HARTFORD, Conn.--(EON: Enhanced Online News)--Engaging people in disease management and healthy living programs is historically challenging for health plans. And historically, disease management programs have followed more of the push rather than the pull model of coaching. Taking a different approach to health coaching, Aetna (NYSE: AET) has integrated motivational interviewing (MI) into its Care Management Disease Management programs and is seeing significant improvements in member engagement, health outcomes and member satisfaction.
“We continue to embrace, refine and evolve the various pathways where MI can be used to guide behavior changes”
MI focuses on mutual, person-centered guidance and has been well-proven in clinical studies to decrease resistance and enhance motivation to change. Building from this evidence, Aetna worked with MI pioneer Kenneth Resnicow, Ph.D., professor, Health Behavior & Health Education, University of Michigan School of Public Health, to apply MI to Aetna’s health coaching and better empower members in their care.
“We are creating a highly personalized member experience with real conversations, not scripted interactions. Members take greater responsibility for their actions and health, and we are seeing improved results in treatment adherence, condition maintenance and overall health,” says Michael Golinkoff, Ph.D., head of Aetna’s Behavioral Health Clinical and Service Delivery.
The program began on a limited basis in 2009 and was fully implemented in 2010. Since, more members are saying "yes" to participating in Aetna’s Disease Management programs. Engagement has increased 43% -- from 53.1% before the program to 76% at the end of the September 2011. Equally important, members are remaining in the programs. Dropouts decreased 55% during 3rd quarter of 2011 compared to pre-MI days.
The increased participation helps members become their healthiest. The increased participation also adds up to real benefits for plan sponsors who have healthier employees, resulting in decreased sick days and disability claims and overall cost savings.
Helping members find their own strength
Practicing the principles of MI, Aetna’s disease management nurses have an enhanced ability to create a safe place for the members to focus on their health. Nurses elicit, rather than impose, motivation to change. They help members explore and reinforce their own arguments for change, and then guide fully informed and autonomous choices.
The approach was critical to a member who was newly diagnosed with high blood pressure and who was discouraged to be on his first chronic prescription medication. The member, a martial arts enthusiast, explained that he put his faith in Qi Gong and Chinese medicine for health. He was very concerned that the medicine’s side effects including lightheadedness would get worse and interfere with his training. Believing the medication was “undermining his yang energy,” he stopped taking it.
Using MI, his nurse case manager helped him explore his health belief system for energetic practices and exercises to “cultivate yang energy.” She helped the member identify obstacles and shape his goals based on his intrinsic motives for wanting better health. She also explained how his blood pressure medication worked by dilating blood vessels and how that related to his symptoms. This removed the “energetic mystery.” His nurse resisted advising the member. Instead, the member decided to use his Qi Gong to manage the side effects, stay on medication 60 days, and then talk to his doctor about any side effects that persisted.
Embedded MI throughout Aetna’s clinical culture
More than 50 Aetna “MI champions,” have been trained, in consultation with Resnicow, to deliver and support MI practices within Aetna. Today, more than 1,800 Aetna clinicians and clinical support staff in Aetna sites around the globe are using MI to help members reach better health. “We continue to embrace, refine and evolve the various pathways where MI can be used to guide behavior changes,” Golinkoff says.
Aetna is one of the nation's leading diversified health care benefits companies, serving approximately 36.4 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.