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Patient Activation: Where Do I Start?

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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Where Do I Start? Culture
and Behavioral Change
February 23, 2014
Craig Swanson
Insignia Health
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.

.

3
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
Remind you of your members / patients?

5
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

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Patient Activation: Where Do I Start?

  • 1. Where Do I Start? Culture and Behavioral Change February 23, 2014 Craig Swanson Insignia Health
  • 2. Conflict of Interest Disclosure Crag Swanson is a stakeholder in Insignia Health. Insignia licenses the Patient Activation Measure®. © 2014 HIMSS
  • 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
  • 5. Remind you of your members / patients? 5
  • 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
  • 7. 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 7
  • 8. The Patient Activation Measure® Patient Activation Measure® © 2014 Insignia Health  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 8
  • 9. Global validation & more than 135+ published studies Countries/ languages:          Arabic  Australia  Canada  China  Creole Czech Republic   Denmark  Filipino  France  French Canadian Germany Greece Hebrew Japan Mexico Netherlands New Zealand Norway        Portugal Russia Slovakia Somali Spain Sweden United Kingdom  United States  Vietnamese 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 9
  • 10. Activation is developmental © 2014 Insignia Health Four levels of activation along a 100-point continuum 1215% 2025% 2530% 2025% 10
  • 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
  • 13. Key PAM Applications © 2014 Insignia Health 13 13
  • 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
  • 16. One size support does not fit all Tailoring Support to Self-management Ability © 2014 Insignia Health 16
  • 17. More complex skills are developed once a base of knowledge & confidence is established © 2014 Insignia Health 17
  • 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