Achieving Value-Based Care Through Interviewing

Las Vegas, NV—Motivational interviewing can increase patient engagement, promote adherence, and produce better outcomes, which, in turn, could ultimately lead to significant health care cost savings, according to a recent presentation at the CRS Fall.

Eileen T. O’Grady, PhD, RN, NP, a nurse practitioner and wellness coach, discussed the function motivational interviewing can play in empowering patients to play a greater role in their health.

Motivational interviewing can provoke lifestyle and behavioral changes. The concept acknowledges that change is a process, elicits the patient to use his or her own motivation to change, and identifies and eliminates barriers to success. Clinicians are instructed not to tell patients what to do but are asked instead to listen to the patient. This enables providers to create goals that are meaningful.

Working With Engaged Patients

“When we start telling people what to do, we often drive them deeper into resistance,” Dr O’Grady said in an interview. “So I think there’s a lot of value to using motivational interviewing to excavate from the person what their motivation is. Why do they want to do this?”

Conversely, “If they don’t have any motivation to do it, you can’t really do motivational interviewing. There’s no point,” she added.

If patients are engaged in the process, however, there can be significant benefits. For instance, patient engagement has been found to lower health care costs. Research shows that an unengaged person costs ≥21% than those who are engaged. Engagement has also been shown to decrease emergency room visits by 29% and reduce hospitalizations by 6%.

Aside from the financial benefits, it is also been found to improve outcomes, increase patient satisfaction, and reduce provider burnout.

Motivational interviewing can help produce significant effects on body mass index, cholesterol, and blood pressure. However, other strategies such as psychologically based interventions, have been found to be more effective for improving A1C levels.

4 Guiding Principles

Dr O’Grady said there are 4 guiding principles of motivational interviewing.

1. Resisting the righting reflex, or resisting the urge to correct a patient. “We don’t have to be right, but let them be right,” she said.

2. Understanding the patient’s motivators for making a change.

3. Using Level 3, or a deeper level, of listening where the clinician is fully engaged in what the patient is saying and listening to the tone of voice to ascertain what is not being said, as well.

4. Empowering the patient. 

Dr O’Grady also noted that it is important to establish “adaptive” goals with the patient that allow for growth and are tied to progress and mastery over time. Using adaptive goal setting also allows failures or missteps along the way that lead to alternative approaches rather than quitting altogether.

To help establish manageable goals that meet the individual needs of the patient, health care providers can ask powerful open-ended questions such as, “What are you not willing to give up?” or, “What do you want to be held accountable for?”

Avoid Piling On

Dr O’Grady said taking small steps that focus on changing 1 behavior at a time and have built-in accountability can help patients find success.

“One of the things that gets in the way a lot is that we do a pile-on and we say we want you to change everything you are eating, we want you to start exercising. That’s overwhelming for somebody in an obese situation,” Dr O’Grady explained.

By identifying obstacles, marrying those obstacles with solutions, and establishing a clear accountability plan, health care providers can help patients tap into their own motivation to change. Clinicians who move away from the role of being the expert and instead concentrate on creating an engaged patient are able to help patients find their own answers, and help make them responsible for their own health.—Jill Sederstrom