Are you an “activated” patient? A new study suggests that involving patients more deeply in their treatment decisions – an approach known as “patient activation” – is correlated with lower costs and better outcomes. Researchers considered data from a Minnesota healthcare system which encompassed over 33,000 patients, looking at impatient, outpatient, laboratory, and patient costs. The researchers then contrasted these costs with a measure of patient activation, which they derived from questionnaires about patient confidence in their doctors: for example, patients were asked to agree or disagree if they were “confident that [they] can tell a doctor [their] concerns, even when he or she does not ask.”
These comparisons revealed that the least activated patients had costs which were 8 percent higher than those with the highest activation scores. These differences increased when considering patients with chronic conditions: a 12 percent difference for those with high cholesterol, and a 21 percent difference for patients dealing with asthma. In the 2011 study, which only considered outpatient care and laboratory work, researchers observed non-activated patients paying costs 21 percent higher than activated patients.
Chapter 224 includes a number of provisions to promote measuring, and acting on, patient engagement. The ACO and medical home certification standards in the law include provisions on shared decision-making, home-based patient activation, end-of-life decision supports, and community based public health interventions that include social determinants of health. We strongly support using patient engagement and confidence measures as a key quality indicator and basis for payment.
Efforts to involve patients in their own care are nothing new, but these arguments have generally been framed in an ethical sense. This new study adds a fiscal incentive for patient activation, which could be a strong motivator for providers to jump on board. The authors of the study suggest monitoring patient activation, using that data to provide support those patients who are less willing or able to make decisions about their care. In any case, these new findings offer the opportunity for new perspectives on treatment and provider-patient interaction, and provide new incentives to try a patient-centered approach.