(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-P7XLMP6'); (function() { var didInit = false; function initMunchkin() { if(didInit === false) { didInit = true; Munchkin.init('867-GML-252'); } } var s = document.createElement('script'); s.type = 'text/javascript'; s.async = true; s.src = '//munchkin.marketo.net/munchkin-beta.js'; s.onreadystatechange = function() { if (this.readyState == 'complete' || this.readyState == 'loaded') { initMunchkin(); } }; s.onload = initMunchkin; document.getElementsByTagName('head')[0].appendChild(s); })();


Implementation Support

About Insignia Health

Insignia Health works with healthcare organisations and health professionals around the world to utilise the Patient Activation Measure® and a suite of related resources to help patients become more successful managers of their health.

The Patient Activation Measure® (PAM®) and over 16 years of health activation research form the cornerstone of a complementary suite of solutions that help clinicians, coaches and health organisations improve health outcomes through the power of patient behaviour. Today, Insignia Health supports the health activation and supported self-management efforts of more than 250 organisations across the world, including integrated care systems, hospitals and trusts, life science firms, and social sector organisations in the UK to provide more personalised care to millions of patients.

What is the Patient Activation Measure® (PAM®)?

The Patient Activation Measure® (PAM®) is a 10- or 13-item survey that assesses the underlying knowledge, skills and confidence that are integral to managing their own health and healthcare.

PAM places individuals into one of four activation levels along an empirically derived 100-point scale. Each level provides insight into an extensive array of health-related characteristics, including attitudes, motivators, and behaviours.

Individuals in the lowest activation level do not yet understand the importance of their role in managing their own health and have significant knowledge gaps and limited self-management skills. Individuals in the highest activation level are proactive with their health, have developed strong self-management skills, and are resilient in times of stress or change.

More than 850 published studies worldwide have documented PAM’s ability to predict a broad range of health-related behaviours and outcomes, including ED/A&E visits, ambulatory care sensitive utilisation, readmissions, and GP and specialist visits.  As activation increases, preventable hospitalisation declines, health outcomes improve, and patient satisfaction increases. One recent UK study found:

  • For emergency admissions, the predicted probability decreased consistently as PAM scores increased
  • Patients with a higher PAM score were less likely to miss their outpatient appointments
  • The number of GP consultations decreased as PAM score increased in general, showing that patients with higher PAM scores consult their GP less often
  • Patients with a higher PAM score had a lower probability of visiting A&E

PAM Application

PAM is used in three key ways:

  • To segment and risk stratify a population
  • To tailor support to PAM activation levels, and
  • To measure impact over time

PAM® Versions

PAM10 and PAM13 are available for a range of purposes, the versions currently available include:

PAM® Administration


Flourish® is a web-based survey administration portal where survey responses are entered to retrieve a PAM® score and level.

Flourish® also includes the ‘knowledge center’, our eLearning suite for basic PAM® introduction and administration training (separated into six modules) and our Coaching For Activation resource for coaches/clinicians to support them as they navigate level focused healthcare and/or coaching with an individual.

Reporting is also available from within Flourish®, enabling you to view, download, and analyse reports in a way that is meaningful to your organisation and other professional bodies.

Flourish® provides the security of having different levels of access:

1. Coach – have the lowest level of access. A coach can only view the patients allocated to them, administer surveys, use the coaching for activation resource, and where access has been granted they can view reports. In addition, they have full access to the knowledge center.

2. Group Administrator – have the same access coaches have. Group Administrators can also see all of the patients within the group/s they are assigned to, can manage reports, and provide coaches with access to the system

3. Client Administrator – is the highest level of access, having all the access of a Group Administrator with the addition of the ability to add group administrators, create/add/edit groups and subgroups, and have sight of the whole programme. It is important to note here that there is a restricted view client administration role which hides the patient information, this is to be used where the Client Administrator should not be viewing patient information – the default setting is ‘all in view’.

Groups and Subgroups

Flourish® works on a Group/Sub-group structure and this is a critical consideration when setting up a new site within Flourish. This is a way of segmenting data to be appropriate to the needs of the organisation.

Insignia Health suggest that you consider what you would like to be able to report on and then work backwards to establish your group/sub group structure.

Insignia Health are here to help out with this and discuss your ideas so please do get in touch to talk this through.


A suite of reports are available, all of which allow for date, PAM version and subgroup variation to view results and download in both CSV and PDF format. Initial decisions must be made to identify desired reporting subgroups aligned to which version(s) of PAM. 

Coaching For Activation (CFA)

PAM-based Coaching for Activation® (CFA) is built on an extensive base of published PAM research and more than 15 years of experience using this model in a variety of coaching and clinical settings. The CFA online tool helps providers and non-clinical staff create personalised care plans with patients. More than 500 goals, 3,000 action steps and hundreds of PAM-based education articles support goals and action steps within this resource. CFA supports asthma, cancer, chronic pain, COPD, coronary artery disease, diabetes/pre-diabetes, heart failure, chronic kidney disease, wellness, and smoking cessation. Guidance and patient education resources within CFA have been reviewed by a UK medical team.

Recent published meta evaluations have documented the positive impact of tailoring to support to activation levels.

Effects of Patient Activation Intervention on Chronic Diseases: A Meta-Analysis. The Journal of Nursing Research, Oct 2020.

An Examination of the Relationship Between Care Management with Coaching for Activation and Patient Outcomes. The American Journal of Managed Care, February 2017.

Significant findings from these evaluations include:

  • PAM increases predict improvements in behaviours across long term conditions and across multiple studies
  • Improvements in patient activation were more likely to occur if the intervention included an interdisciplinary team.
  • Interventions that significantly improved patient activation levels tailored the intervention to participants’ pre-intervention activation levels

Additional Administration Methods

Application Programming Interface (API)

An API allows PAM® integration into clinical or in-house systems, enabling PAM® to be administered through internal systems. For example: apps and patient/clinical platforms.

Insignia Health already have integrations into many UK EMR’s, please do contact us to see how we can work with you to integrate PAM® into your own systems.


SMART on FHIR application allows you to launch and administer PAM® from within your EMR system.

A PAM® integration typically follows the process below, and a straightforward integration can be implemented in as little as four weeks.

To learn more about PAM integration into your own system through Insignia’s scoring Webservice API or SMART on FHIR application, please contact supportUK@insigniahealth.com.

iPad App

Administration of PAM® using an iPad

  1. An iOS-based application that works on iPad:
    • Provides a quick method for enrolling users and administering PAM® surveys
    • All survey data is sent back to Flourish® for scoring
    • Setup is a 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

Information Governance (IG)

A Data Protection Agreement (DPA) is excluded with a PAM licence as exhibit C.

Key PAM® Implementation Considerations

Your Insignia support team will work with you to implement PAM into both technical systems and patient support workflows. Key questions to address are outlined below.

When will PAM® be administered?

  • Administering PAM® at the beginning of a session with an individual will produce the best results.
  • Administering PAM® at the middle or end of a session can increase bad data and outliers.

How you will administer PAM®?

  • Paper, phone, email, in person, iPad, via EMR integration.
  • An organisation 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 will you present PAM® to the individual?

  • It is important to be consistent when presenting PAM® to your individuals. Even if multiple administration methods are being employed, all individuals need to receive the same context through a proper introduction.

Re-administration of PAM®?

  • Re-administration is a must for everyone. This will identify improvements which the individual has made and ultimately enable you to identify which interventions were used, which worked, and which didn’t.
  • Insignia Health recommends re-administering PAM no sooner than once every three months.

Implementation Process View Content

Initial Planning Sessions

These sessions undertake initial scoping with clients’ key stakeholders to capture implementation details, discuss any potential risks and/or opportunities, and to start the journey toward the best possible integration. Sessions cover the following:

1. Project Aims/Objectives, Contracting, and Introductions

  • Establish key contacts – Ensuring that introductions are made and details are held of key organisational individuals.
  • Understanding outcomes clients hope to achieve and how individual self-management supports these outcome objectives
  • Understanding specific goals from using PAM® and connecting to broader outcome objectives.
  • Understanding the PAM® target audience – certain conditions, illness severity segments, age segments, individuals, carers, parents, etc.
  • Risk identification – including Information Governance, the use of PII data, etc.
  • Timescales – setting clear expectations of key dates for implementation/go live dates/length of programme.
  • Contracting:
    • Call off terms and conditions/Master Service Agreement completed/in progress
    • Vendor set up – Identify the Vendor details required for a new account to be set up
    • Purchase Order Number required? Yes/No
    • Invoicing – Invoice raised and sent to the relevant contact
    • Future dates – Dates arranged for regular contract meetings

2. Administration and Scoring Options

  • Determining PAM® administration – who will administer PAM®? How PAM® will be administered (Web-based, in person/paper/phone/email, PAM® Express (consumer facing with customer branding), iPad, Integration into EMR/clinical systems)
  • How will PAM® results be applied? For example, stratification of individuals, to guide conversations, to organise service provision, individual support programmes, support commissioning

3. Technical Set Up & Integration

  • Insignia create a Web-based Flourish® account for each client. This includes set up of group/subgroup structure and uploading the first batch of administrators and users of PAM® if known. Administrators are trained to manage the system and provide access to authorised users
  • Confirmation with client for alternative administration and scoring method(s) of PAM® integration/access, if desired


Knowledge Center e-Learning

It is designed to provide a coach with the minimum competence required to successfully administer PAM®. Divided into six modules and takes approximately two hours to complete all modules. The modules cover an introduction to PAM®, the PAM® approach, low and high-activated individuals, administering the PAM® for best results, and a walk-through of Coaching For Activation.

Webinar Training

Webinar trainings are designed to be as engaging as possible. Delivered via the Microsoft Teams platform. The trainer is available for immediate feedback for questions or comments. Training topics to be covered: What is PAM®, PAM® Personas guide, PAM® Administration, Coaching For Activation.


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


A series of short and free videos that highlight one topic at a time, with an average length of two-minutes per video. These videos serve as a live-action FAQ and can be accessed at any time by the user. This is another support tool at your disposal to ensure that the PAM® reliability is being followed, information is updated regularly and new content added.

Flourish® in Action

A brief overview of Flourish® can be found here.

UK Training Dates

2023 Training Schedule to be published in December

*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.