June 22, 2016
Is Patient Activation the Answer? Engaged Patients Could Yield Lower Costs for Hospitals
Accountable Care Organizations (ACOs) are growing rapidly in the United States because of new pay-for-performance incentives under the Affordable Care Act. These provider networks currently cover more than 28 million patients across the country, whereby they agree to cover a set number of patients for a fixed cost per year. One of the central tenets of the ACO model involves providers agreeing to take on some level of financial risk for the patients in the population they choose to manage (e.g., patients within certain geographic areas, patients with certain conditions), because the health systems are no longer reimbursed for each individual service that they provide. Thus, it has become critical for providers to have a better understanding of which patients are at high risk for excessive utilization, since those patients could have a large impact on a health system’s bottom line.
There has been increased focus in recent years on trying to better understand the extent to which patients take charge in managing their own conditions. This concept, known as patient activation, suggests that risk prediction models will be incomplete if they do not also take into account whether a given patient is able and willing to take steps going forward toward better self-management. Even if a hospital can identify potentially risky patients with utilization data alone, the health system will be less effective at managing those patients without understanding patient activation levels.