“Patient activation” is a phrase that is resonating more and more among health care providers, popping up in many conversations I’ve recently had with hospital and health insurance executives. Patient activation is the degree to which a patient is proactive and engaged in his/her own care.
Why is patient activation so important? Aside from the obvious, personal health benefits one experiences by being “activated”, it can benefit the broader health care system by driving down costs. A study involving 33,000 patients, published in the journal Health Affairs, found that the least activated patients had costs up to 21% higher than patients with the highest activation.
Hospitals, health insurance companies and employers are beginning to use techniques to understand and measure this level of patient activation. One such method is the Patient Activation Measure (PAM), which categorizes patients into one of four activation levels. The PAM assessment is the product of research led by Judith Hibbard, senior researcher at the University of Oregon’s Health Policy Research Group.
The Levels of Patient Activation
The PAM provides a series of 13 statements and asks the patient the degree to which he/she agrees or disagrees with each on a scale from 0 to 100. For example:
“Taking an active role in my own health care is the most important thing that affects my health.”
A patient’s activation level is determined by the overall score from answering the 13 questions. The four levels are (source: Insignia Health):
LEVEL 1: Predisposed to be passive: “My doctor is in charge of my health.”
LEVEL 2: Building knowledge and confidence: “I could be doing more.”
LEVEL 3: Taking action: “I’m part of my healthcare team.”
LEVEL 4: Maintaining behaviors, pushing further: “I’m my own advocate.”
Insignia Health, which licenses PAM from the University of Oregon, has found that a one point increase in a PAM score can result in a 2% improvement in medication adherence and a 2% decline in hospitalization. This has profound implications on benefits to patients and the health care system as a whole.
c2b solutions has found similar descriptions among its health & wellness psychographic segments:
Direction Takers: Defers to physicians; needs directive guidance; high utilizers of health care
Willful Endurers: Reactive; not invested in – but can be overwhelmed by – health issues
Priority Jugglers: Reactive; focuses on others’ health vs. self; many responsibilities
Self Achievers: Proactive; prioritizes health and image; task and achievement oriented
Balance Seekers: Proactive; wellness oriented; weighs options and defines own success
Psychographics uncover consumer motivations and help explain WHY a patient approaches health & wellness in his/her preferred manner. In essence, psychographics can help us understand why a patient may be “activated” and provide the insights to trigger this activation.
Driving Patient Activation
c2b solutions has much experience applying psychographics to positively change patient behavior. This can involve activating difficult patients to participate in a 12 week diabetes intervention program, choosing a health care provider, or purchasing health-related products.
The key is in understanding a patient’s personal motivations and priorities and positioning your message accordingly, using that patient’s preferred influencers and communication vehicles. One psychographic segment may prefer text message reminders while another may need more personal interaction with a health care professional. One segment may desire an extensive reference list of educational resources to investigate on one’s own, while another segment enjoys peer group learning.
Medical outcomes, patient satisfaction, and cost reduction can certainly benefit from methods such as the PAM and patient-centered care.