Blog 13

Enlist the Right Partner to Change Health Behaviors

Can you help your high-risk, high-cost employees change their health behaviors,  improve their health status and lower costs in your health benefit plan? 

As leader of your employee health benefit plan, you need to reduce costs.  You also want to improve the health of your employees, which you know will reduce absenteeism, increase productivity and improve their quality of life. 

Getting the results you want will require your team to be more engaged in the care they receive (as we covered in Blog 12, Engaging Health Plan Participants is Key to Better Health and Lower Costs (and it’s our focus!)).  Greater engagement will empower your employees to change their behaviors and develop healthy habits.  But that is hard for anyone to do, even if it means saving their own lives. 

In our experience, there is a way to help your health plan participants change their behaviors, develop enduring healthy habits and live their best, most productive lives.  It takes time and intense effort, and it requires building trusting relationships.  It is hard work, but the benefits are significant.   

Getting your employees to be more engaged in their care and make healthy behavior change starts with recognizing and addressing the obstacles that exist.  It means rejecting the status quo—which is not easy to do.  Especially considering the challenges that stymie an individual’s efforts to change.  Some examples:

      • Pre-existing unhealthy habits developed over time, which are now so ingrained in our lives that we do them without thinking about them.
      • Chronic health conditions, or unknown, undefined or misunderstood health problems that sap us of the energy and motivation or ability to change.
      • Social isolation or conflict, lack of support from family or friends.
      • Cognitive biases.
      • Lack of time, attentiveness and resources (including money) we think we would need to start taking steps toward a better, healthier life.
      • A sense of helplessness or hopelessness often accompanied by loneliness.

The work of behavior change is hard and typically takes a long time to produce results.  It is a pursuit that demands disciplined effort.  The challenges cited above, and many others, can make plan participants feel overwhelmed.  For affected individuals, just staying on their current course is difficult enough, let alone taking new steps to make a change that sticks. 

The obstacles to greater engagement and healthy behavior change can be so deep and complex that individuals are unlikely to adopt healthier habits on their own.  And existing employee relationships with their primary care providers, clinics or health systems likely won’t produce the needed results, either.  That is particularly true for plan participants who face more obstacles and have more complex health conditions.  The 30 minutes a month—or less—that most providers are able to give to their patients with complex health problems is usually not enough time to effectively tackle all that needs to be addressed. 

Primary care providers do their best to work collaboratively with their patients to identify healthier practices and set goals for health improvement.  And some healthcare systems work more broadly to improve the social determinants of health that affect their patient populations, such as by supporting affordable housing and food initiatives in their communities.  But they can’t take the time necessary to really get to know their patients well.  Constraints on clinician-patient interaction and relationships (e.g., limits on time, energy, attention, scope of responsibility, reimbursement) typically won’t allow the providers to do what is needed, over a long time, to effect the desired change. 

Employers have tried to influence employees’ health behaviors through education (wellness classes, access to educational resources), incentives (health club discounts, reduced insurance costs, paid time off), technology (apps, fitness trackers) and social networks.  They have even invested in facilities and hired providers to serve members on or near their campuses.  These approaches can work for some, but not for all.  Some individuals, including those with the most complex challenges, require more sophisticated and intensive effort.

What can be done?

To be most effective in realizing healthy behavior change in health plan participants, we have found that more is needed. 

Essentially, to foster greater engagement from health plan participants (in their care, in making healthy behavior change), it pays to be more engaged with them. 

Enter the nurse coach, a specially skilled nurse who fills multiple roles–nurse, coach, advisor, advocate, social worker, partner and case manager–but whose sole purpose is to help the higher-risk participants achieve their health goals.

These are clinically skilled professionals equipped to help the participant embrace needed changes, disavow the status quo and make strides toward a healthier life. 

These nurses are good listeners, able to discern where the participant is in their willingness to change and determine the problems to be overcome.  They are go-getters and problem solvers with the agility to move with the participant through their sometimes chaotic worlds—and still have the ability to see opportunities that pop up, and then seize them. 

They are persistent and have the endurance to go the distance the participant needs to go to see positive results and develop lasting healthy behaviors and see positive results.  And, perhaps most important, they are empathetic and highly effective in building trusting relationships.  Empathy and trust are essential for motivating the participant to better engage in making good healthcare decisions for themselves and improve their health. 

Developing Trusting Relationships

As Miller and Rollnick presented in their widely used manual on motivational interviewing, three critical counselor skills for facilitating behavior change are accurate empathy, nonpossessive warmth and genuineness.  The “empathy” they cite involves “reflective listening that clarifies and amplifies the person’s own experiencing and meaning, without imposing the counselor’s own material.”  The presence or absence of this skill, the authors say, can be a significant determinant of the counselor’s (i.e., the nurse’s) ability to help the participant make the desired behavior change.

At the same time, though, as we have learned in our work, the empathy of the nurse coach must co-exist alongside the obligation to be truthful and transparent.  If the participant wrongly thinks he is in good health and is doing what he needs to do to be healthy, the nurse coach must be able to tell them otherwise, which can feel harsh.  The key is to do it in a supportive way that continues to cultivate the trusting relationship the participant needs to be successful. 

That trusting relationship empowers the nurse to work with the participant through a broad array of challenges and factors that can either foster or hinder the participant’s change effort. 

The Work in Action:

Early on in the engagement, the nurse coach assesses the participant’s status and probes their thinking.  To be effective—and avoid being rejected right off the bat—nurse coaches look for something they and the participant can agree is doable. 

Sometimes the direction they take doesn’t directly relate to medicine; it might be mending a relationship or improving time management, for example.

Over time, as barriers to change get removed and little successes become bigger successes, the nurses and participant can tackle a broader scope of issues, such as the participant’s family and social environments.  Roughly 80% of the participant’s ecosystem and social environment have enough influence to affect the outcome of their efforts at healthy behavior change. 

This is a very person-focused vs. disease-focused approach to healthcare management. It is best that the nurses not be bound by any sort of cookbook or predetermined steps in their approach.  Instead, they’ll be more effective where they are able to observe the full scope of the participant’s life and pursue any issues found that may impose constraints on the participant’s ability to live a healthy life.  In this way, it is highly responsive and customized, which is why the key to the program is its structure featuring the multi-faceted nurse coach. 

As employed by Veritas Healthcare Management, this program has been able to achieve positive results at both the individual and health plan levels.  As seen in the cases of participants Marie and John, this intensive program can significantly improve the health, productivity and quality of life for every individual from your plan that participates. 

Further, as plan participants with significant health challenges become healthier, happier employees, their use of health care resources declines, lowering overall plan costs. 

Ultimately then, health plan leaders, the answer to the question above is Yes!  You can help your high-risk, high-cost employees realize healthy behavior change, improve their health status and lower plan benefit costs. It takes hard work and time—and the right partner.  The benefits of the effort, though, are more than worth it.

For more information on helping plan participants make healthy behavior changes, or for general information on our approach to improving employee health while reducing health benefit costs, please contact us at contact Veritas at 

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