We are talking a lot about patient activation or engagement these days. We recognize — or at least I hope we do — that if we plan to bend the cost curve and improve outcomes in this country, we need to have consumers, patients and clients with the knowledge, skill and confidence to manage their health and healthcare in both illness and wellness.
Patient activation goes beyond simply complying with a set of orders; it also asks "why" and "how" and "what if." Activation requires a shared decision approach on the part of both patient and the clinician, not just a patient following orders. Research from more than 400 peer-reviewed articles provides insight into patient activation, including the following:
Medical group practices are teaming up with MGMA, which has partnerrf with Insignia Health, to measure patient activation through PAM® surveys and coaching.
The journey of one health system focused on patient activation included:
While working to overcome initial resistance of team members, one practice observed the following challenges and solutions:
Patient activation goes beyond simply complying with a set of orders; it also asks "why" and "how" and "what if." Activation requires a shared decision approach on the part of both patient and the clinician, not just a patient following orders. Research from more than 400 peer-reviewed articles provides insight into patient activation, including the following:
- Many behaviors we are asking of people are only done by those in the highest level of activation.
- When we focus on the more complex and difficult behaviors, we discourage patients who are least activated.
- When we ask patients to start with behaviors that are more feasible, we increase their opportunity to experience success.
- Multiple behaviors change in the same direction as activation increases.
- Patients who are least activated gain the most when appropriately supported.
- It is the higher-activated patients who show up when self-management resources are offered.
Medical group practices are teaming up with MGMA, which has partnerrf with Insignia Health, to measure patient activation through PAM® surveys and coaching.
The journey of one health system focused on patient activation included:
- Improving health outcomes for more than 3,800 patients within its primary care and specialty care clinics
- Increasing patient activation in their own healthcare as a means of improving health and wellness, chronic disease management and disease prevention
- Decreasing unnecessary use of healthcare resources, such as avoiding unnecessary emergency department visits, preventing unnecessary hospital readmissions and optimizing utilization of lower cost resources through a primary care clinic
- Using the PAM® score to guide patient-specific care plans, educational efforts and motivational coaching, all to spark improved health outcomes
- Empowering nonlicensed team members as health coaches to improve the impact of their interactions with patients
- Positioning the practice for success in a value-based purchasing reimbursement environment
While working to overcome initial resistance of team members, one practice observed the following challenges and solutions:
- Team members felt they were continually being asked to do more.
- PAM® makes current efforts more productive, more impactful. The tools enable us to stop wasting time and effort.
- By not accurately understanding patients’ knowledge, skills and confidence, we are working in the dark and disconnected, with misunderstanding on both sides.
- Aligning patient activation with our history and mission of “meeting patients where they are” helps us “walk the talk.”
- Team members repeatedly said, “I don’t have time for that.”
- PAM® empowers clinicians to work smarter, not harder.
- Survey administration really is quick, and most patients complete it independently.
- Some team members didn’t understand their individual role — what adjustments were needed to current methods and what actions were expected.
- Education, particularly on roles and expectations, became the focus.
- Inertia was also an issue. Practice leaders addressed this challenge through the power of inclusion, champions and repetition:
- Executive leadership supported patient activation efforts from the very start.
- Coaching for activation was included across the practice in a wide variety of roles
- The practice created a steering committee of champions, whose peer-respected voices have had great impact.
- PAM® is visible daily. Issues are discussed every morning at interdisciplinary huddles, team meetings, all staff meetings and organizational newsletters.
- Some team members wanted to integrate PAM® and Coaching for Activation® faster.
- Creating workflows to support patient activation is a key strategy for success.
The practice approach included strategically integrating PAM® surveys first and coaching for activation second. The practice:- Gained PAM® concept buy-in by training clinicians and team members in PAM®
- Integrated PAM® survey administration in clinic and health homes care management
- Administered a Clinician Readiness Survey to assess an internal baseline for coaching for activation
- Began building patient activation workflows for patients whose PAM® level or score was documented in the practice's EHR
Moving forward, Coaching for Activation® will be embedded in all clinic and health homes workflows in 2018.
Lessons learned to date:- Early efforts already show improved PAM® scores.
- Funding for workflow integration is key to speeding adoption rate and impacting outcomes.
- When clinicians and health homes care managers can tie patients’ individual efforts to improving PAM® scores, patient engagement significantly increases, sparking additional momentum.
- Celebrate the successes
Summary
Research finds that consumer health behavior or self-management, the leading nonmedical determinant, accounts for 40% to 50% of health outcomes. Add environmental and social circumstances to this mix, areas where increased individual engagement can mitigate these influencers, and the rate increases to 70% .1
The importance of nonmedical determinants is clear: Consumers hold the keys to improved population health. Join other practices and health systems in their journey toward improved patient activation. Contact MGMA for more information.
Note:
1. Schroeder S. “We can do better — Improving the health of the American people,” New England Journal of Medicine, Sept. 20, 2007; 357: 1221-1228.
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