3. Learning Objectives
• Describe key elements of patient and consumer engagement and
health activation from a variety of stakeholder perspectives.
• Discuss patient activation and the role of measurement
• Learn what successful providers and practices do to begin and sustain
a program for patient activation, including culture and behavior
change.
• Design your organization and systems to engage patients and families
more effectively and practice in a truly patient-centered way.
• Understand some of the innovative approaches taken to activate
patients and how to scale those innovations.
.
3
4. STEPS™ & Patient Activation
Relationship to Patient Activation
Satisfaction and experience with
clinicians improves with higher
patient activation
Patients lower in activation account
for the vast majority of readmissions
Patients higher in activation are
significantly more likely to seek and
use information
Self-management (screenings,
adherence, nutrition, etc.) improves
significantly as activation increases
Utilization and costs decline with
increasing activation
4
6. Consumers hold the key to their own wellbeing
Determinants of Health
Source: World Health Organization. Commission on
Social Determinants of Health Final Report
6
6
11. Demographics and socioeconomics have
little impact on activation
What explains variation in PAM scores?
Self Rated Health (9.5%)
How often feel depressed (2.4%)
Being male (0.9%)
How much anxiety (0.3%)
Income (0.4%)
Being Hispanic (0.2%)
Age (0.2%)
Being Caucasian (0.0%)
Being African American (0.0%)
Other (86%)
10%
Social Support (9.2%)
Self Rated Health (5.8%)
Education (1.5%)
Quality of Life ( .006%)
Physician Support (.003%)
Being Caucasian (.001%)
Other (83.4%)
2%
2% 1% 0%
1%
9%
6%
0%
0%
0%
0%
0%
0%
0%
86%
Source: National HH Panel
Study 2009
83%
Source: National chronic
condition study 2005
11
12. Adoption of PAM is broad
• Hospitals and health systems in 40 states
ACOs
Readmission prevention
Medical Homes
• National and regional health plans
Commercial
Medicare Advantage
Medicaid
• State Medicaid
Care Coordination Organizations
Health Homes
• Pharmaceutical firms
• Employers
12
12
14. PAM Predictive Power – Medical Cost
Patients in the lower two PAM levels are at significantly
greater risk for high cost utilization
Medical Cost (billed) by Activation
Level
Level 1
$10,864
Level 2
Level 3
Level 4
$9,476
$7,758
$5,969
Hibbard, J. Greene, J., Overton, V. Patients With Lower Activation Associated With Higher
Costs; Delivery Systems Should Know Their Patients’ ‘Scores’. Health Affairs, February
2014
14
15. PAM levels guide the journey to best practice
self-management
Source: Hibbard National Study, Patients managing a chronic condition, N=1,544
15
18. PAM Applied in Telephonic Coaching
Coaching tailored to levels outperforms support that
emphasizes compliance with guidelines
ROI:
ER visits declined 22%
Readmissions declined 33%
Increased adherence to
immunization and drug regimens
Significantly greater drop in
diastolic BP
Significantly greater drop in LDL
Hibbard, J, Green J, Tusler, M. Improving the Outcomes of Disease Management by Tailoring Care to
the Patient’s Level of Activation. The American Journal of Managed Care, V.15, 6. June 2009.
18
19. PAM Applied in a Medical Home
Allocating resource and tailoring support to activation levels
cuts ER use by nearly 50%
ER/urgent care visits down
42% in 18 months
Statistically significant
improvement in 8/10 clinical
measures
Improved adherence
Increase in controlled blood
pressure from 56% to 76%
Improvement in A1c & LDL
47% of patients improved
PAM scores
24% increase in office
appointments
Source: PeaceHealth’s Team Filingame Uses Patient Activation Measure to
Customize the Medical Home, Center for the Health Professions Research Brief, May
2011
Increased patient satisfaction
19
20. Using activation levels to allocate resources
Source: PeaceHealth’s Team Filingame Uses Patient Activation Measure to Customize the Medical Home,
Center for the Health Professions Research Brief, May 2011
20
21. Achieving STEPS™ Objectives through
Activation
More activated patients = better health and lower utilization
► Know a patient’s level of activation to
improve interactions and outcomes
► Allocate resources to where the
return on activation is greatest
► Help the low activated access and
use information
► Tailor support and education to a
patient’s level of activation
► When activation increases Triple Aim
goals are realized
21