Where Do I Start? Culture and Behavioral Change

February 23, 2014

Craig Swanson

Insignia Health

Conflict of Interest Disclosure

Crag Swanson is a stakeholder in Insignia Health. Insignia licenses the Patient Activation Measure®.

© 2014 HIMSS

Learning Objectives

• Describe key elements of patient and consumer engagement and health activation from a variety of stakeholder perspectives.

• Discuss patient activation and the role of measurement

• Learn what successful providers and practices do to begin and sustain a program for patient activation, including culture and behavior change.

• Design your organization and systems to engage patients and families more effectively and practice in a truly patient-centered way.

• Understand some of the innovative approaches taken to activate patients and how to scale those innovations.

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STEPS™ & Patient Activation

Relationship to Patient Activation

Satisfaction and experience with clinicians improves with higher patient activation

Patients lower in activation account for the vast majority of readmissions

Patients higher in activation are significantly more likely to seek and use information

Self-management (screenings, adherence, nutrition, etc.) improves significantly as activation increases

Utilization and costs decline with increasing activation

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5

Remind you of your members / patients?

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Source: World Health Organization. Commission on

Social Determinants of Health Final Report

Consumers hold the key to their own wellbeing

Determinants of Health

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Measurement must go beyond cataloging deficits and “unactionable” data

“If you do not know how to ask the right question, you discover nothing” – W. Edward Deming

© 2014 Insignia Health

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The Patient Activation Measure®

Developed in academia

3 key domains assessed –

Knowledge, Skills,

Confidence

Assesses an underlying

construct – one’s ability to

self-manage

Interval level

measurement on a 100pt

scale

Two key metrics – score

and levels of activation

Validated in worldwide

research. 135+ published

studies

Patient Activation Measure®

© 2014 Insignia Health

Global validation & more than 135+ published studies

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Conditions:

Disease prevention

Diabetes

Hypertension

CAD

CHF

Metabolic Syndrome

High cholesterol

COPD

Asthma

HIV

Cancer (various)

Back-pain/Spinal

Surgery

Mental Health (various)

Multiple Sclerosis

Parkinson's

Sleep Apnea

Chronic Pain

Digestive Disorders

Multiple Co-morbidities

Arabic

Australia

Canada

China

Creole

Czech Republic

Denmark

Filipino

France

Countries/ languages:

French

Canadian

Germany

Greece

Hebrew

Japan

Mexico

Netherlands

New Zealand

Norway

Portugal

Russia

Slovakia

Somali

Spain

Sweden

United

Kingdom

United States

Vietnamese

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Activation is developmental

Four levels of activation along a 100-point continuum

12-

15%

20-

25%

25-

30%

20-

25%

© 2

01

4 In

sign

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Demographics and socioeconomics have little impact on activation

10%

2% 1% 0%

1%

0%

0%

0%

0%

86%

Self Rated Health (9.5%)

How often feel depressed (2.4%)

Being male (0.9%)

How much anxiety (0.3%)

Income (0.4%)

Being Hispanic (0.2%)

Age (0.2%)

Being Caucasian (0.0%)

Being African American (0.0%)

Other (86%)

9%

6%

2%

0%

0% 0%

83%

Social Support (9.2%)

Self Rated Health (5.8%)

Education (1.5%)

Quality of Life ( .006%)

Physician Support (.003%)

Being Caucasian (.001%)

Other (83.4%)

What explains variation in PAM scores?

Source: National HH Panel

Study 2009

Source: National chronic

condition study 2005

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Adoption of PAM is broad

• Hospitals and health systems in 40 states

ACOs Readmission prevention Medical Homes

• National and regional health plans

Commercial Medicare Advantage Medicaid

• State Medicaid

Care Coordination Organizations Health Homes

• Pharmaceutical firms

• Employers

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Key PAM Applications

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© 2014 Insignia Health

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PAM Predictive Power – Medical Cost

Hibbard, J. Greene, J., Overton, V. Patients With Lower Activation Associated With Higher

Costs; Delivery Systems Should Know Their Patients’ ‘Scores’. Health Affairs, February

2014

Patients in the lower two PAM levels are at significantly greater risk for high cost utilization

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$10,864

$9,476

$7,758

$5,969

Level 1 Level 2 Level 3 Level 4

Medical Cost (billed) by Activation

Level

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Source: Hibbard National Study, Patients managing a chronic condition, N=1,544

PAM levels guide the journey to best practice self-management

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One size support does not fit all

Tailoring Support to Self-management Ability

© 2014 Insignia Health

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More complex skills are developed once a base of knowledge & confidence is established

© 2014 Insignia Health

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Coaching tailored to levels outperforms support that emphasizes compliance with guidelines

Hibbard, J, Green J, Tusler, M. Improving the Outcomes of Disease Management by Tailoring Care to the Patient’s Level of Activation. The American Journal of Managed Care, V.15, 6. June 2009.

PAM Applied in Telephonic Coaching

ROI:

ER visits declined 22%

Readmissions declined 33%

Increased adherence to immunization and drug regimens

Significantly greater drop in diastolic BP

Significantly greater drop in LDL

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Source: PeaceHealth’s Team Filingame Uses Patient Activation Measure to

Customize the Medical Home, Center for the Health Professions Research Brief, May

2011

PAM Applied in a Medical Home

ER/urgent care visits down 42% in 18 months

Statistically significant improvement in 8/10 clinical measures

Improved adherence

Increase in controlled blood pressure from 56% to 76%

Improvement in A1c & LDL

47% of patients improved PAM scores

24% increase in office appointments

Increased patient satisfaction

Allocating resource and tailoring support to activation levels cuts ER use by nearly 50%

Source: PeaceHealth’s Team Filingame Uses Patient Activation Measure to Customize the Medical Home,

Center for the Health Professions Research Brief, May 2011

Using activation levels to allocate resources

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Achieving STEPS™ Objectives through

Activation

► Know a patient’s level of activation to improve interactions and outcomes

► Allocate resources to where the return on activation is greatest

► Help the low activated access and use information

► Tailor support and education to a patient’s level of activation

► When activation increases Triple Aim goals are realized

More activated patients = better health and lower utilization

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Questions? Thank You.

Craig Swanson

cswanson@insigniahealth.com