Behavior Change: The Path Towards Health Transformation

Every health provider knows a patient who is facing chronic conditions or who continually struggles with feeling unwell.

And every provider knows that patient could improve their health by making some lifestyle changes.Yet even when patients and providers both know the potential positive impact, behavior change can be incredibly difficult to achieve.

In this resource, you’ll find an overview of the science of behavior change and why it’s essential to helping patients, an explanation of the barriers that prevent providers from helping patients achieve behavior change, and a new model of primary care that makes it possible again.

How the Current Healthcare System Keeps Behavior Change Out of Reach

Chronic, preventable conditions affect the majority of Americans, costing our healthcare system huge amounts of time, money, and other resources. According to the CDC, six in ten adults in the US have a chronic disease and 4 in 10 have two or more. Chronic diseases are the leading causes of death and disability in the US, and the leading drivers of our total $3.5 trillion in annual healthcare costs.

Chronic conditions place a heavy burden on patients, providers, and systems. And many could be avoided but only through a care approach that goes beyond treatment of symptoms to nurture meaningful behavior change in patients. Unfortunately, a fee-for-service model of care makes this impossible.

No time for change

A traditional healthcare model puts providers under pressure to see as many patients as they possibly can every single day. In this volume-based, fee-for-service model, the average appointment time has gotten shorter and shorter, and it has now dipped well below 10 minutes per patient.

In a fee-for-service model, shorter appointments mean more revenue, but patients pay a high price. When appointments are rushed, providers are more likely to only focus on their most acute problems, administer prescriptions, or make a referral. Providers simply don’t have time to get a full understanding of a patient’s multiple health concerns, identify a treatment plan, and communicate it to the patient — let alone start a conversation about behavior change.

Stalled progress on health goals

Providers do their best to address underlying causes of health issues, in spite of the pressure placed on them by a traditional model of healthcare. They might make recommendations to avoid specific future problems: eat better, lose weight, or stop smoking, for example. They might refer a patient to specialty care. But without any practical way to follow up with patients on these goals, or adequate time and resources needed to address behavioral health concerns, providers can only wait and hope that patients can somehow find a way to do it on their own.

This system can’t be described as healthcare. It’s sick care — a system set up to treat a patient only when their problems are acute or chronic. The only way to truly improve health is to change behavior, and that takes time, trust, and expert coaching.

What True Behavior
Change Looks Like

Behavior change happens when patients create and sustain habits that improve their daily quality of life and their long-term health. Healthcare providers can help patients build the self-efficacy to make healthier choices by guiding them through the process of behavior change.

It starts with whole person care

Dr. Stephen Spann, founding dean of The University of Houston College of Medicine, explains what a biopsychosocial approach to primary care looks like:

“We don’t divvy people up into physical, mental, social, and spiritual dysfunction. We look at them as a whole … My commitment will be to get the patient well. It’s a unique approach; remember that 50% of problems that patients bring to their primary care doctors are not biological. They’re psychosocial.”

Providers need to be able to understand and treat the whole person — not just their most acute symptoms. This means meeting patients where they are, understanding their health concerns in the context of their lives, and working to overcome the psychological and social factors that could potentially hold them back from achieving behavior change.

It intersects with behavioral health

Behavioral health includes mental health and the treatment of behaviors arising from a patient’s mental health. It is distinct from behavior change, which is simply the process of a person creating new lifestyle habits that support their health.

Behavioral health and behavioral change are not the same thing, but they can be closely linked. Unaddressed behavioral health concerns can be a root cause of health issues — poor diet, high alcohol consumption, chronic pain, or sleep issues. Behavioral health symptoms like stress, anxiety, and depression can also be a major roadblock to behavior change. They place such a heavy burden on patients that they’re unable to make progress on health goals.

When providers can address behavioral health, patients are much more likely to achieve lifestyle changes to improve their health in other ways too.

It unlocks better health outcomes

It could look as simple as drinking enough water, or remembering to wear sunscreen, or a daily self-reminder to take an important medication. It could be the gradual process of switching to a healthier diet or the transition from a sedentary lifestyle to an active one.

Behavior change will look different for every patient, but it is key to addressing a long list of health concerns related to nutrition, exercise, sleep, smoking, and more. It can prevent a host of chronic conditions and diseases, including diabetes, cardiovascular disease, chronic obstructive pulmonary disease (COPD), and some cancers.

How Advanced Primary
Care Prioritizes
Behavior Change

How can we change the healthcare system to bring behavior change within reach for patients? It starts by finding ways to support patients better.

To encourage behavior change, providers must build trusting, personal relationships with patients, provide care that understands the patient as a whole person, and give patients ongoing support. For these reasons, the ideal setting to help patients achieve behavior change is within primary care.

Vera’s advanced primary care (APC) model is an evolution of primary care that combines a clinically integrated care team approach with a population health model supported by rich informatics — designed to nurture every patient towards behavior change that leads to better health outcomes. APC includes health coaching to support patients in all aspects of their lives.

Vera Whole Health coaching

In the Vera APC model, every care team includes a clinically integrated health coach who works with providers to provide whole health care to every patient. The role of the coach is to meet regularly with patients and help them identify health goals, make changes to their lifestyles, and achieve a better quality of life.

Coaches are trained through Vera Coach Onboarding, a program approved by the National Board for Health and Wellness Coaching. This training equips them to use empathetic listening and the Transtheoretical Model (TMM) of behavior change to understand what patients need and how they can work together to overcome them. Every time an unhealthy behavior is changed, patients move towards a long-term, sustainable, healthy lifestyle.

For coaches, the greatest reward is seeing patients build self-efficacy:

You’re really helping them rather than just giving them advice. You’re making them resourceful. It’s like coaching yourself out of a job. You want to coach them so they can coach themselves, so they can make their life as healthy as it can be.
Cheridan Bryant, Vera Whole Health Coach Operations Manager

Removing barriers to behavioral support

In a traditional primary care setting, providers have limited ability to connect their patients with therapy and other behavioral health resources. They can recommend it to patients, but the majority of patients won’t end up seeking it out — either because the prospect seems intimidating or uncomfortable or because they simply struggle to get access to behavioral health care.

The APC model encourages patients to meet with coaches (and sometimes behavioral health specialists) via telehealth or in the familiar setting of their care center. This makes behavioral support easy to access, so patients don’t feel intimidated.

Having behavioral health next door, it’s amazing how much things have changed. So whereas if I’m practicing by myself, people keep coming back with the same issue and really have a hard time moving past something … when I can connect them with behavioral health right across the hall, it’s pretty cool to see how we’re getting to the root cause of some of people’s issues.
Paula, Vera Whole Health Provider

Every member of the care team uses a coaching approach to motivate and guide patients. Providers and coaches work together to create individual care plans for each patient that takes a full biopsychosocial approach to their health.

The 5 Key Stages of Change

TMM is the core of the APC approach to health coaching and behavior change. It outlines five stages that an individual moves through to reach effective, lasting change. Vera Whole Health coaches use TMM to guide patients towards taking ownership of their own health.

Through low-pressure conversations, health coaches diagnose which stage of TMM each patient is in and then help them move along the continuum of change.

Expand the boxes for more information.

1. Precontemplation

In this stage, patients aren’t thinking about changing or don’t believe they can make the change in the next six months. They may feel resigned to the current state of their health or feel that the cons of making a change outweigh the pros.

2. Contemplation

In this stage, patients are becoming more aware of the potential benefits of making a change. When weighing the pros and cons of changing their behavior, they find that the pros are equally balanced with the cons. Patients in the contemplation stage may start taking action in the next six months.

3. Preparation

Patients are now ready for change in the next 30 days. They may have even taken some steps forward, like buying a gym membership or reading up on nutrition. These small steps are precursors to sustained lifestyle changes.

4. Action

At this stage, patients have started their new behavior but have been doing it for less than six months. For example, they have started an exercise program or successfully started phasing out unhealthy foods from their diet.

5. Maintenance

When a new behavior has been successfully integrated into a patient’s life for more than six months, they have entered the maintenance stage. The patient is working to prevent relapse into earlier stages and feels confident in their ability to change and improve their own health.

Throughout all five stages, coaches use empathetic listening to understand each patient and walk in their shoes. Rather than pressuring them to make a change they aren’t ready for, coaches focus on getting to know the patient and listening for indications that they are curious about change. Then, they help patients identify lifestyle changes and encourage them throughout preparation, action, and maintenance.

Anyone can tell someone what to do. But helping a patient to become their own coach — increasing their self-efficacy — is the key to lasting change.

You have to meet somebody where they’re at. Each stage has goals that are specific to that state of change. More importantly, you have to help identify what is motivating them. You have to help them recognize victories and use that to fuel movement. How it’s reflected in our brand boils down to empathy. At Vera, we help people change behavior by esteeming through empathetic listening.
RYAN SCHMID, Vera Whole Health CEO

Behavior Change In Action: Patient Stories

Through the APC model, care teams have the time and resources to listen to patients, build trusting relationships, and understand their complex care needs. Here are some examples of health coaching in action.

Gaining competence and confidence

Bob Jennings, a veteran UPS driver dealing with 33 years of strain from sitting, standing, bending, and lifting, experienced a fall that injured his spine and led to chronic pain in his back and legs. For Bob, who was also diabetic and overweight, this injury presented a major obstacle to physical movement and stamina.

When Bob visited his care center, his provider connected him with his health coach, who helped him establish health goals and work towards them together through regular communication and small, achievable steps. In Bob’s own words, “We didn’t try to climb Mount Everest the first day.”

Step by step, Bob and his health coach started climbing. And the plan is working. Bob now manages his diabetes with diet and exercise alone and is seeing improvement in his physical stamina.

For Bob, the constant support of a health coach helped him to take ownership of his health journey:

Accountability is everything to me because it just motivates you to achieve your goals. You start seeing some results, then you start getting some competence and confidence — you just feel better and more. You know what I mean? You just feel better about it. ‘Oh, absolutely. I got this.’
BOB JENNINGS, VERA MEMBER

Little goals that changed everything

Robin Hebert, a mother and full-time student working on her masters degree, had already overcome an incredible challenge: recovering from heroin addiction and alcoholism. But she felt defeated by unsuccessful attempts to control her weight. When she visited a care center, she found out she had high blood sugar and high cholesterol and agreed to meet with a health coach.

With the help of her health coach, Robin shifted her thinking towards manageable, achievable goals:

As soon as we started talking and setting these little goals, I just got on board … Everything just kind of started falling into place.
ROBIN HEBERT, VERA MEMBER

Through health coaching, Robin achieved her weight loss goal, transformed her diet, and quit her 25-year smoking habit. She and her health coach even came up with a big-picture plan to save money for another semester of grad school. Health coaching changed Robin’s perception of healthcare:

I’ve never gone to my doctor to talk about stuff, and now I do. Now I call them right away. Because I just like them. It feels like home. It feels like family.
ROBIN HEBERT, VERA MEMBER

Reshaping Primary Care Around Behavior Change

Behavior change is the most effective way to stop or reverse a wide range of unhealthy conditions and help people achieve true health. With a primary care model that is designed to create behavior change, patients will experience better long-term health outcomes that will ultimately lower the overall cost of care.

The traditional fee-for-service model of healthcare prevents providers from nurturing lasting behavior change. But if primary care can be reshaped to follow the APC model, behavior change can transform the lives of individuals and shape the future of healthcare.

To learn more about how Vera Whole Health can help you implement a value-based advanced primary care model please get in touch with us today. We’d love to talk.

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