Published on March 5, 2014
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
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
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
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
Activation is developmental © 2014 Insignia Health Four levels of activation along a 100-point continuum 1215% 2025% 2530% 2025% 10
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
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
Key PAM Applications © 2014 Insignia Health 13 13
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
PAM levels guide the journey to best practice self-management Source: Hibbard National Study, Patients managing a chronic condition, N=1,544 15
One size support does not fit all Tailoring Support to Self-management Ability © 2014 Insignia Health 16
More complex skills are developed once a base of knowledge & confidence is established © 2014 Insignia Health 17
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
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
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
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
Questions? Thank You. Craig Swanson firstname.lastname@example.org
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