Managed Care - August 2012 - (Page 43)
P L A N W AT C H
Motivation Program Makes Talk Potent
Blue Cross Blue Shield of Michigan teaches effective interviewing techniques to nurses on the front lines of chronic disease
By Frank Diamond
hat the managed care industry relies more and more on nurse leaders (as we noted here: http://preview.tinyurl.com/ nurse-execs) does not for a moment detract from recognition of the crucial role that nurses play in the trenches. Like most health plans, Blue Cross Blue Shield of Michigan realized long ago that sustained interaction between providers and patients with chronic conditions might lead to better outcomes and lower costs. Last year, the insurer launched a program in which nurses were taught motivational interviewing techniques, and it seems to be paying off. A recent review of nurse calls shows that the program resulted in a 46 percent increase in the use of motivational interviewing skills by the nurses. “Did our engagement rates go up as well?” asks Michelle Silvaggi, RN, director of chronic condition management and wellness programs. She hopes that future studies will provide the answer.
rapport with one patient, and the contact can range from one to six months. “It really opens up the dialogue and gives members the chance to express how they’re feeling,” says Silvaggi. “They feel they’re being heard.” The nurses validate patients’ lifestyle goals.
The wall The program started because nurses too often ran into a wall when trying to encourage changes in lifestyles. “Nurses told their supervisors that it was challenging to get patients to buy into making changes,” says Silvaggi. “Their feedback set us on a course to look at additional tools or training for nurses to help them motivate patients to make changes. It’s not enough for a nurse to tell patients what they should do. The nurse has to help the patients set their own goals.” Motivational interviewing is being applied to all plan members age 18 and up who suffer from asthma, diabetes, COPD, congestive heart failure, or cardiac vascular disease. The plan has more than 4 million members, but Silvaggi does not know how many have undergone motivational interviewing. The program involves one nurse developing
People make changes “That’s probably the biggest piece for our plan members,” she continues. “They have this chronic disease or traumatic event going on, and to have that rapport with somebody who validates your feelings — really, anybody will feel, Thank you for being there to talk with me. You’ll see people make changes and take control of their own health.” The program started with a weekend educational session for BCBSM nurses that was conducted by Bruce A. Berger, PhD, RPh, an expert on motivational coaching. However, plan officials soon realized that the nurses needed ongoing education and monitoring. “There was no carryover,” says Silvaggi, “no continuing education for the motivational interviewing.” So the plan hired HealthSciences Institute, which offers a certificate program in health coaching. “They came in and said, We can give a really in-depth workshop on motivational interviewing, but we won’t leave it there,” says Silvaggi. “We’ll continue to work with your team, help you create champions within your team to serve as mentors to other team members. We’ll set up a monitoring system to categorize the calls and track results.” Seeing improvement “And,” she continues, “we’ll make sure we’re seeing improvement in the motivational skills that are being taught and in nurses’ ability to effectively conduct motivational interviews with patients.”
AUGUST 2012 / MANAGED CARE
Table of Contents for the Digital Edition of Managed Care - August 2012
Managed Care - August 2012
Legislation & Regulation
News & Commentary
Private Exchanges: Practice Makes Perfect
Hospitals and Providers Ganging Up on Plans?
Q&A: Kaiser Permanente’s Sharon Levine, MD
God Save the Health Care System!
Future Points to Greater PBM/Plan Cooperation
Managed Care - August 2012