Communication is key: Engagement approaches in behavioral health

Nancy Boerner, MD, MBA, Chief Medical Officer

Monarch Healthcare and OptumCare Pacific West Region


Monarch HealthCare is an Independent Practice Association (IPA) and part of OptumCare®. Monarch delivers managed care coordination for over 200,000 patients in Southern California and participates in three accountable care organizations (ACOs). 

They provide county-wide coverage, contracting with 2,250 physicians in addition to employing 140 practitioners comprised of PCPs, advanced care providers, specialists and hospitalists.

To advance the health of its members, in 2015 the Monarch HealthCare emergency room (ER) steering committee developed a patient outreach program run by social worker-led care teams. 

Patient care coordinators and social workers sought to engage members spending the most time in the ER. Experiences from this outreach effort highlighted a theme: many patients were brought to the ER with behavioral health concerns. 

Anxiety and depression, complicated by chronic pain, opioid dependence and substance abuse made quality of life worse for many people. By working closely with members, the care coordination team defined key strategies to engage patients and to work alongside them to improve their health. 

Focus on symptoms

Offering care solutions for patients on the topics of mental health and substance use calls for a delicate touch. The language used by care coordinators is inclusive and non-judgmental. Care providers are mindful of stigma and the effect it has on seeking medical care. 

Monarch HealthCare team members use caution with clinical labels such as depression and addiction and instead identify symptoms, framing wellness issues in terms of the effects they have on a patient’s life. 

“If I was concerned about a patient experiencing the symptoms of depression and anxiety I might recommend exercise resources, telling them that participating could improve their energy and help them sleep more soundly,” recalls patient care coordinator Elona Culwell.

Using neutral descriptors in favor of loaded clinical terminology helps to develop a relationship of trust. The trust between patient and care team is essential to engagement.


Patient-centered support

The team assesses each patient for gaps in care. Social service needs are addressed concurrently with medical needs. Once an open dialog is established, care team members can assess further areas of strength and motivating factors that can be used to support patient healthy choices.

A member may be averse to traditional counseling or talk therapy. Perhaps they do not identify as having a mental health problem. The best resource to offer is the resource most appropriate to the patient. 

“If the member is spiritual, I would of course refer them to pastoral care,” advises social worker Craig Pulido.

In a case of a senior with weight loss and depression, Dr. Desmond Lew asserts that “it may be most appropriate to address issues of isolation and motivation to eat by referring to a senior center with group meals.” 

Better than a one-size-fits-all strategy of consulting psychology and psychiatry, the individualized approach deals directly with core issues. 


Growing trust

Making positive change in member lives uses the same fundamental technique, no matter what health challenge they face. Tailored care yields the best results. 

Providing support that improves a patient’s behavioral health is delicate work. It requires informed and sensitive providers who treat members as individuals.

The Monarch HealthCare team achieves successful engagement through a process of building trust and offering patient-centered solutions. Engagement begins with outreach to assess each member as an individual.

Through a careful listening process, care coordination team members learn about a patient’s unique health concerns and gain an awareness of areas of stigma and sources of support. With specific knowledge of their patients, care team members address problems with a tailored approach.

Using appropriate language is a key to open communication between the care team and the member. Focusing on symptoms and quality of life measures over clinical terminology demonstrates to the patient that their own health concerns are the focus. 

Gathering the details on how a member’s state of health impacts important areas in their life can be the key to finding the right resources (centers of faith, social activities, support groups). 

Trust is vital in addressing the psychological dimension of care. With open, non-judgmental communication strategies and patient-centered approaches, Monarch HealthCare is engaging members in better health.


The views and opinions expressed herein are those of the authors and do not necessarily represent the views of OptumCare. The views and opinions expressed may change without notice. 

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