The More Activated a Patient Is, Lower HC Costs Hibbard Health Affairs Feb 13There are many ways to measure and express “patient engagement.” One such metric is “patient activation,” innovated by Dr. Judith Hibbard, long affiliated with the University of Oregon. Dr. Hibbard has written extensively about the Patient Activation Measure, PAM, first described in 2004. She and a team of researchers have determined that the higher a patient’s PAM score, the lower their health costs.

Patient engaement Health AffairsHibbard et. al. published these findings in the February 2013 issue of Health Affairs, which is entirely devoted to patient engagement – a top topic in Health Populi.

The team analyzed the medical records of 33,163 patients who received services at Fairview Health Services of Minnesota. Patients with the lowest PAM scores had average costs 8% greater in the base year and 21% greater in the first half of the second year than peer patients with the highest PAM scores.

Note the definition of patient activation: “understanding one’s role in the care process and having the knowledge, skills, and confidence to take on that role,” according to Hibbard’s 2004 landmark article linked above. Hibbard defines “engagement” as a broader term which includes but isn’t limited to patient activation.

The PAM score is calculated based on a patient-administered questionnaire that covers 13 areas describing their beliefs, knowledge and confidence in managing their own health tasks. Hibbard and colleagues have published many articles in peer-reviewed journals that assert that patients with higher PAM scores are more adherent to doctors’ instructions, engage in healthier behaviors more often, seek out health information, and get preventive care more than people with lower activation.

Health Populi’s Hot Points:  The Hibbard team’s conclusions embody the mantra of Health Populi and HealthcareDIY: “Patients who have more knowledge, skill, and confidence in managing their health, and who are more adept at navigation and using the health care system, appear to incur lower costs.”

Central to empowering patients is delivering health literate care as discussed by Dr. Howard Koh, current Assistant Secretary for Health at the Department of Health and Human Services, et. al., in Health Affairs in February 2012.

Addressing health engagement, and in particular bolstering activation and health literacy, delivers a win-win for individuals who could achieve more optimal health outcomes, along with the health system, payers, and ultimately the national economy. Value-based and accountable care programs in particular should pay attention to Hibbard’s research and adopt activation strategies to best manage the financial risk they’ll assume in new health financing regimes.