Pay attention to “patient activation”

New manuscript in Health Affairs on “activated patients”:

Research indicates that patients who are more activated, based on their Patient Activation Measure score, are significantly more likely than patients who are less activated to adhere to treatment regimens, get preventive care, and participate to a greater degree in decisions about their care. More activated patients are also more likely to engage in healthy behavior and to seek out and use health information, compared to less activated patients.

There is evidence that patients who are more activated are less likely to be obese or to smoke, while being more likely to have clinical indicators that fall within normal parameters—such as normal blood pressure, cholesterol, and hemoglobin A1c levels—in contrast to patients who are less activated. There is also evidence that more activated patients are less likely than less activated patients to use the emergency department or to be hospitalized. All of these relationships hold true even after patients’ health status, age, sex, and income are controlled for.

This study went a little farther. It looked at how much activated versus unactivated patients cost:

In this article we examine the relationship between patient activation levels and billed care costs. In an analysis of 33,163 patients of Fairview Health Services, a large health care delivery system in Minnesota, we found that patients with the lowest activation levels had predicted average costs that were 8 percent higher in the base year and 21 percent higher in the first half of the next year than the costs of patients with the highest activation levels, both significant differences. What’s more, patient activation was a significant predictor of cost even after adjustment for a commonly used “risk score” specifically designed to predict future costs. As health care delivery systems move toward assuming greater accountability for costs and outcomes for defined patient populations, knowing patients’ ability and willingness to manage their health will be a relevant piece of information integral to health care providers’ ability to improve outcomes and lower costs.

A patient who is activated is one who understands their health issues, the health care system, and how he or she fits into it. Sometimes people refer to “patient engagement” as the process of activating a patient. I can tell you from experience it’s hard. So few people really understand the system, let alone how to use it. Unfortunately, activated patients are not only healthier, they cost us much less.

Increased patient engagement may be one of those things that both improves outcomes and reduces spending. We should get on that.


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