Patients With Lower Activation Associated With Higher Costs; Delivery Systems Should Know Their Patients’ ‘Scores’
Abstract
Patient activation is a term that describes the skills and confidence that equip patients to become actively engaged in their health care. Health care delivery systems are turning to patient activation as yet another tool to help them and their patients improve outcomes and influence costs. In this article we examine the relationship between patient activation levels and billed care costs. In an analysis of 33,163 patients of Fairview Health Services, a large health care delivery system in Minnesota, we found that patients with the lowest activation levels had predicted average costs that were 8 percent higher in the base year and 21 percent higher in the first half of the next year than the costs of patients with the highest activation levels, both significant differences. What's more, patient activation was a significant predictor of cost even after adjustment for a commonly used "risk score" specifically designed to predict future costs. As health care delivery systems move toward assuming greater accountability for costs and outcomes for defined patient populations, knowing patients' ability and willingness to manage their health will be a relevant piece of information integral to health care providers' ability to improve outcomes and lower costs.
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The Patient Activation Measure (PAM) is a validated measure of patient activation that includes a person's beliefs, motivation, and actions for self-care.
“Participants also completed the 10-question Patient Activation Measure (PAM), a validated measure of patient activation that includes person’s beliefs, motivation, and actions for self-care at these visits [9,23,24].”
Cites
Hibbard, J. H., Stockard, J., Mahoney, E. R., & Tusler, M. (2004) · Health Services Research · doi:10.1111/j.1475-6773.2004.00269.x · Cited by 2,748 · see citing works
Self-citationDevelopment and Testing of a Short Form of the Patient Activation Measure
Hibbard, J. H., Mahoney, E. R., Stockard, J., & Tusler, M. (2005) · Health Services Research · doi:10.1111/j.1475-6773.2005.00438.x · Cited by 1,939 · see citing works
Self-citationGreene, J., & Hibbard, J. H. (2011) · Journal of General Internal Medicine · doi:10.1007/s11606-011-1931-2 · Cited by 1,030 · see citing works
Self-citationDo increases in patient activation result in improved self-management behaviors?
Hibbard, J. H., Mahoney, E. R., Stock, R., & Tusler, M. (2007) · Health Services Research · doi:10.1111/j.1475-6773.2006.00669.x · Cited by 906 · see citing works
Self-citationA 2020 vision of patient-centered primary care
Davis, K. C., Schoenbaum, S. C., & Audet, A. J. (2005) · Journal of General Internal Medicine · doi:10.1111/j.1525-1497.2005.0178.x · Cited by 683 · see citing works
METHODS FOR ANALYZING HEALTH CARE UTILIZATION AND COSTS
Diehr, P. K., Yanez, D., Ash, A. S., Hornbrook, M. C., & Lin, D. Y. (1999) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.20.1.125 · Cited by 663 · see citing works
Is Patient Activation Associated With Outcomes of Care for Adults With Chronic Conditions?
Mosen, D. M., Schmittdiel, J. A., Hibbard, J. H., Sobel, D. S., Remmers, C., & Bellows, J. (2007) · Journal of Ambulatory Care Management · doi:10.1097/00004479-200701000-00005 · Cited by 478 · see citing works
Self-citationNutting, P. A., Miller, W. L., Crabtree, B. F., Jaén, C. R., Stewart, E. E., & Stange, K. C. (2009) · The Annals of Family Medicine · doi:10.1370/afm.1002 · Cited by 472 · see citing works
Druss, B. G., Zhao, L., von Esenwein, S. A., Bona, J. R., Fricks, L., Jenkins-Tucker, S., Sterling, E., DiClemente, R., & Lorig, K. (2010) · Schizophrenia Research · doi:10.1016/j.schres.2010.01.026 · Cited by 363 · see citing works
Online Diabetes Self-Management Program
Lorig, K., Ritter, P. L., Laurent, D. D., Plant, K., Green, M., Jernigan, V. B. B., & Case, S. (2010) · Diabetes Care · doi:10.2337/dc09-2153 · Cited by 316 · see citing works
Improving the outcomes of disease management by tailoring care to the patient's level of activation.
Hibbard, J. H., Greene, J., & Tusler, M. (2009) · PubMed · Cited by 312 · see citing works
Self-citationMethods for Improving Regression Analysis for Skewed Continuous or Counted Responses
Afifi, A. A., Kotlerman, J. B., Ettner, S. L., & Cowan, M. J. (2006) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.28.082206.094100 · Cited by 263 · see citing works
Management of Chronic Disease by Patients
Clark, N. M. (2003) · Annual Review of Public Health · doi:10.1146/annurev.publhealth.24.100901.141021 · Cited by 262 · see citing works
Remmers, C., Hibbard, J., Mosen, D. M., Wagenfield, M., Hoye, R. E., & Jones, C. (2009) · Journal of Ambulatory Care Management · doi:10.1097/jac.0b013e3181ba6e77 · Cited by 242 · see citing works
Self-citationFowles, J. B., Terry, P., Xi, M., Hibbard, J., Bloom, C. T., & Harvey, L. (2009) · Patient Education and Counseling · doi:10.1016/j.pec.2009.02.018 · Cited by 221 · see citing works
Self-citationEffect of Patient Activation on Self-Management in Patients With Heart Failure
Shively, M. J., Gardetto, N. J., Kodiath, M. F., Kelly, A., Smith, T. L., Stepnowsky, C., Maynard, C., & Larson, C. B. (2013) · Journal of Cardiovascular Nursing · doi:10.1097/jcn.0b013e318239f9f9 · Cited by 203 · see citing works
Deen, D., Lu, W.-H., Rothstein, D., Santana, L., & Gold, M. R. (2010) · Patient Education and Counseling · doi:10.1016/j.pec.2010.07.026 · Cited by 152 · see citing works
Disease Management and the Organization of Physician Practice
Casalino, L. P. (2005) · JAMA · doi:10.1001/jama.293.4.485 · Cited by 139 · see citing works
Translating Primary Care Practice Climate into Patient Activation
Becker, E. R., & Roblin, D. W. (2008) · Medical Care · doi:10.1097/mlr.0b013e31817919c0 · Cited by 132 · see citing works
Practice Redesign And The Patient-Centered Medical Home: History, Promises, And Challenges
Kilo, C. M., & Wasson, J. H. (2010) · Health Affairs · doi:10.1377/hlthaff.2010.0012 · Cited by 129 · see citing works
Hibbard, J. H., & Tusler, M. (2007) · Journal of Ambulatory Care Management · doi:10.1097/00004479-200701000-00002 · Cited by 127 · see citing works
Self-citationActivating Seniors to Improve Chronic Disease Care: Results from a Pilot Intervention Study
Frosch, D. L., Rincon, D., Ochoa, S., & Mangione, C. M. (2010) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2010.02980.x · Cited by 97 · see citing works
Donald, M., Ware, R., Ozolins, I. Z., Begum, N., Crowther, R., & Bain, C. (2011) · Patient Education and Counseling · doi:10.1016/j.pec.2010.05.031 · Cited by 63 · see citing works
Terry, P. E., Fowles, J. B., Xi, M., & Harvey, L. (2011) · American Journal of Health Promotion · doi:10.4278/ajhp.091029-quan-348 · Cited by 35 · see citing works
Plan design and active involvement of consumers in their own health and healthcare.
Hibbard, J. H., Greene, J., & Tusler, M. (2008) · PubMed · Cited by 15 · see citing works
Self-citationPatient Activation and Functional Recovery in Persons Undergoing Spine Surgery
Skolasky, R. L., MacKenzie, E. J., Wegener, S. T., & Riley, L. H. (2011) · Orthopedics · doi:10.3928/01477447-20110922-04 · Cited by 13 · see citing works
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Hibbard, J. H., & Greene, J. (2013) · Health Affairs · doi:10.1377/hlthaff.2012.1061 · Cited by 1,787 · see citing works
Many Mobile Health Apps Target High-Need, High-Cost Populations, But Gaps Remain
Singh, K., Drouin, K., Newmark, L. P., Lee, J., Faxvaag, A., Rozenblum, R., Pabo, E. A., Landman, A., Klinger, E., & Bates, D. W. (2016) · Health Affairs · doi:10.1377/hlthaff.2016.0578 · Cited by 201 · see citing works
Frias, J., Virdi, N., Raja, P., Kim, Y., Savage, G., & Osterberg, L. (2017) · Journal of Medical Internet Research · doi:10.2196/jmir.7833 · Cited by 211 · see citing works
Team-Based Care and Patient Satisfaction in the Hospital Setting: A Systematic Review
Will, K. K., Johnson, M. L., & Lamb, G. (2019) · Journal of Patient-Centered Research and Reviews · doi:10.17294/2330-0698.1695 · Cited by 134 · see citing works
Jerofke, T., Weiss, M., & Yakusheva, O. (2014) · Journal of Advanced Nursing · doi:10.1111/jan.12286 · Cited by 61 · see citing works
Shah, V. O., Carroll, C., Mals, R., Ghahate, D., Bobelu, J., Sandy, P., Colleran, K., Schrader, R., Faber, T., & Burge, M. R. (2015) · PLOS ONE · doi:10.1371/journal.pone.0125820 · Cited by 45 · see citing works
Eikelenboom, N., van Lieshout, J., Wensing, M., Smeele, I., & Jacobs, A. E. (2013) · Trials · doi:10.1186/1745-6215-14-336 · Cited by 26 · see citing works
- Authors
- Hibbard, J. H., Greene, J., & Overton, V.
- Affiliations
- University of Oregon (US)
- George Washington University (US)
- Fairview Health Services (US)
- Venue
- Health Affairs
- Publisher
- Health Affairs Publishing, LLC
- Published
- 2013-02
- Volume
- 32
- Issue
- 2
- Pages
- 216-222
- ISSN
- 0278-2715 (ISSN-L)
- 1544-5208
- OpenAlex
- W1980913014
- Cited by
- 398
- References
- 26
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 25 · 2023: 20 · 2022: 21 · 2021: 32 · 2020: 18 · 2019: 31 · 2018: 45 · 2017: 36 · 2016: 50 · 2015: 47 · 2014: 26 · 2013: 30
- FWCI
- 119.34
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Health Affairs (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Health Professions › General Health Professions › Patient Satisfaction in Healthcare
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- patient activation, health care costs, cost prediction, risk adjustment, health care delivery systems, patient engagement, cost accountability
- MeSH terms
- Adult, Aged, Chronic Disease, Cost Control, Delivery of Health Care, Female, Humans, Male, Middle Aged, Patient Participation, Quality of Health Care, Health Care Costs, Health Care Reform
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