SCAN Health Plan’s Member2Member Program is a telephonic outreach initiative that encourages members to become more physically active and assists members experiencing common geriatric conditions such as urinary incontinence, issues with mobility, balance or falls, and depression. Peer advocates reach out to members with whom they have something in common, in order to build trust, develop relationships, provide education, and share personal experiences. Advocates encourage members to talk with their physicians about their health, and use motivational interviewing to guide behavioral change. The goals of Member2Member are to leverage peer interaction and support to improve physical and mental health by helping members speak to their doctors and receive treatment or guidance as needed. Why does this build trustworthiness? This program emphasizes the importance of communication and caring, empathic relationships to encourage patients to receive the care they need.
How It Works
SCAN’s Member2Member program is a telephonic outreach initiative that assists members who need a little more encouragement to become more physically active and/or are experiencing common geriatric conditions such as urinary incontinence, issues with mobility, balance or falls, and depression. Participants are referred to the program based on their responses to a voluntary health survey.
Peer Advocates are paid, non-clinical staff who are also SCAN members. They reach out to targeted members with whom they share commonalities in order to build trust, develop relationships, provide education, and share personal experiences. They encourage members to communicate with physicians about their health and use motivational interviewing to guide behavioral change. Outreach is conducted in both English and Spanish.
For example, a member who says she is physically inactive will be encouraged to track her steps or activate her Silver Sneakers membership. A member facing urinary incontinence will be encouraged to do Kegel exercises, reduce beverage consumption later in the day, and discuss physical therapy, cognitive behavior therapy and medication with her physician.
Member2Member is a medium-term intervention. Peer Advocates make no more than five calls to each member, and by design the program lasts no more than three months.
The goals of Member2Member are to leverage peer interaction and support to improve physical and mental health by helping members speak to their doctors and receive treatment or guidance as needed.
Skills and Competencies
Member2Member relies on the following skills and competencies:
- Shared personal experience. Each Peer Advocate is a SCAN member and shares a background similar to that of the member they are working with. They use their common connections to build empathy and gain the trust of the member.
- Motivational interviewing. Peer Advocates are trained to use the information they glean in conversations with members to persuade the member to take specific steps to improve their health. If they learn a member is at risk for falling and they live at home, for example, they’ll discuss removing small rugs from hallways in order to minimize the risk of tripping over them.
In 2016, data from SCAN’s Health Outcomes Survey (HOS) indicated that four issues often faced by seniors were particularly vexing for our members—Monitoring Physical Activity, Improving or Maintaining Mental Health, Reducing Risk of Falling, and Improving Bladder Control. We knew that resources existed to help members effectively manage these issues, but that they were often overlooked.
Several studies at the time showed that peer support could be an important factor in improving health outcomes and reducing risks. Most significantly, the Chronic Disease Self-Management Program, created by Stanford researcher Kate Lorig, demonstrated that peer support could help reduce hospitalizations and emergency dept. visits. Additional data demonstrated that peers could play a strong role in helping members modify lifestyles, be encouraged to follow through on medical treatment, and derive support and socialization through interaction.
With these studies in mind, SCAN began the Peer Advocate program with a cohort of ten advocates and 10,000 members.
In the program’s first year, our ten Peer Advocates connected with 5,500 SCAN members.
In 2020, SCAN Health Plan’s 19 Peer Advocates connected with 10,000 SCAN members.
Data from 2018, the last year for which we have formal data, indicates that Peer Advocate interventions increased the number of members seeking treatment for urinary incontinence by 25%.
Likewise, Peer Advocate interventions also led to increases in the number of members taking action to improve their health with regard to the four other identified geriatric conditions (become more physically active, issues with mobility, balance or falls, and depression.)
This practice is entirely scalable and has been scaled. Based on our experience of the program, we believe the ideal ratio of Peer Advocates to members is 1:560.
The most limiting factor with this program has been the need for staff oversight and support. Peer Advocates are trained to be peers, but they do not have any clinical expertise. And yet, they are discussing sensitive healthcare topics with the members they connect with. As such, their work must be monitored and guided.
What’s more, many Peer Advocates report that members ask them healthcare questions during their conversations, and they often need support and guidance in order to help steer members to appropriate sources of help. SCAN has plans to expand our Member2Member program significantly, which will require additional staffing.