Personal Nurses Motivate Patients

Humana’s new Personal Nurse® service — which uses specially trained nurses to help members better understand and self-manage their conditions — is off to a successful start. Since it was launched last April, nearly 30,000 Humana members have received support through the program, which uses Humana’s Center for Health Metrics’ predictive modeling tool to identify members who appear to need additional support based on their claims or care-seeking patterns.

The technology-aided tool analyzes claims and demographic data to identify members most likely to experience an exacerbation in their condition or a significant increase in health care resource use in the near future. Those members receive a phone call from a Humana Personal Nurse, who provides counsel and guidance as desired. The members selected to receive the intervention are chosen “automatically” by the predictive modeling tool, which means that they or their physicians do not refer them to the Personal Nurse service.

Unlike case- or care-management programs, the Personal Nurse model encourages individuals to become more proactive in managing their condition. “The goal of the service is to empower members to take more control over their own health and health care and to facilitate their understanding of their condition,” said Patricia Whitt, R.N., a Personal Nurse manager. “It’s really focused on empowerment and guidance, rather than care coordination.”

The level of assistance provided by the nurses is based on the member’s receptivity or wishes, Whitt noted. Some members simply want to become better educated about their condition and how they can manage it, while others seek coaching and support to help them address lifestyle issues affecting their health.

Though nascent, the program has been well-received by Humana members who have received the intervention, said Personal Nurse coach Rebecca Cox, R.N., B.S.N., who trains and assists the Personal Nurse team. “Many of the members who have worked with our Personal Nurses have made changes that have improved their self-management or have taken steps — such as starting an exercise program or losing weight — to improve their own health,” she said. Rather than being proscriptive, the nurses focus on listening to a member’s concerns and providing resources as requested or appropriate.

“Most of the time, people know that they need to lose weight, stop smoking or check in with their physician more frequently. But they’re either ambivalent or unable to motivate themselves,” Cox said.

“The whole idea is to help members move from being inactive to proactive, and when they’re proactive about their health, they’re happier,” said Deanna Holladay, R.N., B.S.N., a Humana Personal Nurse. “Sometimes they just need to know that it’s OK to ask questions — and when they do, both the member and his/her family members return from the visit better informed.”

Members who have a severe illness or several co-morbid conditions may need ongoing support from the Personal Nurse. For example, Cox recalls a member she worked with who had diabetes, Crohn’s disease and ulcerative colitis. Generally overwhelmed by her medical issues, the woman had no sense that she might be able to improve her health. “I never said that she should change her diet or have her blood sugar checked; I just listened to her express the difficulties she was having,” Cox said.

By the time Cox called again, the member — who said she was impressed by the fact that Cox had reached out to her — had actually begun taking steps to improve her health. In part because of the support she received from Cox, the woman started an exercise program and began having her blood sugar checked frequently. Cox has stayed in touch with the member, who now sees that she can play an important role in improving her health status. “This is really about getting the member to believe that changes can be made, and that even small changes might bring big results in either improved health or better self-management,” Cox said.

Holladay had a similar exchange with a member who had a heart condition and diabetes and had recently returned home from a hospital stay. Although the man had read about his health conditions and had been educated on related lifestyle issues by his doctor and nurse, he wasn’t sure how to begin taking charge of his health.

“He knew what needed to be done, but not how to get there,” Holladay said. “By encouraging him to take small steps, such as parking at the far end of the lot rather than near the door, he eventually improved his physical fitness and got his diet under control. When he began to notice a difference in how he was feeling, that became a motivator in itself. It’s very rewarding — for us as nurses and for the member.”

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