our goal is to get the hemoglobin A1c down, but the member’s goal may be something else. You have to have buy-in to get someone to change, and that’s why it’s critical to build that relationship to find out what motivates the member and what their goal really is," Estabrook says.
As members progress toward meeting their personal goals, the lab results will improve, she adds.
"It’s human nature that when someone tells you to do something you resist, and what we think the member should do isn’t always the best fit. We work with the members about what things they’d like to do to get their chronic conditions under control," Estabrook notes.
For instance, one member with chronic obstructive pulmonary disease wanted to be able to go out to lunch with friends but was too debilitated to make the effort.
The care manager worked with him on an exercise program and taught him about the disease process and how to conserve his energy.
Many of the members in the program are employed but have conditions such as diabetes that are not quite in control.
"We try to work with them to give them an incentive. For instance, if they can control their diabetes better, they might have more flexibility in their diet. We show them how one thing impacts another thing," Estabrook says.
The care managers get the members involved in taking care of some of the details necessary to meet the goals.
For instance, if a member says he is ready to try to lose weight, the care manager tells him where he can find a suitable diet and says she’ll call back in a week or so and review the diet with the member. She may suggest a consultation with a dietitian or suggest that the member talk to his primary care physician about a diet. If the care manager calls back and the member hasn’t found a diet to try, the care manager talks with him about the reasons he hasn’t done it.
"We might have to rethink the plan and come up with an alternative goal. It might really not be convenient for the patient to find a diet, and we’ll send it to them. Or they might have said they were ready to lose weight but they aren’t quite ready," she says.
The Health Advance care managers gradually move the members in the direction of change, coaching them toward their goal.
The care managers give members the responsibility for following up with their physician and helping gather information for the care management database.
For instance, instead of calling the physician for a report on a member’s visit herself, the care manager has the member collect the laboratory information and other results.
"We assist members in managing their own health as opposed to managing it for them. When people are responsible for handling it themselves, they are more likely to follow through," she says.
The Health Advance care managers build a relationship with the members and don’t push them to make changes until they are ready.
"We are building a trust and a comfort level. As they are more comfortable with the discussion and feel more confident about changing their lifestyles, they start to work on their goals," she says.
The Health Advance care managers do little extra things for the members as well, such as helping them with their benefit question so they don’t have to call another number.
"We do a little piece and they do a little piece," Estabrook says.
Involving members in goal setting and getting them to take personal responsibility for their own health are keys to the success of Harvard Pilgrim Health Cares Health Advance Care Management system, according to Liz Estabrook, RN, manager of care management for the Wellesley, MA-based health plan.Subscribe Now for Access
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