Hospitals score patients on their 'activation' levels

'Everyone assumes this is a soft science'

Writing in the Wall Street Journal this week, Laura Landro looks at how hospitals and insurers are measuring how engaged patients are in their own care—and how they are using the data.

How activation is measured

Hospitals, insurers, and employers are using an assessment called the "Patient Activation Measure" (PAM) to assess engagement levels.

A PAM score is determined based on how strongly a patient agrees or disagrees with 13 statements, such as, "I am confident that I can tell a doctor my concerns, even when he or she does not ask." PAM scores range from 0 to 100, with 100 being the best score. The scores are then used to place patients into one of four activation categories.

Proponents of the PAM scoring system say it makes it easier for providers to customize care for patients and provide them with special coaching or other interventions. The customized care is meant to help patients gain confidence and change their own health behaviors.

"Everyone assumes this is sort of a soft science, but we can measure patient activation just as rigorously and scientifically as other things in health care," says Judith Hibbard, lead developer of the PAM assessment and a senior researcher at University of Oregon's Health Policy Research Group.

Hallmarks of highly—and barely—activated patients

Hibbard and her colleagues have conducted hundreds of studies using PAM, including one on more than 33,000 patients at Fairview Health Services in Minneapolis. The study, published in Health Affairs in 2013, found that patients with the lowest PAM score incurred 21% more costs than patients with the highest scores.

Health Affairs: Health-literate, confident patients cost less

According to Hibbard, patients who are "highly activated" and engaged in their care incur lower health costs and enjoy better outcomes because they are better at managing chronic conditions and following instructions after a medical procedure.

But, as many as 40% of Americans do not have the skills, confidence, and knowledge to become highly activate patients, according to Landro. These less-engaged patients fail to get preventive screenings, take medications, and often are readmitted to hospitals following medical procedures. According to a 2013 study in the Journal of General Internal Medicine, patients with the lowest PAM scores were two times more likely to be readmitted within 30 days than patients with the highest scores.

One of the biggest challenges on the front lines of medicine is how to help patients manage not only one but often many chronic illnesses that progress and become more problematic," says Suzanne Mitchell, lead author of one PAM study.

How hospitals are using PAM to boost engagement

Insignia Health—a Portland-based company that holds the exclusive license for PAM—says even a single point increase on the score can result in a 2% decline in hospitalization and a 2% improvement in medication adherence.

WellPoint uses a customized six-question PAM assessment to gauge the activation of new Medicare beneficiaries and patients in its chronic condition programs. The aim of the assessment is to predict "what level of support this person needs from the health plan," says Dan Newton, a WellPoint vice president.

Meanwhile, Vancouver-based PeaceHealth used PAM scores at one of its primary care practices, according to spokesperson Shelley Buettner. Over 18 months, the practice saw a 42% decline in ED and urgent care visits and has since begun employing the assessment at more of its locations (Landro, Wall Street Journal, 3/31).


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