Steep costs associated with low activation

As voices calling for more patient engagement in healthcare grow louder, a new study reveals that patients with very low activation levels are significantly associated with higher healthcare costs now and in the future.

A study released in the February issue of Health Affairs found that patients with the lowest patient activation scores had predicted average costs in the base year that were 8 percent higher than patients with the highest activation scores and 21 percent higher in the first half of the next year.

Patient activation is a term describing the skills, knowledge, willingness and confidence patients have to become actively engaged in their healthcare. Patient activation falls under the umbrella of patient engagement but is not synonymous.

The study analyzed 2010 and 2011 data from 33,163 primary care patients of Fairview Health Services, a large healthcare delivery system based in Minnesota. Researchers assessed patient activation using the Patient Activation Measure.

Other research using the Patient Activation Measure, the researchers noted in their study, has indicated that patients with higher activation adhere to treatment plans and medications, get preventive care and are more likely to engage in healthy behaviors than those with lower levels of activation.

Given the association between higher patient activation and lower costs and lower patient activation and higher costs, the study concludes that implementing techniques to increase patient activation may be a way for the healthcare industry to improve patient outcomes and lower costs.

“I think that there is a lot of dawning of understanding now that patients have to be part of the solution,” said Judith Hibbard, one of the authors of the study and a senior researcher at the Health Policy Research Group of the Institute for Sustainable Environments.

Patients with low activation, she said, often respond well to tailored support, which encourages them to become more involved with their care. As patients with low activation become better educated and experience some small successes, their motivation goes up and they increasingly become more activated.

Tailored support includes helping patients prepare for medical visits, coaching them on questions they should ask, and following up with patients after a visit to go over what happened during the visit.

While this sort of support most often takes place in a primary care setting, Hibbard said, hospitals can engage their patients by doing follow-up home visits after hospitalization or follow-up phone calls to help newly-discharged patients prioritize their post-hospital care and ultimately reduce hospital readmissions.