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Building Patient Activation for Value-Based Models of Care

Insight Article - March 8, 2017

Population Health

Pamela Ballou-Nelson RN, MSPH, PhD, CMPE

Patient activation refers to a person’s ability to manage their health and healthcare. An activated consumer has knowledge, skill and confidence to manage their health and healthcare in wellness and illness.

Demographic and morbidity trends have shifted the focus of care away from acute episodes to the management of long-term conditions. Chronic conditions account for 60% of deaths and 70–80% of healthcare spending in developed countries. (Schroeder, S. We Can Do Better – Improving the Health of the American People, New England Journal of Medicine, Sept 20, 2007; and The World Health Organization, Commission on Social Determinants of Health Final Report)

The chronic care model was built with the understanding that the patient would learn how to manage their care on a day by day basis. However, the level of patient activation varies considerably in the U.S. population, with less than half of the adult population, 41%, at the highest level of activation (Health Tracking Household Survey sponsored by Robert Wood Johnson Foundation, 2007).
As depicted in this diagram, patient activation awareness and self-management skills are critical to outcomes that bring value to patients and lower costs for all.

How do we realize patient activation at the practice level?

Research shows that clinicians have been slow to embrace support for patient self-management. Clinicians strongly endorse patients to follow medical advice but are less likely to endorse that patients should be able to make independent judgements or take independent actions. Discussing a practice's culture around patient self-management is a critical first step.  Stratifying patients according to activation level using the evidence based tool Patient Activation Measure® (PAM®) provides an effective method to:

  • Guide resource allocation at the practice level.
  • Tailor support to a patient's abilities.
  • Improve patient safety, and satisfaction.

Patient activation can be measured with a tool that has over 12 years of research. The Patient Activation Measure is a global assessment of an individual’s self-management competency. PAM quickly evaluates three key personal health domains – knowledge, skills and confidence – and segments consumers into one of four activation levels along an empirically derived continuum. Coaching for activation focuses on seven core areas of self-management – condition and symptom understanding, medication adherence, diet and nutrition, physical activity, stress and coping, information seeking and smoking cessation. Each area of self-management is tailored to health status, addressing diabetes, asthma, COPD, CHF, CAD, hypertension, high cholesterol, as well as disease prevention through a lifestyle module. Within each self-management core category, information, goals and related action steps are tailored to an individual’s health status and level of activation. Goals and steps are supported with self-care resources suitable for coaching use or distribution to a participant. 

As the diagram below indicates, activation is developmental and moving patients along the scale of activation will yield positive outcome results for meeting the goal of value based models of care. For more information about how your practice can utilize the Patient Activation Measure contact MGMA Consulting at 877.275.6462 ext. 1877. 

About the Author

Pamela Ballou-Nelson
Pamela Ballou-Nelson RN, MSPH, PhD, CMPE
Consultant MGMA Consulting

Pamela Ballou-Nelson, RN, MSPH, PhD, has more than 30 years of experience in healthcare management, focusing on practice process transformation, patient-centered medical homes (PCMH), workflow analysis, quality measures, care management, population health and patient activation across the continuum of care. Nelson has worked with both provider and payer organizations to help them work toward alternative care and payment models. As clinical quality director for Adventist Health Network in Chicago, Nelson was responsible for leading physicians and hospital directors in their clinical integration process. Nelson has also worked with numerous commercial payers on quality outcomes and effectiveness measures, including compliance with Medicaid care management programs, along with Medicaid insurance contracts and high-risk and dual-eligible patient programs. She has also trained, advised and mentored more than 80 practices in various levels of readiness, preparing them for value-based payment reform, process improvement, improved quality outcomes and increased efficiency through PCMH recognition with 2011 and 2014 standards. She has a BSN from the University of Utah, an MA from Wheaton College, and an MS and PhD in Public Health from Walden University. In addition, she is an NCQA 2014 PCMH certified content expert and frequently speaks on PCMH transformation for accountable care organizations and population health initiatives.


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