Opinion: Applying Lessons of Great Coaches to Motivate Members in Healthcare

One of the most important aspects that separate good, knowledgeable sports coaches from the ones who win championships year after year is that the repeat winners understand they need to see and treat their players as individuals. They know what motivates one player to excel, whether it’s getting in their face and coming down hard or providing soft guidance and support, will cause another to fail miserably and they adjust accordingly.

As former New York Giants Head Coach and Super Bowl winner Bill Parcels has said, “Look, coaching is about human interaction and trying to know your players.”

What works in the world of athletics also works in the real world, especially when it comes to motivating members to improve their own health. You can’t settle for blanket solutions or approaching everyone with the same set of tools. To be truly effective, you must understand the individuals with whom you’re working.

That’s why having population health analytics that identify high-risk members, no matter how sophisticated they are, isn’t enough. You need to be able to get below the data to understand what will get members motivated and activated, as well as what will prevent them from following a program, if you hope to succeed at a higher level.

It would be easy if you could follow football legend Lou Holtz’s advice when he was asked how he got to be such a great motivator of players: “Motivation is simple. You eliminate those who are not motivated.”

But health plans don’t have that option. Managed care leaders must meet their members where they are and work with them to change any negative behaviors impacting their health to positive ones. Not just temporarily but in the long term.

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One of the most important ways care managers of health plans can do that is to have regular, meaningful conversations with the members in their care using motivational interviewing and other in-depth techniques. Care managers need to discover what is important to members and how better health might impact it.

For example, a member who has difficulty walking due to diabetes or obesity may want to dance at her daughter’s wedding or throw a football in the backyard with his grandson. The care manager who can develop a strategy based on those personal, concrete goals will be far more likely to have success motivating that member than one who talks in the abstract about being healthy in “the future.” Especially since humans are wired with a “present bias” that normally places our short-term desires (e.g., eating a big, delicious bowl of ice cream) ahead of our future needs (walking, not losing a foot, etc.).

Yet it takes more than simply talking to gain the full picture.
Some people will avoid the truth so they don’t have to make changes. Others will sincerely state things they believe to be true that aren’t.

This is where in-home visits for the highest-risk members can be a game-changer for health plans. A nurse, care manager, or even unlicensed staff member who walks into the member’s home can see exactly how they live to gain a better understanding of who the member is.

Something a professional can do is take note of the surrounding neighborhood to help fill out the social determinants of health (SDoH) picture. Members who live in “food deserts” will find it far more difficult to adhere to a healthier diet no matter how motivated they are. Understanding the inherent barriers to activation will help ensure plans of care are designed to overcome or avoid them.

To date, adoption has been slow due to costs in areas other than in Medicaid programs. But as healthcare in general recognizes the value of understanding the SDoH and other environmental factors that contribute to member health, the pervasiveness of face-to-face, in-home visits is expected to grow.

Once this non-clinical information has been gathered, health plans can work with members and their providers to help develop care pathways members will embrace rather than resist or avoid entirely. For example, the mother who has trouble walking but wants to dance at her daughter’s wedding can be shown how purposeful walking over a very short distance for a few days can lead to progressively longer walks, and ultimately lead to dance lessons or practice sessions at home.

Then, once the behavioral change has been implemented for that specific, member-driven goal, it will be far easier to carry forward as a matter of habit. This, in turn, can lead to slowing, stopping or even reversing disease progress, depending on the condition. When that happens, emergency department visits, inpatient stays, and unplanned readmissions are likely to be reduced, lowering the cost of caring for that member while improving member health and satisfaction overall.

Perhaps most important, the health plan will become an active partner in the member’s health instead of just a deduction on his/her paycheck or a place to send monthly checks. This relationship-based approach will help build member loyalty and gives health plans something to compete on other than price.

Analytics and population health management, by their nature, are about working with huge numbers. However, you can’t forget the human element behind those numbers.

As any successful professional coach can tell you, coaching people on an individual basis and determining what motivates them rather than using a single, cookie-cutter approach, isn’t easy. But it’s well worth the effort, because it enables you to make a real difference. It’s like women’s basketball legend Pat Summit has said, “Coaching is the great passion in my life, and the job to me has always been an opportunity to work with our student athletes and help them discover what they want.”

Approach your members in that way and the dividends will be enormous.  

Marina Brown is vice president of clinical programs for eQHealth Solutions, a population health management and healthcare IT solutions company that touches millions of lives each year. The organization has more than 30 years of experience working with payers, providers and government entities on increasing quality outcomes and optimizing payer and provider networks. She can be reached at mbrown@eqhs.org.