Seven Steps for Developing High-Performance Wellness, Disease Management & Care Management Teams

 

Purchasers expect new value from health plans, vendors and provider organizations. In response, population health improvement program leaders are building high-performance teams to better engage and activate members, as well as deliver superior clinical outcomes and offset costs. Sustainable health care spending depends on reducing the demand for avoidable, costly health care services. Given that behavior is the biggest driver of disease risk and avoidable health care spending, behavior change must be a core competency of health care programs and organizations. And better program performance requires the use of validated, evidence-based wellness, disease management and care management approaches by professionals. These approaches should be backed by the workforce development and performance improvement strategies already widely used in other industries. Today, population health improvement programs face more competition from organizations that not only attract and develop the right talent, but measure, manage and drive continuous performance improvement. This will be as true for medical homes, chronic care collaboratives, health plan programs or specialty population health improvement programs.

Delivering better value requires a paradigm shift from traditional “plug and play” workforce models. In the past, simply filling a slot with a licensed professional that could serve patients by phone or face-to-face—to support evidence-based medical care or offer patient education—was considered sufficient. In staffing decisions, prior candidate experience in acute care or case management was desired, long ramp-up times for new hires were expected, and avoidable turnover accepted. Professionals were expected to apply past acute care-oriented training and experience to their new roles with little or no population health improvement experience, training or competency assessment. Moving forward, the focus on better operations, algorithms, outcomes measurement and technology will continue, but we'll begin to see program leaders increase investments in sourcing, selection, development and performance management of the professionals who serve members or patients as a key value driver.

Like other industries before, health care is moving from a “productivity” to a “performance” focus—transitioning from simply delivering services to achieving results. As the focus on workforce development increases, program leaders are asking which steps they can take to deliver better performance improvement value. They'll consider how health care organizations focused on population health or chronic care improvement distinguish themselves from competitors based on program and staff quality. Backing up marketing with strong results will be expected. The following are seven steps that programs and organizations can take to develop high-performance health coaching, disease management and care management teams:

1. Strategically Source & Select Key Talent

Poorly suited or prepared new hires can lead to staff morale problems, long ramp-up times, suboptimal program performance, and costly turnover. With nurses and other clinicians in short supply, it’s even more important to use strategic sourcing and selection solutions that cut staffing costs and support better program outcomes. Working with patients at risk or affected by chronic conditions requires more advanced communication, negotiation, and engagement and activation skills than acute care. While acute care experience can be invaluable, hiring managers shouldn't underestimate the impact of “soft skills,” or assume that past case management experience translates to readiness to engage with members in the evidence-based ways that drive measurable results. To support better hires, more programs offering phone-based services are screening all applicants by phone to assess phone presentation and communication skills, for example. Also, behavioral interviews are being used to assess how candidates might respond to typical job scenarios.

2. Make Evidence-Based Care Routine

While most understand the importance of evidence-based medical care, evidence-based health coaching, disease management and care management may be new. As more and more population health improvement programs claim to offer “evidence-based services,” purchasers are becoming increasingly skeptical of marketing claims. As in the case of physicians and others who claim to deliver evidence-based medical care, savvy purchasers are asking for evidence of how behavior sciences and theories are applied. They'll also look for evidence of how staff competence and performance are assessed. In the evolving health care environment, purchasers will be looking for proof that validated, patient-centered approaches and interventions are embedded in programs—as opposed to patient education, informal life coaching or “pop psychology”—oriented health coaching approaches.

3. Support the “Culture Change” from Acute Care to Population Health Improvement

Nurses and other clinicians new to population health improvement may take months or years to transition from the acute model of care focused on advice, patient education and instruction—to a patient activation and self-care support model and culture. This is a major reorientation for clinicians trained and experienced in acute care settings. Frequently, clinicians who work with the chronically ill rely on “instructing” patients on recommended care, advocating for lifestyle change or pushing for treatment compliance. Not surprisingly, many of these same clinicians cite “patient resistance” as their #1 barrier. A number continue to believe that “resistance” is a patient problem. Conversely, clinicians who have been exposed to popular health coaching programs or high-level motivational interviewing concepts may err in the other direction—letting patients drive encounters in overly long, counseling-oriented, drifting encounters. Helping clinicians combine their clinical expertise and value with validated approaches such as motivational interviewing takes time, support and focus. Organizations must actively support this transition.

4. Develop & Apply Staff Competency Models That Support Better Chronic Care

Organizations in most industries rely on competency models to improve team and organization performance. Competency models specify the behaviors that employees must demonstrate to succeed in their roles and support better organization performance. These competencies can be clinical, e.g., evidence-based medical care, or nonclinical, e.g., communication skills. Competency models for organization job roles should drive sourcing, selection, and training and development. Competency models should also drive performance measurement and management (including rewards and recognition). In health care, we assume that traditionally trained and credentialed health care professionals will perform in ways that support new organization goals. However, unless we explicitly define these behavior competencies, professionals will be not aligned or equipped to support best organization performance and value.

5. Measure & Management Performance

Better member and purchaser value depends on clinicians who can be both productive and deliver quality care. Productivity in primary care settings is usually measured by patients seen or services delivered. In phone-based population health improvement settings, traditional call center metrics have been used, e.g., calls made or completed, to measure productivity. Often, there is some type of generic review of call quality or member satisfaction. In health care, there is an assumption that care quality is assured if the professional is a licensed health care professional. However, traditional licensure and accreditation programs are based on the acute model of care. The Institute of Medicine has called for the “retooling” of current health care professionals to address the needs of today’s patients who are at greatest risk of chronic, not acute conditions. For professionals in population health improvement, assessing staff adherence with evidence-based practice and impact on patient-level outcomes are two domains that should be included. Standardized tools should be used to code calls, and regular feedback and mentoring should be provided to staff.

6. Develop Career Ladders in Population Health Improvement

Many of today’s organizations are using career ladders to support employee growth, satisfaction and achievement. However, typical health care career ladders are often based on more specialization, not interdisciplinary, patient-centered competencies. This can be discouraging for highly skilled nurses who may have more advanced patient engagement, activation or health coaching skills. Professionals working in population health improvement roles may have limited options for demonstrating their knowledge and proficiency in evidence-based chronic care and health coaching. In health plan wellness, disease management and care management programs, career ladders can help support employee achievement, job satisfaction, performance and retention. They also communicate that key patient self-management support and health coaching competencies are valued and recognized.

7. Drive Better Member Engagement Through Employee Engagement

Most service organizations know that satisfied employees make satisfied customers. Whether it’s a primary care clinic or a health plan disease management program, employees who do not feel empowered or valued will be less likely to provide good customer service or engage and empower members or patients. Leadership and human resource policies need to reflect the best practices of employee engagement. Rewards and recognition programs need to be used to reinforce good performance. Effective leaders understand the importance of showing staff that they care about their satisfaction and success by conducting annual satisfaction or engagement surveys to identify areas for improvement. And remember, if you ask for feedback be prepared to share results and take action. Additionally, it's critical to support leaders and supervisors in mastering the same listening and coaching skills that staff are expected to demonstrate in their encounters with members or patients.

 

 

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