10 Motivational Interviewing Strategies for Deeper Patient Engagement in Care Management

10 Motivational Interviewing
Strategies for Deeper Patient
Engagement in Care Management

© 2016 Health Catalyst
Proprietary. Feel free to share but we would appreciate a Health Catalyst citation.
Patient Engagement in Care Management
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.

Patient Engagement in Care Management
This presentation 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.

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.

Effective Care Management
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
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 Empowers Patients
Care managers can use motivational
interviewing to empower patients in their own
care, rather than projecting outside goals to an
individual’s situation.
The motivational interviewing method of
engaging patients was developed by clinical
psychologist William Miller in 1983 to address
substance abuse.
Over the years, however, research has shown
that the technique is effective at reducing many
potentially risky behaviors and promoting
healthy behaviors.

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.
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
CHANGEI want to take my medication
as prescribed.
THE ABILITY TO
CHANGEI 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.

Patients sometime get stuck in what motivational
interviewing calls sustain talk; they express that
they cannot commit to positive change:
I quit smoking two years ago, but I started
again and can’t quit this time.”
The care manager can reframe that statement:
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:
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 risk missing
a critical element: the patient perspective on and
motivation around improving their overall health.
By understanding a patient’s 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.
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.
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.
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.
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.
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.
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.
Taking your medication every night before
bed is a hassle. How about taking it in the
morning instead?”

Technology Enhances 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.
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 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.

Patient Engagement is the Heart of
Care Management
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.

For more information:
“This book is a fantastic piece of work”
– Robert Lindeman MD, FAAP, Chief Physician Quality Officer

More about this topic
Link to original article for a more in-depth discussion.
10 Motivational Interviewing Strategies for Deeper Patient Engagement in Care Management
How Care Management Improves Performance for Clinicians, Compliance with MACRA,
and Outcomes for Patients Like Olivia Dr. John Haughom, Senior Advisor, Health Catalyst
Introducing the Breakthrough Health Catalyst Care Management Product Suite
Paul Horstmeier, Senior VP
Patient-Centric Care Management Is a Strong Strategy
Dr. Bill Knowles, Senior Director of Client Engagement
Care Management: A Critical Component of Effective Population Health Management
Health Catalyst – Success Story
Capturing the Voice of the Patient: Using PROMs Improves Shared Decision Making
Health Catalyst – Success Story

Other Clinical Quality Improvement Resources
Click to read additional information at www.healthcatalyst.com
KimSu joined Health Catalyst in September 2015 as Care Manager Lead. Prior to coming to
Health Catalyst, she worked for Tufts Health Plan as Care Management Relationship Manager.
KimSu has a degree in Education from Lesley University, a degree in Nursing from Regis
College, and is currently working on a Psychiatric Nurse Practitioner MSN at Regis College.
KimSu Marder

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