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

2. 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.
What does it really mean to be an activated engaged consumer and how to we make that happen in large population groups and within individuals?

3. Activation is developmental
Having measurement, --- enormous opportunity to understand the process of becoming more engaged. Also understand what is going on with people at different points on this continuum. Low end. Poor problem solving, negative emotions, overwhelmed, discouraged, rather not think. May not see it as their job.
High end. Have health goals, pro-active, information seekers, good problem solving skills.
Think about the person at the low end… coming in for a visit.
People who are not activated– giving them more information is not going to help.
Source: J.Hibbard, University of Oregon

4. 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 self-management behaviors
Engaged in more health information seeking behaviors

5. Activation Level Linked with Most Behaviors
Activation is about taking ownership and taking charge.
Good news: activation is changeable– when gaining in activation, more than one behavior changes…
Bad news: many of the behaviors…
Source: US National sample 2004

6. Implications Experiencing success
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
By not really knowing where people are– we are in effect throwing non-swimmers into the deep end of the pool and hoping for the best.
What about people who are not activated, are we just discouraging them further?
start with behaviors that are feasible– whether the clinical encounter– telephonic coaching– employer communications– -- the idea is to help or
People gain a sense of competency:
Experiencing success
Physician support is important
Encouragement
Seeing others like them succeed.

7. Low activation signals problems (and opportunities)
Study population – Age 50 to , At least one serious chronic condition 7

8. The Activation can predict utilization and health outcomes two years into the future for diabetics
% change for a 1 point change in PAM Score
Comparing a PAM Score of 70 (L4) vs. 50 (L2) P
Hospitalization
1.7% decline
34% decreased likelihood of hospitalization
.03
Good A1c control
(HgA1c < 8%)
1.8% gain
40% greater likelihood of good glycemic control
.01
A1c testing
3.4% gain
68% greater likelihood of testing
LDL-c testing
Robust measurement that predicts important outcomes…
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.

9. What specific Interventions Have Been Shown to Increase Activation?
Stanford CDSMP (peer support and problem solving)
Worksite programs– Environmental
Tailored coaching
Clinician support
Social Norms (modeling, messaging, opportunities to engage in behaviors)
Opportunities or situations that make it easier to engage in behaviors and to experience success (which builds confidence)
Environments that are supportive of self-management and healthy behaviors are correlated with higher levels of activation:
Physician support for self management
Employers that support healthy behaviors (both providing opportunities and setting norms)
Families and neighborhoods that enable and encourage healthy behaviors

10. 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.

11. The intervention group demonstrated significant reductions in utilization
Tailored coaching
Usual coaching

12. 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.