10 Motivational Interviewing Strategies for Deeper Patient Engagement in Care Management

March 8, 2018

Article Summary

Care management programs are most successful when patients are deeply engaged in their own care. Using the motivational interviewing technique, care managers work with patients to identify personal care goals and motivators to follow the care management program.

Ten strategies guide the motivational interviewing process, each focusing on patient-centered insights (e.g., pros and cons to following care management and barriers to adherence). With mobile technology to support these interactions, motivational interviewing can become a seamless, and vital, part of the care management workflow.

Bird's eye view of professionals in the medical field sitting around a table in a meeting

How do care managers get patients to enroll in care management and keep them actively involved in their own care? With patient engagement. Patients who are engaged in their care become partners with their care team, setting goals and finding solutions that best meet their individual needs and circumstances. To effectively engage patients, care managers need the right interviewing techniques and the right technology to support and sustain patient engagement.

This article explains how motivational interviewing can help care managers more effectively engage patients and partner with them to better understand patient care needs, goals, and concerns. In care management, motivational interviewing is a collaborative approach, between the care manager and the patient, that’s focused on strengthening the patient’s motivation to adhere to the care plan and change behaviors that interfere with better health. With supportive technology, care managers can further optimize motivational interviewing and achieve the best possible care management outcomes.

Patient Engagement Enables Effective Care Management

In 2010 the Affordable Care Act (ACA) created the nonprofit Patient-Centered Outcomes Research Institute (PCORI) to fund evidence-based research on patient outcomes and outcomes that are important to the patient. PCORI researchers have found that patient engagement improves adherence to care plans, which improves outcomes and drives down cost.

In healthcare today, patients are the center of the care team, making patient engagement pivotal in care management. Historically, clinicians took a more directive approach to care, giving patients a limited role in the decision-making process. But as healthcare continues its shift to a patient-centered approach, care managers are increasingly seeking effective ways to engage patients.

Patients Make a Commitment to Better Health on Their Own Terms

The importance of patient engagement in care management starts before a patient even enters a care management program. Some patients may be hesitant to enroll in a care management program; they may feel they can manage their own care or are worried about the cost of care management and how it impacts health insurance.

The first task for care managers is to engage patients in a way that encourages them to participate in care management and communicates that care managers are partners in care, not instructors or directors. Patients will be more likely to be make better healthcare choices and identify realistic, achievable goals they can sustain—and feel empowered doing so.

To fully leverage the benefits of patient engagement, care managers need an interviewing technique, such as motivational interviewing, that helps clinicians and patients set healthcare goals that reflect the patient’s desires and circumstances. Together, care managers and patients will set weekly goals, as determined by the patient, and decide on the best ways to communicate with the patient to keep them involved. For example (depending on factors including age and personal preference), some patients will prefer to communicate via text or in an app, whereas others will respond better to a phone call or visit.

Motivational Interviewing in Healthcare Empowers Patients

Care managers can use motivational interviewing to empower patients in their own care, rather than projecting outside goals onto an individual’s situation. The motivational interviewing method of engaging patients was developed by clinical psychologist William Miller in 1983 to address substance abuse disorders. Over the years, however, research has shown that the technique is effective at reducing many potentially risky behaviors (e.g., gambling and excessive drinking) and promoting healthy behaviors (e.g., improving diet, exercising more, and adhering to a medication regimen).

The heart of motivational interviewing is the ability to sustain empathy with patients during conversations, rather than being directive. With motivational interviewing care managers can also identify the type of talk that well best serve patients and encourage them to follow their care plans.

The heart of motivational interviewing is the ability to sustain empathy with patients during conversations, rather than being directive. With motivational interviewing, care managers can also identify the type of talk that well best serve the patient and encourage them to follow their care plan.

What’s known as change talk includes three levels:

  • The desire to change (“I want to take my medication as prescribed”).
  • The ability to change (“I can ask a family member to go to the pharmacy for me”).
  • The need to change (“If I don’t take my medication, I may be readmitted to the hospital”).

Patients sometime get stuck in what motivational interviewing calls sustain talk; they express that they cannot commit to positive change (e.g., “I quit smoking two years ago, but I started again and can’t quit this time”). The care manager can reframe that statement and say, “What did you do before that helped you quit?”

An important part of motivational interviewing is to guide the patient towards change talk and a commitment to achieve a positive goal (commitment talk). Expressed at the end of a motivational interviewing session, commitment talk seals the patient’s commitment to a care management goal (e.g., “I am going to take my medication every day, as prescribed”).

10 Motivational Interviewing Strategies

Care managers who are accustomed to teaching patients about their care needs and plan (a directive approach) risk missing a critical element: the patient perspective on and motivation around improving their overall health. By understanding a patient’s concerns (e.g., stress related to a new diagnosis, medication, care schedules, or financial concerns), care managers can better identify barriers to care and work with the patient to find the best solution. 

Care managers can use 10 strategies for motivational interviewing to build trust with  patients, engage them in their own care, and help them find motivation to adhere to their care plans:

  • Strategy #1: Ask a question that will prompt change talk as an answer. For example, “What are some things you can do to make sure you take you medication regularly?”
  • Strategy #2: Ask for the pros and cons of both changing and staying the same. For example, “How will taking for medication lower your risk of hospital readmission? How will another hospital readmission (i.e., continuing to miss medication doses) impact you?”
  • Strategy #3: Ask about the positives and negatives of the target behavior. For example, “How will taking your medication improve your condition? What are the negative impacts of taking your medication (e.g., cost, side effects)?”
  • Strategy #4: When the patient expresses change talk theme emerges, ask for more details. For example, “In what ways? Tell me more? When was the last time that happened?”
  • Strategy #5: Ask about a time before the patient enrolled in care management. For example, “How were things different before your care management program?”
  • Strategy #6: Ask what may happen if the patient makes the changes according to their care management plan. For example, “If you follow all your care management recommendations, what will be different? How do you see your health five years from now?”
  • Strategy #7: Ask about extreme outcomes. For example, “What are the worst things that might happen if you don’t follow your care management plan? What are the best things that might happen if you follow the plan?”
  • Strategy #8: Offer ways to clearly measure the impact of care management. For example, “On a scale from one to 10 (where one is not at all important and a 10 is extremely important), how important is it to improve your health? What do you think you can do to get closer to a 10?”
  • Strategy #9: Ask about the patient’s main health goals. For example, “Do you want to be healthy enough to travel to this summer? What upcoming family events do you want to attend?”
  • Strategy #10: Think like the patient and reframe any barriers into a positive strategy. For example, “Taking your medication every night before bed is a hassle. How about taking it in the morning instead?”

Technology to Make the Most of Motivational Interviewing

With the ten motivational interviewing strategies in place, care managers are prepared to help patients find their own motivation to follow their care management plans. To further strengthen motivational interviewing, care managers can use technologies specifically developed to support care management. The Health Catalyst Care Management Suite, for example, hosts applications that can support the motivational interviewing process and help care managers optimize patient engagement.

Because Health Catalyst’s care management tools are customizable, health systems can build conversation guides that lead the care manager through motivational interviewing. The care manager can continue to tailor the tool for each patient by adapting questions based on patient feedback and reframing the language to recognize the patient’s goals and commitment to those goals.

In addition, other care management tools can survey patients to capture patient-reported outcome measures and assess patient perception of their functional well-being and health. These surveys can encourage patients to think about new questions and look at their health in a different way. Throughout the motivational interview process, the care manager can use a patient channel on the care coordination application to monitor patient progression and provide positive feedback and education.

Patients also remain engaged in the motivational interviewing process with care management applications and can communicate with their care teams in real-time. For example, by using the Health Catalyst Care Companion, a mobile app available on a smart phone, patients can securely message their care team and access their health-related content. With the assistance of these tools and applications, the care manager can optimize the motivational interviewing process and partner with the patient to achieve positive behavioral change.

Patient Engagement Is the Heart of Care Management

As healthcare increasingly moves toward patient-centered care, and new technologies support more patient involvement, patient engagement will continue to be a critical component of healthcare delivery. This is particularly true in care management, where long-term partnerships between care managers and patients will drive better outcomes at reduced costs.

By following a 10-step strategy for motivational interviewing and leveraging technologies that facilitate and sustain patient engagement, care managers can help patients become true partners in their own care, empowering them to make changes to achieve better health.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

  1. Care Management: A Critical Component of Effective Population Health Management
  2. Capturing the Voice of the Patient: Using PROMs Improves Shared Decision Making

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