What has not been clear is what a physician can do to improve a patient's activation measure. First, Overton says she had to gain physicians' trust about using PAM with patients. Now, even though definitive clinical outcomes are not yet available, the results of the most recent PAM study have allayed physicians' concerns, says Overton, because researchers found that when PAM levels improve, so does patient health.
Published in March in Health Affairs, a longitudinal study of patients who had their PAM levels taken twice, once in 2010 and again in 2012, showed that 58% of patients did not move between PAM levels, but of the 42% of patients who did either increase or decrease their activation level, their outcomes and costs moved with them. For example, 9% of patients with a baseline of PAM level of 3 or 4 moved to a PAM level of 1 or 2. Those patients' incidence of having higher A1c levels, going to the emergency department, and being obese also increased, as opposed to those who improved their PAM levels.
Fairview Medical Group is engaging with its clinicians now to figure out what interventions are most effective at improving a patient's PAM score. "This study is a turning point for us," says Overton. "We're trying to understand how to help our clinicians embrace certain ways of interacting with patients that are engaging to patients and are likely to improve their engagement. What does it really take to change activation levels? We're looking at patient-facing technologies, patient monitoring, websites related to their disease management, and improving provider interpersonal communication skills and coaching skills."
Overton says the medical group has taken a step in determining how it can improve patients' PAM scores by differentiating how patients are managed. For example, Fairview Medical Group experimented with using health coaches to help depressed patients. She says the group added a health coach to the care management of mildly to moderately depressed patients with a low PAM score. The additional resource was supposed to improve patients' depression, but what the group found was that the combination of depression and low activation was too much for a health coach to handle. Overton says they learned that patients needed more targeted resources.
"We're going back to the drawing board," says Overton. "We're pursuing using more behavioral health counselors for patients with depression and a low activation score, but using health coaches for patients with high activation scores. Our behavioral health resources are scarce, and we want to make sure we get the right patients to the right resources."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.