The ideal healthcare patient, according to some veins of cutting-edge research, looks a lot like this: engaged, in charge, knowledgeable, skillful and confident. And the positive outcomes of these attributes can be tremendous, from improved medication adherence and more office visits to fewer hospital readmissions and ER use.
Researchers from Insignia Health believe they have the answer. It’s called the Patient Activation Measure, a unique assessment tool that has been the focus of multiple clinical studies that have revealed its benefit as a baseline marker of a patient’s ability to self-manage as well as a predictor of quality outcomes.
More important, it has proven to be highly effective for the top users of healthcare services – those who consume 80 percent of services and associated costs – according to Chris Delaney, founder of Insignia Health, which offers PAM, a tool originally developed at the University of Oregon.
As new delivery models like the medical home and accountable care continue to flourish, providers will need to pay closer attention to measures that are tied to reimbursement. Some of those measures are tied closely to a patient’s level of activation, according to Delaney. “We know which folks would be at risk for not being able to achieve those measures, which would adversely impact a hospital, clinic or provider group [based on incentives and penalties],” he says.
sat down with Delaney to talk about the importance of activation and how it relates to patients’ care in medical homes and accountable care organizations.
[Ed Note: Delaney will share more insight into the power of activation during the upcoming webinar
taking place Feb. 22.]
Medical Home Today: Can you describe the Patient Activation Measure?
Chris Delaney: The Patient Activation Measure assessment evaluates an individuals’ ability to self-manage. It measures three key domains – knowledge, skills and confidence – which we’ve learned drives someone’s ability to be a successful manager of one’s health and healthcare.
PAM scores allow an organization to target their resources to where they’re able to do the most good. And that’s typically lower activation individuals. These individuals are significantly more likely to struggle with medications, to be readmitted post-discharge to a hospital, and to be more frequent users of the ER and inpatient stays.
Our model reveals four levels of activation, which are derived from a PAM survey score. The lower two levels consist of individuals that account for a significantly disproportionate share of healthcare spending. So, first and foremost, PAM can help organizations target their resources effectively. Secondly, it gives you the ability to understand how best to work with an individual – to understand what someone is capable of taking on and how to help them be successful.
We don’t believe in pushing all folks to achieve the same guideline behaviors. Rather, we know that it’s a journey for many. If you’re learning to swim, you start in the shallow end. Unfortunately, in healthcare we tend to put most people in the deep end. We tell them all the important things they need to do. For those lower in activation, this is a recipe for failure. You need to meet the individual where they are in the journey. With a PAM score, you really know how to help them become more successful self-managers over time.
At its root, how does PAM work?
The PAM assessment is a survey that organizations can incorporate into their own systems or use our software solutions. It’s a 10- or 13-question survey, based on the population being served. When it’s completed, you receive both an underlying score and a level of activation.
Four levels of activation provide organizations with a model that can be effectively incorporated into their work. The underlying score is important as well. We’ve seen in published studies that even a few points of movement is quite meaningful. As an example, we know that just a single point change in PAM score is worth a 2 to 3 percent decline in hospitalization.
Who uses PAM?
Our clients span healthcare. We are working with hospitals and clinics around the country, pharmaceutical firms, health plans, and Medicaid and Medicare organizations. These efforts include care transition programs, disease and case management, wellness programs and the patient centered medical home.
What’s the relationship between PAM and emerging models of care delivery?
Over the next few years, accountable care organizations will be paying considerable attention to the measures that will assess quality and influence reimbursement. A PAM score can provide immediate guidance. Patients lower in activation will put these quality measures at risk without tailored support that recognizes what they are capable of taking on. PAM has an enormous amount of utility for ACOs as a prospective measure.
Does the same go for the medical home?
I think what the medical home is trying to accomplish is part and parcel with accountable care. It’s about knowing the patient better, collaborating more strongly across healthcare team members, and helping the patient become a more engaged member of his or her healthcare team. The Chronic Care Model has long recognized the importance of patient self-management.
Having a PAM score begins this journey. We have a number of clients that have successfully incorporated PAM and PAM-based coaching into their practice patterns. Published research has shown the benefits of tailored support in the clinic setting – reduced hospitalization, increased use of office appointments, improved adherence and improved biometrics.
How does this play into the future of the medical home?
Medical homes, with a variety of designs, will play an important role in accountable care. A large number of success criteria are dependent on patient self-management – improving HbA1c, lowering cholesterol, taking medications as prescribed, avoiding preventable ER visits and hospital admits, and getting cancer screens. The medical home has the opportunity to provide not only integrated and technology enabled support, but to also recognize and incorporate a patient’s self-management ability into the care continuum.