Leading with influence at Medica

“As a care management executive, I have spent the past 25 years figuring out how to systematize influence into effective, measured ways to achieve results,” says Alan Spiro. “Care management is different than delivery. We deal in systematic approaches, mainly towards controlling costs and improving quality. When I read Cialdini’s book Influence in the 1980s, though, it really helped me to understand that the care management industry doesn’t actually manage anything. Actually, our work is based on an influence, or advocating, model. We’re here to help people navigate a very complicated system, which makes the whole issue about how to influence members to make better care decisions that reduce costs and improve quality.”

Putting ethical influence at the heart of the organization
Spiro and two others co-founded the health care management company Accolade in 2007 using an influence model as opposed to a traditional management model. To illustrate the difference, Spiro points to the design of Accolade’s call center. “Usually, care company call centers are seen as a financial service (as opposed to medical one), which patients can call to find out about their benefits. Typically, these centers try to resolve client inquiries as efficiently as possible, partly to keep costs down, with the highest aim being quick, pleasant calls. This isn’t the case at Accolade.” Instead, Accolade approaches incoming member calls as opportunities to ethically influence care decisions. “In health care, emotions, rather than logical reasoning, often drive decisions,” Spiro explains. “And this tends to drive health-care costs: fear drives costs. Responders are thus trained to keep people on the phone and find or create, in Accolade parlance, “golden moments,” in which they can influence them toward making less emotional, more rational choices.” For example, Spiro explains that members often call from emergency room parking lots to find out if their network covers those particular ERs. Instead of just answering that question, however, Accolade’s policy is to try to find out as much as possible about what’s happening, while a nurse is brought on the line to assess the caller’s medical condition. “Often, responders discover by talking to them that it would lower costs and improve the quality of their care to go see their regular doctors rather than going into the ER. In the U.S. an emergency room visit typically costs $1000 versus $200 for an office visit, and the waits tend to be much longer, so when it makes sense, we try to persuade our members to make that better care decision.”

Most of us need training to build our powers of persuasion
Spiro notes that persuading people to change their minds about decisions that they weren’t even calling about it in the first place takes training. “The pre-suasive tactics can seem obvious and, for some people, they do come naturally, but for most of us they don’t,” says Spiro, who explains that Robert Cialdini, the author of Influence, was brought in as a key advisor at Accolade to help systematize the principles of influence. “When we set up our training programs, we realized that it’s about training our people to un-learn all the small points that work against us when we’re trying to persuade others. For example, in the United States we’re culturally programmed to ask permission to bring the nurse into the conversation when a member calls. It feels impolite not to ask. According to the principles of influence, however, it’s crucial not to ask: we need to make a declarative statement, not pose a question, for the sake of building our authority. There’s a ton of small details like this – building authority, finding points in common, and so on – that require training.”