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Tailoring Patient Support To Levels of Activation
Application of the Patient Activation Measure®
To Achieve Better Care, Improved Health & Lower Costs
Cynosure Health Summit
“The Great Quality Swap Meet”
© Insignia Health 2012. Proprietary & confidential
Chris Delaney
Insignia Health
May 21, 2012
The Patient Activation Measure® (PAM)
 Developed at the University of Oregon by Dr. Judith Hibbard and Dr. Bill
Mahoney
 More than 200 studies of health activation in academic and medical
centers, with 80+ peer reviewed published studies thus far
 Measures an individual’s knowledge, skills and confidence for managing
their health and healthcare
 Survey instrument assigns an individual to an activation level (1 - 4) based
on and a numeric score (0 – 100). Most individuals score between 30 and
80. 10 to 12 points separate activation levels
 Provides insight into an wide array of health-related attitudes and
behaviors
 Hospital and clinic clients in roughly 25 states
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Activation is developmental -- four segments along a continuum
General population
10-20% of the
population
20-35% of the
population
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20-30% of the
population
20-30% of the
population
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Worldwide research validates the PAM’s validity and reliability
More than 80 published studies across conditions and populations provide
pivotal health activation guidance
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Low activation signals problems (and opportunities)
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A PAM score is predictive of future utilization and outcomes
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How capable is this individual at managing his or
her health and healthcare decisions?
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Understanding Patients From the
Perspective of Activation
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Hundreds of patient characteristics – motivators, behaviors,
outcomes, have been mapped to activation levels
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Emotional disposition plays a profound role in activation
and how best to communicate with patients
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Achieving best practice self care or evidence based guidelines
is developmental. A PAM score guides the journey
Data Source: RWJ Aligning Forces
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Medication taking is a struggle for the low activated
Source: 2010 – 2011 Care Transition QIO Program
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The low activated find much less value in their clinical interactions
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Tailoring Support to Levels of Activation
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Activation level insights guide support toward what is
realistic and achievable for a given level
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A PAM score can play a pivotal role in resource allocation
Source: PeaceHealth’s Team Filingame Uses Patient Activation Measure to Customize
the Medical Home, Center for the Health Professions Research Brief, May 2011
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Targeting the low activated is a key strategy in care transitions
Source: QualityNet Conference Dec 2010. Alabama Quality Assurance Foundation (QIO)
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Coaching for Activation® online & print resources guide patient support
ACTIVATION LEVEL BASED COACHING GUIDE
PAM LEVEL 1
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“My doct or t akes care of me.”
“I don’t underst and t he cause”!
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SPECIFIC GOALS & RELATED ACTION STEP OPTIONS TO CONSIDER
Condition Knowledge & Symptom Awareness (example goals & steps)
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Build skill in problem solving around managing symptoms
Step: Write down symptoms, how they felt, and what might have
triggered the symptoms. Discuss findings w/member of health care team
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Build basic knowledge about condition
Step: Explain what their condition is in one or two simple sentences
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Learn important targets/numbers related to their health condition
Step: Be able to explain their numbers and where they fall
Medications (example goals & steps)
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Learn how medications work, their risks, benefits, and side effects.
Step: Identify concerns and knowledge gaps related to medications and
close these gaps
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Identify barriers to taking meds and problem solve together
Step: Observe for a week when and how medications are taken. Spot
missed days/does and what might have gotten in the way
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Begin to work toward taking medications as part of daily routine
Step: Together, fill out a medication chart that includes all prescribed and
over-the-counter medications + dosing directions
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0" %. %$1 &* 2+$ ) . $1 &* 2+2 ) . /#+
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May not understand that they need to play a role in their own health
Lacks basic knowledge about their condition
May not understand treatment options, or self-care expectations
May not feel in charge of own health and healthcare
Use to failure
Feels very overwhelmed with regard to self-care and healthcare.
Experiences a lot of negative emotion that makes it hard to cope
Poor problem solving skills
Low confidence in their ability to impact their health
Difficulty following through on treatment regimens
Has trouble connecting behavior to health
30%-40% Rx adherent; High rate of ERuse/hospitalization
Build confidence through small step goals that they can make a difference in
their health and how they feel
Overcome feelings of being overwhelmed by giving permission to take it one
step at a time. Don’t overwhelm with too much information
Increase self-awareness by connecting his/her behaviors to their health, and
how he/she feels
Help member see that through their own actions they can have a positive
impact on their health
Focus on current (not long-term) health issues
Use positive messages, avoid disagreements, and show empathy
Don’t “jump the gun!” asking them to do behaviors beyond their level
Begin to problem solve around small issues to overcome barriers to behavioral
change.
Let the individual choose the area to work on, and then guide toward
appropriate goals/steps
SPECIFIC GOALS & RELATED ACTION STEPS OPTIONS TO CONSIDER
Diet & Nutrition (example goals & steps)
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Pay attention to the habits & stressors that promote poor diet, identify an
opportunity to improve, and try it out
Step: Keep track of the food that is eaten for at least a few days in the
coming week. What is eaten and how much? Try taking pics with a
phone camera. Are there triggers that lead to certain food behaviors?
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Develop basic knowledge of ‘good’ and ‘bad’ foods. Understand the
characteristics of each. Reflect on portion sizes and how full he/she feels after
meals
Step: Make a small diet “upgrade” in the next week – replace high
calorie/fat snack w/ fruits/veggies; go LF or NF with some foods; reduce
portion size, try a new fruit/veggie rich in color
Physical activity (example goals & steps)
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Start to develop an understanding of the specific benefits of physical activity,
Step: Keep track of the types and amounts of activity he/she gets in a
day, and how it makes them feel. Discover where there may be some
opportunities to fit in more activity, and try adding a few extra minutes to
something that they already do
© 2010 | For use with a valid copyright license only!
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* CareMap guides support diabetes,
COPD, CHF, care transition and a
general chronic condition version
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Coaching Model Impact: National DM Firm
Coaching tailored to levels improves outcomes and reduces cost
Clinical Indicators
Medications: intervention group
increased adherence to recommended
immunizations and drug regimens to a
greater degree than the control group.
This included getting influenza vaccine.
Blood Pressure: Intervention group
had a significantly greater drop in
diastolic as compared to control
group.
LDL: Intervention group had a
significantly greater reduction in LDL,
as compared to the control group.
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
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Coaching Model Impact: PeaceHealth Medical Home
• Statistically significant
improvement in 8/10
clinical measures
• Improved adherence
• Increase in controlled
blood pressure from
56% to 76%
• Improvements 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
© Insignia Health 2012. Proprietary & confidential
• Increased patient
satisfaction
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PAM as a Key Vital Sign
Activation requires supporting individuals where they are and moving away
from a uniform approach that pushes guideline behaviors for all
The lower activated (levels 1 & 2) are poor self-managers and account for
75%+ of healthcare costs
The low activated (levels 1 & 2) have accounted for 80% to 100% of readmits
in care transition programs
Coaching support tailored to levels consistently demonstrates the ability to
improve patient self-management and reduce healthcare costs
Tailoring to activation levels helps to align resource to were the need is
greatest
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