Several years ago, we noted that patient activation was popping up in many conversations among hospital and health insurance executives. The push toward value-based care combined with the pressure to reduce preventable hospital readmissions has kept patient activation—and its cohort, patient engagement—in the conversation spotlight.
And why not? Aside from the obvious, personal health benefits of being an activated patient, patient activation benefits 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 percent higher than patients with the highest activation.
Turning Patient Activation into Patient Engagement
Health Affairs defines patient activation as “a patient's knowledge, skills, ability, and willingness to manage his or her own health and care”—or in more basic terms, “confidence.”
Assessing “Confidence” with PAM
To understand and measure patient activation, hospitals, health insurance companies and employers often use 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.
PAM utilizes 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. As outlined by Insignia Health, the four levels are:
- 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 1-point increase in a PAM score can result in a 2 percent improvement in medication adherence and a 2 percent decline in hospitalization. On its own, this has profound implications on benefits to patients and the healthcare system as a whole. But consider the potential benefits when “confidence” gets amplified by “motivation.”
Uncover Patient Motivation and More with Psychographic Segmentation
Patient engagement is the means to sustain activation—even increase it—over time. The c2b solutions psychographic segments can be found at all four patient activation levels, but provide insight into a patient’s unique attitudes, motivations and preferences:
- Direction Takers: Defers to physicians; needs directive guidance; high utilizers of health care
- Willful Endurers: Reactive; not invested in – and 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 and wellness in his/her preferred manner. In essence, psychographics can help us understand why a patient may be “activated” and provide the insights to not only trigger this activation, but to strengthen and continue it over time.
Applying psychographics has been shown to effect positive change in patient behaviors—from encouraging a patient to choose a healthcare provider or purchase health-related products to activating patients to participate in wellness or chronic disease management programs.
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 healthcare 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. These insights can help patients move along the levels of activation.
Resources such as PAM and c2b Consumer Classifier offer healthcare providers important insights into individual patients to drive improvements in patient satisfaction and health outcomes while reducing costs.
And as Clayton Christensen, Rebecca Fogg and Andrew Waldeck wrote in their 2017 paper, Health for hire: Unleashing patient potential to reduce chronic disease costs, “There can be no solution to the healthcare crisis that does not address America’s unchecked epidemic of chronic disease, which afflicts more than half our citizens and consumes 86% of the exorbitant $3.2 trillion spent each year on care.”
When healthcare providers address confidence and motivation with individual patients—throughout the patient journey—that much-needed solution is within reach.