A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Patient "Activation" Critical Component of Better (and Cost-Effective) Care

Patient "Activation" Critical Component of Better (and Cost-Effective) Care

March 10, 2016

Patients who are engaged in their own care, and have the access and confidence to take an active role in their own health are sometimes referred to as “activated” patients. HCFA has long supported encouraging medical care providers to use patient activation or patient confidence measures, as they “result in better health outcomes, reduced costs, reduced disparities, and better satisfaction with one’s health care.” Our ACO recommendations urged use of these tools which encourage patients and clinical providers to be full partners in care.

Now, a new Health Affairs study has confirmed the value of these tools in the ACO context, and the implications are far-reaching.

ACO care managment targets high-risk patients for additional support. These high-risk patients are expected to need the most care, and high levels of support should result in the most cost savings, as well as better health outcomes. However, health systems generally look at past medical claims data for guidance on the likely future needs of high-usage consumers. For this new study, researchers posited that the missing element was the lack of consideration of a person’s level of “activation.” Knowing this can help predict how likely a person is to use costly services, and can help improve care.

In the study, researchers looked at people who were considered to be high-risk based on the standard measures which look at demographic characteristics, episodes of care, diagnoses, and pharmacy use. They then examined this population's activation levels, and divided them into 4 categories based on their specific level of activation. The study found that those who were more engaged in their care had a lower chance of being hospitalized or of having emergency room visits. The study also found that overall costs were generally lower for patients with high activation levels. The study found that "combining the costs associated with hospitalizations and ED visits, the differential between the patients at the lowest level of activation and the highest level was $5,168 in 2012 and $3,129 in 2014."

What does this mean for patient-centered care? Health care providers can use these tools to more accurately tailor their care based on the patient’s activation levels. Also, a number of interventions have been shown to effectively increase patient activiation levels. This study confirms the value of paying attention to the whole patient, and not just their medical test scores. HCFA will continue to press for more use of patient activation and confidence tools in Massachusetts health care.

                          - Sara O'Brien