Patient Activation Changes as a Potential Signal for Changes in Health Care Costs: Cohort Study of US High-Cost Patients

Abstract

BACKGROUND: Programs to improve quality of care and lower costs for the highest utilizers of health services are proliferating, yet such programs have difficulty demonstrating cost savings. OBJECTIVE: In this study, we explore the degree to which changes in Patient Activation Measure (PAM) levels predict health care costs among high-risk patients. PARTICIPANTS: De-identified claims, demographic data, and serial PAM scores were analyzed on 2155 patients from multiple medical groups engaged in an existing Center for Medicare and Medicaid Innovation-funded intervention over 3 years designed to activate and improve care coordination for high-risk patients. DESIGN: In this prospective cohort study, four levels of PAM (from low to high) were used as the main predictor variable. We fit mixed linear models for log 10 of allowed charges in follow-up periods in relation to change in PAM, controlling for baseline PAM, baseline costs, age, sex, income, and baseline risk score. MAIN MEASURES: Total allowed charges were derived from claims data for the cohort. PAM scores were from a separate database managed by the local practices. KEY RESULTS: A single PAM level increase was associated with 8.3% lower follow-up costs (95% confidence interval 2.5-13.2%). CONCLUSIONS: These findings contribute to a growing evidence base that the change in PAM score could serve as an early signal indicating the impact of interventions designed for high-cost, high-needs patients.KEY WORDS: medicare; patient activation; health economics; return on investment.

Racial Disparities in Patient Activation: The Role of Economic Diversity

“…Clinicians must continue to develop and test consumer informatics tools' as well as understand the underlying mechanisms that affect differences in patient outcomes when using those tools. There is evidence that developing individualized plans of care, based on patient activation scores, improves patient outcomes (Greene et al, 2015;Hibbard et al, 2015Hibbard et al, , 2017Lindsay et al, 2018;Sacks et al, 2017); however, further research is needed to evaluate if the mediating effects of income and financial security on patient activation found in this research persist in other patient populations. When clinicians have access to their patient's financial capability data, they have the opportunity to co-develop plans of care that are sensitive to this social determinant of health.…”

“…In several studies, Black individuals had a lower level of patient activation than White individuals (Alexander et al, 2012;Eneanya et al, 2016;Hibbard et al, 2008;Lubetkin et al, 2010). Lower engagement in self-managing behaviors in Black populations may contribute to differences in health outcomes (Lindsay et al, 2018). Promisingly, when the difference in PAM level decreases between populations, models predict parity in health outcomes regardless of race (Hibbard et al, 2008).…”

Commentary for “The wellness incentive and navigation intervention improved health‐related quality of life among medicaid enrollees: A randomized pragmatic clinical trial”

“…Since Guo et al's analysis did not display the baseline distribution of PAM levels, we do not know how many participants started at the lower activation levels and moved up to a higher level during the intervention. This can be impactful as moving up just one level of activation is linked with a reduction in health care costs of 8 percent over a one‐year period . Similarly, we are unable to discern from the data shown, which participants were helped most by the WIN program.…”

“Get Ready and Empowered About Treatment” (GREAT) Study: a Pragmatic Randomized Controlled Trial of Activation in Persons Living with HIV

“…37 Improvements in PAM levels are associated with lower odds of having an emergency department visit 38 and lower health care costs among highcost patients. 39 These findings suggest greater costeffectiveness when targeting patients at increased risk for high costs. Moreover, the intervention was successful in engaging patients in use of the ePHR with a variety of educational levels and variable rates of prior electronic technology use.…”