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Information and Documents

Who is Insignia Health

Insignia Health works closely with hundreds of healthcare organizations and providers around the world to help patients become more successful managers of their health. This collaboration is anchored by the Patient Activation Measure® or PAM® and a proven model to apply PAM results to align resources and tailor support based upon a patient’s level of activation. Over two decades of research shows that as activation increases self-care improves and ED visits, unplanned hospital admits and readmits decline.

What is the Patient Activation Measure® (PAM®), and Why is it Important?

A strong body of research shows that individual behavior has the greatest impact on illness burden and premature death among the key determinants of health. Helping patients achieve sustainable gains in their self-management ability is essential to the success of value-based programs where most performance measures are dependent on patient behavior.

The patient activation journey begins with measurement. The PAM survey is a 13-item survey that measures a person’s self-management ability or activation. PAM questions assess the knowledge, skills and confidence essential to managing one’s own health and healthcare. The assessment segments individuals into one of four increasing levels of activation along a 100-point scale. The value of even a single point of change along the 100-point scale is meaningful, with 10 to 12 points between PAM levels. The four PAM levels are aligned with a deep understanding of patient behavior and the barriers and enablers to achieving sustainable gains in activation. PAM activation levels help to guide patient support through optimal use of resources and tailored communications. Change in activation (pre and post PAM administration) is used to assess program or intervention impact and is a performance measure for the CMS MOM model.

The PAM is a fast, reliable and effective tool that can predict behavior in and is a performance marker to accurately show improvement for each patient.

Additionally, the PARENT and CAREGIVER PAM are used in situations where giving the patient the Patient Activation Measure is not conducive to accurate results (ie. Severe mental health issues, cognitive brain disorders, age… etc). Giving a parent or a caregiver the respective PAM measures that persons Activation level and score, not the patient. It measures the knowledge, skills and confidence of their caregiver or parent. People will score differently based on their role so it is not surprising to find a person with differing scores and levels based on the PAM version they completed.

Scoring Options

Everyone receives Flourish
plus one option:

• Flourish only (Everyone receives)
• Flourish + PAM iPad App
• Flourish + API
• Flourish + SMART App

• Epic EHR Integration
• Cerner – Contact Insignia Health directly

Flourish only

(Please see Supporting Documents below for a video demonstration)

1. To support PAM administration, Insignia Health will provide participants access to our Flourish Platform:

  • The Flourish Platform is Insignia Health’s HIPPA compliant, centralized platform for enrolling patients, scoring PAM surveys, and reporting (both for you and to support required downstream reporting to CMS).

2. The Flourish Platform includes:

  • Flourish Admin (Web based application)
  • Flourish iPad (iOS based app)
  • PAM SMART App (SMART on FHIR, allowing integration w/ EHR)
  • Flourish API (RESTful APIs allowing clients to build the PAM survey within their system)
  • All options will provide back a PAM score and level
  • All options will be using the patient MBI number as an identifier only

3. All Participants receive access to Flourish Admin and one additional option, but can purchase access to additional options.

4. As required by the model, Insignia Health will provide a quarterly data feed that will include all scored surveys for the previous quarter and participants that were excluded from the program or opted out of the program.

5. We have role-based access controls to provide your teams with the ability to enroll patients, administer and score surveys, and also to view reports. The three roles are:

  • Client Administrators (view all patients)
  • Group Administrators (view patients assigned to their group)
  • Coaches (view patients assigned to their groups)

See support documents for details of each role

6. Groups can be set up to separate data (See below for details).

7. We also have 16 language options imbedded in Flourish and we have over 30 on paper. (See list under supporting documents)

8. Administration options:

  • In-person (read to the patient)
  • Paper (completed by the patient)
  • Email (Can email to group of patients or individual patient)
  • PAM Express (Please see supporting documents for more information)

If you choose PAM Express as a scoring option, Insignia Health will need the following information (language is limited to English only):

  • Your business logo for the header of the website (please attach and see requirements below)
  • Choose a header color for the webpage (Green is default)
  • A name for the subdomain (ex: ABCHealthOrg.insigniahealth.com)
  • Or give it over the phone

9. Once a survey is administered, the system will provide back a PAM score and level.

10. Coaches will have access to all PAM history, allowing them to view how the patients PAM score and level have changed over time.

Option 1: Flourish + PAM iPad App

(Please see Supporting Documents below for a video demonstration)

1. iOS based application that works on iPads:

  • Provides a quick method for enrolling users and administering PAM surveys
  • All survey data is sent back to Flourish for scoring
  • Setup Quick and easy process, taking only a few minutes
  • Insignia Health will provide you a manual and will walk you through the setup process
  • Once the initial iPad is setup, you will be responsible for setting up additional iPads

2. Regarding the administration process:

  • Registration requires a patient MBI
  • Select the survey to be administered, the PAM survey or caregiver
  • Answer the survey:
    • Coach view – reiterate PAM score and level
    • Patient view – reiterate no PAM score and level
  • PAM History (and syncing):
    • The PAM app will store PAM history until connected to the internet.
    • Once connected, PAM surveys will be sent to the Flourish Platform.

Option 2: Flourish + API
(Application Programming Interface)

(Please see Supporting Documents below for a video demonstration)

1. APIs that allow you to integrate the PAM survey within your standard workflow:

  • Secured using a client Identifier and password
  • All data is stored within the Flourish Platform

2. Setup Process consists of:

  • Your team building the 13 PAM questions and answers within your in-house care management system or EHR
  • You will build the integration required to connect your system to the Flourish APIs
  • Minimally requires 2 calls:
    • Enroll User: Required prior to survey scoring
    • Score Survey: Sent survey answers with the corresponding MBI sent in the previous call
    • System will send a response that includes the PAM score and level

3. You will build fields to store the PAM score, level, and history.

4. Implementation Timeline:

  • Can take a few days to weeks, varies by in-house team and system complexity

Option 3: Flourish + SMART App

(Please see Supporting Documents below for a video demonstration)

1. SMART on FHIR application allowing you to launch and administer PAM surveys from within your EHR system Supports:

  • Epic – App Orchard
  • Cerner – App Store
  • Working towards future integrations

2. Launch Process:

  • A link or button will be displayed within the patients record
  • Click on the link or button
  • Launch the PAM SMART App within the EHRs browser

3. Features:

  • If no previous PAM surveys, provide a brief overview of the different PAM levels
  • Click take a survey button
  • Complete the 13 questions, click submit
  • Cerner does not support this functionality

Flourish Group/Subgroup Structure

A client’s organizational structure can consist of up to two levels of hierarchy: Group(s) and Subgroups(s). All clients must have at least one Group/Subgroup and every Group must have at least one Subgroup associated with it. This structure allows the client to control clinician’s access to a limited set of patient/member data and view Flourish Admin Reports based on Groups/Subgroups.

The client or sponsoring organization is setup at the Client level and provides an aggregate view of the entire organization. The Client Administrator role accesses patient/member data at client level and can see reports at a Client level or on a group by group basis.

Groups allow the Client to be segmented for access and reporting purposes. Coaches and Group administrator roles can be configured so that they only see the users and reports that belong to the Groups to which they have been assigned. Additionally, different surveys (for example PAM13 vs. Care-giver PAM13) can be provisioned for different groups.

Subgroups are required for each Group created within the structure. A Group may have more than one Subgroup associated with it to allow for more access and reporting segmentation. A Group admin assigned to the Group will see all subgroups within the Group. Coaches are assigned at the Subgroup level.


Integrating PAM into your workflow can take some careful thought and consideration. Practice patterns and workflows may vary across sites. Insignia’s team will share best practices, developed and refined over the last 15 years, to support the best possible integration of PAM for an organization.

After the decisions have been made about which scoring options will be utilized, PAM versions selected and groups and subgroups created, there are several things to keep in mind when integrating PAM into your workflow.

  • When PAM will be administered: Administering PAM at the beginning of a session with a patient will yield the best results. Administering PAM at the middle or end of a session will increase bad data and outliers.
  • Methods of PAM administration: There are several ways that the PAM can be given (paper, phone, iPad, EMR). It is possible that an organization may use one or multiple methods. Consideration must be given to when PAM will be administered, by whom and how will that data be applied.
  • How to administer the PAM assessment: It is important to be consistent when presenting PAM to your patients. Even if multiple administration methods are being employed, all patients need to receive the same context through a proper introduction.
  • How often to re-administer PAM: Insignia Health recommends re-administering PAM no sooner than once every 3 months.
  • Find a list of languages available under supporting documents

Please see examples under support documents to aid you in your workflow process decision-making.


The eLearning platform is designed to get a coach up to minimum competence with PAM. It is divided into 6 modules and should take a coach approximately 2 hours to complete all modules. The eLearning modules cover an introduction to PAM, the PAM approach, low and high-activated patients and administering the PAM for best results.

On-site Training:
On-site training is designed for maximum effectiveness with immediate feedback to training group. Trainer will answer any and all questions relating to PAM and its administration on the spot while helping navigate potential road blocks to completing PAM. On-site training is meant to be dynamic and engaging to ensure best practices and fidelity are upheld.

On-site training consists of a 4-hour block of time comprehensively discussing PAM and how to best implement the survey for maximum use. Breaks will be given approximately once an hour and trainer will remain open for follow-up questions or comments.

Training consists of a PowerPoint presentation, a folder with helpful handouts and job aids. The training is designed to be fully interactive and tailored to each audience.

Training topics to be covered: What is PAM, PAM Personas guide and PAM Administration.

Webinar Training:
Webinar trainings are designed to be as engaging as possible via the Webex platform. The trainer is available for immediate feedback for questions or comments. Webinars are generally preferred when staff members are remote and cannot gather in one location.

The webinar training is similar to the On-site training but tends to be less effective than an On-site training. Materials will be sent ahead of time for learners to be prepared the day of the event.

Training topics to be covered: What is PAM, PAM Personas guide and PAM Administration.

Train the Trainer:
The Train-the-Trainer training consists of 1.5 days of comprehensive training for staff members. Class sizes are limited to 12 learners. They will be provided all supporting documents to complete a full training independent of the Insignia trainer. Over the course of the day and half training, learners will go beyond basic training and have several opportunities to present the material with feedback from Insignia staff. Insignia will continue to support the trainers post training with resources and a direct line for questions and inquires as they arise. *Requires SOW and additional charges

Monthly Web Trainings
Insignia Health provides 12, free web trainings per year. These two-hour trainings are hosted by Insignia at the beginning of each month and are designed to get the learner up to minimum competence with the PAM survey. Attendance is required as these trainings are not recorded and active participation is highly encouraged. The trainings consist of a 2-hour web session that cover pertinent background and administration skills. Sessions usually entail typical patient interactions with a wide variety of conditions and is geared toward the entry level PAM user.

Insignia Health has put together a series of ultra-short and free supportive tools that endeavor to answer only one question at a time. These video vignettes highlight one burning topic at a time with an average length of 2-minutes per video. These videos serve as a live-action style FAQ and can be accessed at any time by the user. This is another support tool at your disposal to ensure that the PAM survey fidelity is being followed as information is updated regularly and new content added.

*Please see video demonstrations under support documents for more information

CMS Training Dates:
*Please note: All training dates will consist of the same material and it is not required to attend more than one session. Only attendance to one session is required, please choose the date and time that works best for you and be ready to dive deep into the PAM world.*

Administering to Difficult Patients
Training Dates TBD

Next Steps

1. Fill out questionnaireCLICK HERE FOR QUESTIONNAIRE

2. Expect a meeting to be scheduled if implementation into systems:

Flourish only:
Clients will be set up and sent access to the system post training in March

Flourish + iPad: 
Clients will be set up and sent access to Flourish with log in password instructions for the setup of the iPad in March post training

Flourish + API: 
Meetings will be set up with Insignia Health implementation team

Flourish + SMART App:

Epic – Contact Epic in the App Orchard, they will send an email to Insignia Health. 
Insignia Health will contact client to set up an implementation meeting

Cerner – Contact Insignia Health directly

3. Register for training

4. Support email & Phone number:

888-305-8632 – Please leave a message and we will reply within 1 business day.

5. If selecting the PAM Express please send the following with the questionnaire:

a. Your business logo for the header of the website (please attach).
The logo must be a specific size and style for it to work properly. The requirements are:

120×50 pixels (40×50 for mobile)
One of the following formats ( .jpg, .gif, .png, .svg)
Stand out and look good with specified background colors.

b. Choose a header color for the webpage (Green is default)

c. Provide a name for the subdomain (ex: ABCHealthOrg.insigniahealth.com)