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This presentation from the HIMSS14 Patient Engagement Symposium looks at patient activation -- what providers are doing to begin and sustain it.
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Conflict of Interest Disclosure
Crag Swanson is a stakeholder in Insignia Health. Insignia licenses the Patient Activation Measure®.
© 2014 HIMSS
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.
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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
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Source: World Health Organization. Commission on
Social Determinants of Health Final Report
Consumers hold the key to their own wellbeing
Determinants of Health
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Measurement must go beyond cataloging deficits and “unactionable” data
“If you do not know how to ask the right question, you discover nothing” – W. Edward Deming
© 2014 Insignia Health
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The Patient Activation Measure®
Developed in academia
3 key domains assessed –
Knowledge, Skills,
Confidence
Assesses an underlying
construct – one’s ability to
self-manage
Interval level
measurement on a 100pt
scale
Two key metrics – score
and levels of activation
Validated in worldwide
research. 135+ published
studies
Patient Activation Measure®
© 2014 Insignia Health
Global validation & more than 135+ published studies
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Conditions:
Disease prevention
Diabetes
Hypertension
CAD
CHF
Metabolic Syndrome
High cholesterol
COPD
Asthma
HIV
Cancer (various)
Back-pain/Spinal
Surgery
Mental Health (various)
Multiple Sclerosis
Parkinson's
Sleep Apnea
Chronic Pain
Digestive Disorders
Multiple Co-morbidities
Arabic
Australia
Canada
China
Creole
Czech Republic
Denmark
Filipino
France
Countries/ languages:
French
Canadian
Germany
Greece
Hebrew
Japan
Mexico
Netherlands
New Zealand
Norway
Portugal
Russia
Slovakia
Somali
Spain
Sweden
United
Kingdom
United States
Vietnamese
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Activation is developmental
Four levels of activation along a 100-point continuum
12-
15%
20-
25%
25-
30%
20-
25%
© 2
01
4 In
sign
ia H
ealt
h
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Demographics and socioeconomics have little impact on activation
10%
2% 1% 0%
1%
0%
0%
0%
0%
86%
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%)
9%
6%
2%
0%
0% 0%
83%
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%)
What explains variation in PAM scores?
Source: National HH Panel
Study 2009
Source: National chronic
condition study 2005
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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
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PAM Predictive Power – Medical Cost
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
Patients in the lower two PAM levels are at significantly greater risk for high cost utilization
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$10,864
$9,476
$7,758
$5,969
Level 1 Level 2 Level 3 Level 4
Medical Cost (billed) by Activation
Level
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Source: Hibbard National Study, Patients managing a chronic condition, N=1,544
PAM levels guide the journey to best practice self-management
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One size support does not fit all
Tailoring Support to Self-management Ability
© 2014 Insignia Health
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More complex skills are developed once a base of knowledge & confidence is established
© 2014 Insignia Health
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Coaching tailored to levels outperforms support that emphasizes compliance with guidelines
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.
PAM Applied in Telephonic Coaching
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
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Source: PeaceHealth’s Team Filingame Uses Patient Activation Measure to
Customize the Medical Home, Center for the Health Professions Research Brief, May
2011
PAM Applied in a Medical Home
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
Increased patient satisfaction
Allocating resource and tailoring support to activation levels cuts ER use by nearly 50%
Source: PeaceHealth’s Team Filingame Uses Patient Activation Measure to Customize the Medical Home,
Center for the Health Professions Research Brief, May 2011
Using activation levels to allocate resources
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Achieving STEPS™ Objectives through
Activation
► 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
More activated patients = better health and lower utilization
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