Question

1. Why is the Patient Activation Model significant to healthcare organizations interested in improving population health?

2. Discuss any 2 ways a health care practitioner/professional can engage their patients/clients.

Answer 1

1. Why is the Patient Activation Model significant to healthcare organizations interested in improving population health?

As the social insurance industry changes to esteem based consideration, deciding how to adequately draw in patients in their consideration has turned into a developing test for clinics and wellbeing frameworks. ‘Patient activation’ describes the knowledge, skills and confidence a person has in managing their own health and care. Evidence shows that when people are supported to become more activated, they benefit from better health outcomes, improved experiences of care and fewer unplanned care admissions.

Patient activation describes the knowledge, skills and confidence a person has in managing their own health and care. The concept of patient activation links to all the principles of person-centred care, and enables the delivery of personalised care that supports people to recognise and develop their own strengths and abilities. It underpins an asset-based approach that supports people to develop their capability to manage their own health and care by giving them information they can understand and act on, and providing them with support that is tailored to their needs.

While patient activation is closely linked to other concepts such as ‘self-efficacy’ and ‘readiness to change’, it is a broader and more general concept, reflecting attitudes and approaches to self-management and engagement with health and healthcare, rather than being tied to specific behaviours.

The Patient Activation Model is based on four levels of patient beliefs and knowledge of their health.
At Level 1, people identify as passive recipients of care.
During Level 2, people are beginning to learn how their behavior connects to the larger context of overall health, yet they are still unclear about basic health facts.
Level 3 people are actively building knowledge to manage their health. They still lack the confidence and skills to maintain behaviors.
Level 4 people take active role to maintain their health. They have the confidence and skillsets to successfully adopt new health behaviors. However, patients may not be maintain these behaviors under extreme stress or crisis.

Organizations use PAM to identify at-risk patients, target resources and tailor implementation to support patients along the activation process. Health communicators can use information about patient beliefs and knowledge to inform communication strategies. PAM can serve as a model to develop communications to effectively educate, inform and engage patients within the healthcare setting.

Patient engagement is an increasingly important component of strategies to reform health care. There is a growing body of evidence showing that patients who are more activated have better health outcomes and care experiences, but there is limited evidence to date about the impact on costs. Emerging evidence indicates that interventions that tailor support to the individual’s level of activation, and that build skills and confidence, are effective in increasing patient activation. Furthermore, patients who start at the lowest activation levels tend to increase the most. The Affordable Care Act recognizes that engaging patients in their own care is a cornerstone of successful health system reform and is critical to the success of accountable care organizations and patient-centered medical homes. A growing body of evidence links patients’ activation levels to their health and cost outcomes. In this article we review evidence of the contribution that patient activation makes to health outcomes, costs, and patients’ experiences of care.

Patient activation emphasizes patients’ willingness and ability to take independent actions to manage their health and care. Multiple domestic and international studies have empirically demonstrated that people who score higher on the Patient Activation Measure are significantly more likely than people who score lower to engage in preventive behavior such as having regular check-ups, screenings, and immunizations. More highly activated people are also significantly more likely to engage in healthy behavior such as eating a healthy diet and getting regular exercise. Moreover, those who score higher are more likely to avoid health-damaging behavior such as smoking and illegal drug use. Less activated patients are also three times as likely to have unmet medical needs and twice as likely to delay medical care, compared with more activated patients. Highly activated patients are two or more times as likely as those with low activation levels to prepare questions for a visit to the doctor; to know about treatment guidelines for their condition; and to seek out health information, including comparisons of the quality of health care providers.

Several studies have documented that more highly activated patients consistently report more positive care experiences. Most of the studies looking at patient activation and patient experience are cross-sectional, which makes it impossible to know the direction of causality. However, new evidence suggests that highly activated patients report better care experiences from a given provider than do less activated patients who see the same provider. Highly activated patients may have the skills and confidence to elicit what they need from their providers. These findings suggest that patient experience scores, such as those on the Consumer Assessment of Healthcare Providers and Systems survey, may be a reflection of a transaction that is shaped by both the clinician and the patient and is not just a measure of provider performance. These interventions seek to change the social environment to facilitate people’s changes in beliefs, social norms, skills, and opportunities to engage in healthy behavior. In an experiment involving two large companies, employees were randomly assigned to a control group or to a group receiving one of two different workplace interventions focusing on wellness or being an informed health care consumer. Although the two intervention arms emphasized different issues, both included health classes, environmental changes such as posters and information campaigns, and personal coaching for high-risk employees.

Innovative delivery systems are measuring activation to improve and individualize patient care and to strengthen the patient’s role in improving outcomes. They are improving care principally by tailoring coaching, education, and care protocols to patients at different levels of activation. Delivery systems are also making more efficient use of their resources by providing more support to patients who have a heavy disease burden and limited self-management skills (less activated patients), and less support to patients with greater skills.

2. Discuss any 2 ways a health care practitioner/professional can engage their patients/clients.

Patient engagement is an essential strategy for achieving the “triple aim” of health care:

Improving the patient experience. Patients are expecting and demanding greater control over their care. Provisions in the Affordable Care Act now link performance related to patient experience metrics to reimbursement. For the first time, health care organizations—and eventually individual providers—will be paid partly based on how they are rated by patients.

Advancing population health. Today, health care practices must meet new industry standards that emphasize outcomes instead of services delivered. Practices are on the hook for achieving better cost and clinical outcomes with initiatives such as Meaningful Use, Patient-Centered Medical Homes (PCMH), and Accountable Care Organizations (ACOs).

Reducing costs. Focusing on patient engagement can improve efficiency, reduce out-migration and reduce overall costs of patient care.

To successfully achieve patient engagement in your health care practice, consider these five elements:

1. Define your organization’s vision for patient engagement.
2. Create a culture of engagement.
3. Employ the right technology and services.
4. Empower patients to become collaborators in their care.
5. Chart progress and be ready to change and adapt.

Patient engagement has always been a good thing to strive for in health care practices. Today, however, patient engagement is an essential strategy for achieving what the Institute for Healthcare Improvement calls the “triple aim” of health care: improving the experience of care, improving the health of populations, and reducing per capita costs of health care. Specifically, patient engagement can help health care practices: Improve the patient experience. The Affordable Care Act links reimbursement to performance on patient experience metrics. For the first time, health care practices—and eventually individual providers—will be paid partly based on how patients rate them. For example, the Medicare Shared Savings Program includes 33 individual measures to assess the care provided by Accountable Care Organizations (ACOs). Of these, seven are related to the patient’s or caregiver’s experience of care, and they have equal weight with others related to care coordination and patient safety, preventive health, and at-risk populations. A recent survey by the California HealthCare Foundation found that patients pay more attention and become more engaged in their health and medical care when they have easy access to their health information online; this is especially true for patients with lower incomes.