Value-based care (VBC) reimbursement models are designed to reward providers for improving patient outcomes and controlling costs of care. This is in contrast to the traditional “fee for service” (FFS) model, under which providers are financially rewarded based on volume.
While it is providers who are paid for performance under VBC contracts, their ability to generate positive clinical outcomes depends largely on their success in engaging patients in their own care journeys. Patient engagement is critical to effective care coordination and care management.
In a 2016 study, the Commonwealth Fund wrote that “patients who did not feel competent to manage their own health or navigate the health care system were more likely to develop a chronic disease over a three-year period than ‘activated’ patients with good self-management skills.” Patients with low activation levels were “linked to significantly greater likelihood of hospitalization and emergency department (ED) use for ‘ambulatory care-sensitive’ conditions,” or conditions that are avoidable if properly managed.
A patient engagement strategy The first step for providers in creating a patient engagement initiative is to gain a greater understanding of patient status by stratifying a patient population to identify people who have one or more chronic diseases. Once chronic/polychronic individuals are identified, providers can implement outreach efforts to educate these people about managing their conditions and conduct outreach to offer care opportunities.
An important element of risk is how well patients both manage their health and navigate the healthcare system. To identify people who could benefit most from a care intervention, providers can use a Patient Activation Measure (PAM) that scores individuals on a 0-100 scale. Individual PAM scores can be categorized into four levels of activation, from low (1) to high (4). Level 1 patients are considered least able to manage their health.
Once providers establish a baseline PAM score, they can implement educational and informational programs to help patients improve their abilities to manage their health. Follow-up PAM testing then can be conducted to measure progress.
Once a baseline PAM score is established, providers can seek to improve a patient’s ability to self-manage through education, after which they should conduct a follow-up measurement to assess progress. “The outcome measured is a change in activation over time,” writes the American College of Physicians. “The change score would indicate a change in the patient´s knowledge, skills, and confidence for self-management. A positive change would mean the patient is gaining in the ability to manage her health.”