Improved Activation, Cost Savings
To succeed, health programs must engage the least activated: levels 1 & 2. The impact of these two levels on health costs is nearly twice their 30-45% representation in employed and Medicare-aged populations. Tailoring support to activation levels has proven effective at moving the low-activation individuals.
Disease Management Program Study
In a 6-month study, an intervention group was coached by phone using the PAM and tailoring support to levels of activation. A control group, represented by another call center, did not tailor support to levels of activation. Both call centers were trained in Motivational Interviewing (MI). The intervention group gained 4.6 points in activation over 5 months, while significantly outperforming the control group with declines of 22% in ER visits and 33% in hospitalization. The Intervention group generated healthcare savings net of control group change of $156 per member per month.
Medical Home Program
Since 2009, PeaceHealth, a clinic and hospital system in OR, WA and AK, has been using the PAM and Coaching for Activation in support of their patient centered medical home and care transition programs. Patient support and coaching resources is tailored to level of activation.
From April 2009 to September 2012 results from Eugene, OR show a steady decrease in patient visits to the ER or urgent care (see chart). Findings also show improved patient access to clinic appointments with an increase from 60% to 74% of open slots. Hypertensive patients with controlled BP went from a baseline of 56% in Jan 2009 to 77% as of Jan 2011, while diabetes patients saw improvements in LDL and A1C.
Medicaid Program Study
The PAM and its related tailored coaching was integrated into one of three Medicaid pilot programs in the state of Washington. It was the only pilot to show a positive return. Coaching was provided through in-home sessions and phone support over a 9-month period. The intervention group generated savings of $109 per member per month, beyond the nominal saving seen in the control group. 80% of health care savings were driven by reduced ER utilization.
