Transcript Engaging Consumers to Improve Health and Reduce Costs Judith Hibbard, DrPH Professor University of Oregon © 2008 University of Oregon.

Engaging Consumers to Improve
Health and Reduce Costs
Judith Hibbard, DrPH
Professor
University of Oregon
© 2008 University of Oregon
Engaged Consumer
• What does it mean to be “activated” or
“engaged?”
• Have knowledge, skill, confidence to manage health
and health care
• In any population group, some people will be
at the low, middle, and high end of this
dimension.
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Activation is developmental
Source: J.Hibbard, University of Oregon
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Activation Level is Predictive of Behaviors
Research consistently finds that those who are more
activated are:
– Engaged in more preventive behaviors
– Engaged in more healthy behaviors
– Engaged in more disease specific selfmanagement behaviors
– Engaged in more health information seeking
behaviors
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Activation Level Linked with Most Behaviors
Source: US National sample 2004
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Implications
▶
Many of the behaviors we are asking of people are only done by
those in highest level of activation
▶
Persistence in asking – when don’t understand--in medical encounter
▶
Effectively use high deductible health plans
▶
Knowing about treatment guidelines
▶
Using quality information/ knowing where to find it
▶
When we focus on the more complex and difficult behaviors– we
may discourage the least activated
▶
Start with behaviors more feasible for consumers to take on,
increases individual’s opportunity to experience success.
▶
Help consumers by breaking behaviors down into smaller steps
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Low activation signals problems (and opportunities)
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The Activation can predict utilization and health
outcomes two years into the future for diabetics
Hospitalization
Good A1c control
(HgA1c < 8%)
A1c testing
LDL-c testing
% change for a 1
point change in
PAM Score
Comparing a PAM
Score of 70 (L4) vs.
50 (L2)
1.7% decline
34% decreased
likelihood of
hospitalization
.03
1.8% gain
40% greater
likelihood of good
glycemic control
.01
68% greater
likelihood of testing
.01
3.4% gain
Carol Remmers. The Relationship Between the Patient Activation Measure, Future Health
Outcomes, and Health Care Utilization Among Patients with Diabetes. Kaiser Care
Management Institute, PhD Dissertation.
Multivariate analysis which controlled for age group, gender,
race, comorbidities and number of diabetes-related prescriptions.
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P
What specific Interventions Have Been
Shown to Increase Activation?
• Stanford CDSMP (peer support and problem
solving)
• Worksite programs– Environmental
• Tailored coaching
• Clinician support
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Tailored Coaching Study
▶ Intervention group coached based on level of activation.
Control group was “usual care” coaching (DM company)
▶ Examined changes in claims data, clinical indicators, and
activation levels
▶ 6 month Intervention period.
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The intervention group demonstrated significant
reductions in utilization
Tailored coaching
Usual coaching
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Supporting Activation
►Means supporting people where they are
►Moving away from a generalized approach to a
tailored or segmented approach.
►Doing so will likely increase the efficiency and efficacy
of efforts.
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