Chronic Care Management: How to Change Health Behaviors and Lower the Onset of Diabetes
An estimated 85% of avoidable healthcare spendingcan be attributed to behavioral factors such as lifestyle issues, non-adherence to clinical treatments, and ineffective self-management of chronic disease. In fact, non-adherence with medication regimens alone costs the industry $290 billion per year and unhealthy lifestyle choices (e.g. overeating, poor diet, lack of physical activity, and tobacco use) are primary risk factors for most of the chronic diseases impacting our national wellbeing. Yet, according to the Institute of Medicine and the World Health Organization, today’s healthcare workforce is not well prepared to address these modern threats to public health.
Understanding the root cause of the chronic disease epidemic
In an article published in Health International, titled “Changing patient behavior: The next frontier in healthcare value,” it was noted that “changing individual behavior is increasingly at the heart of healthcare.” Diabetes, one of our most devastating diseases, is the poster child for prevention through healthy behavior change. Despite advances in medical science and technology, diabetes remains theseventh leading cause of death in the US. Unfortunately, more clinical knowledge is not translating to better outcomes because patient behavior is not being addressed properly. Sustained lifestyle changes aimed at weight management, for example, can help patients reduce their risk for developing diabetes.
Chronic care management: how to drive real behavior change
To eradicate or reduce the diabetes epidemic, providers and payers must align care delivery with opportunities to change behaviors and prevent the onset of the condition. The following are four ways to address behavior change with your populations:
1. Identify the barriers to behavior change
Why are people non adherent and disinterested in lifestyle changes? Bruce Berger, a well- known proponent of motivational interviewing for behavior change suggests that we need to dig deeper to understand what the patient is thinking. In response to providers telling patients to take their medication, lose weight and exercise, patients may be asking themselves:
“Why bother, I feel fine?” or “What’s in it for me?”
To address this issue, the Health International article mentioned earlier suggests implementing a ”person-focused” approach, which recognizes that human decision making is not always rational and is affected by systematic cognitive biases, habits, and social norms. In some cases, patients may not even realize the extent of their healthcare issues. For example, the article quotes a recent survey in which “76% of the participants with high-risk clinical conditions described themselves as being in excellent, very good, or good health.”
To address these biases, the article suggests that physicians should focus on more than just the clinical diagnosis and work to identify other factors that may be impeding health improvement. For example, a newly-diagnosed diabetes patient “may be overweight, suffer from heart disease, have mild-to-moderate depression, mistrust his clinician, and be socially isolated."
2. Use existing data to better understand your patient population
Many providers today are challenged with not only the ongoing management of their diabetic patients but with taking that next step to facilitate much needed behavior change. Providers realize that a change in their approach to care is not optional and coaching is needed to prevent/delay the onset of chronic disease. To identify the patients that would benefit from more intensive chronic care management support and engagement, providers can use existing data sets, including:
- Traditional claims-based analysis (tests, diagnoses, procedure codes and predictive modeling)
- Patient-driven health assessments (online or office visit)
- Biometric data, such as lab values
3. Incentivize behavior change with challenges, technology and insight
Patients today have easy and immediate access to a wealth of information online. They are more aware of their options and they want to be heard. Use this increased awareness to encourage the use of self-management technologies (such as mobile apps, gamification challenges, home monitors, and other innovative tools) that are easy and convenient for patients to use regularly. There are multiple kinds of apps that are particularly useful for diabetic patients, such as food and exercise trackers, and blood glucose meters that link to physician offices. Most importantly, there is an opportunity to help patients choose the tools and resources that work best for them.
4. Implement continuous and supportive behavior change coaching
ACOs and provider practices should provide behavior change and lifestyle coaching resources and education for those interacting with patients. These services allow the practitioner and the patient to identify internal motivations and barriers to develop a plan for care plan compliance. Coaching can:
- Help the patient make sense of what he/she is being asked to do
- Facilitate an honest conversation about the risks and benefits associated with the behavior change
- Enable the provider to Identify what opportunities exist to address the patient’s motivation for change
Coaching addresses the gap between individuals’ actual health status and how they understand and experience their health on a daily basis. This approach ensures the patient knows what to do as well as how to achieve their care plan goals.
Learn more about Health Dialog’s Chronic Care Management programs.