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By Sarah C. Threnhauser, MPA

Last month as part of our ongoing coverage of The 2018 OPEN MINDS Performance Management Institute, I had a chance to touch base with Debbie Cagle-Wells, Chief Marketing Officer at Centerstone about their value-based health plan partnerships (see The Evolution Of Successful Value-Based Contracting). During that conversation, she noted the increased use of health plan incentive payments based on an interesting quality metric: consumer activation.

If you aren’t familiar with consumer activation, it is similar to consumer engagement with one important difference— consumer decisionmaking power. Consumer activation refers to a consumer’s knowledge, skills, ability, and willingness to manage his or her own health and care. The key is that consumers are making independent choices about managing their health care. In contrast, consumer engagement refers to work done by health care provider organizations to help lead consumers, ultimately, to activation. (For more consumer engagement, check out the work being done by Nicole Schechter, Psy.D., Rehabilitation Psychologist, Johns Hopkins School of Medicine-Is Consumer Engagement A Habit At Your Organization?).

So how do executive teams improve their consumer engagement and consumer activation skill set—an area where most service provider organizations have limited skills (see Making Consumer Engagement A Reality). The first step is measuring where the organization is at. For example, assessing the organization’s customer service. In our OPEN MINDS Performance Dashboard, these measures include net promoter score, customer satisfaction, customer experience monitoring, and online reputation. For more, OPEN MINDS Circle Elite members can refer to the March presentation by my colleague Monica E. Oss, The Transition To Value: Balancing The Strategic Challenges Of Performance Measurement, Talent & Capital.

Another option is to track consumer activation using a measure similar to the Patient Activation Measure (PAM). The measure involves ranking consumers on a 0-to-100 scale in four categories: (1) believing the consumer role is important, (2) having the confidence and knowledge necessary to take action, (3) actually taking action to maintain and improve one’s health, and (4) staying the course even under stress (see Development of the Patient Activation Measure (PAM): Conceptualizing and Measuring Activation in Patients and Consumers and Increasing Patient Activation to Improve Health and Reduce Costs). A meta-analysis in Health Affairs (see What The Evidence Shows About Patient Activation: Better Health Outcomes And Care Experiences; Fewer Data On Costs), that looked at results using PAM, found that a higher score led to: more positive care experiences; fewer complications from chronic diseases; better care coordination; and fewer hospitalizations and emergency department (ED) visits. Specifically, for every 10-point increase on the measure, the probability for an (ED) visit dropped one percentage point. And, activated consumers had better health outcomes in 9 of 13 measures (see When Patient Activation Levels Change, Health Outcomes And Costs Change, Too).

How to bring consumer activation into your overall engagement strategies? A recent article in PatientEngagementHIT, 4 Patient Education Strategies that Drive Patient Activation, outlined four strategies:

  1. First, assess your consumer’s “health literacy”—Better-educated consumers are more active in managing their health care. Provider organizations should focus on categorizing consumers into groups based on levels of understanding and information needs, and then focus education strategies according to consumer need (see Less Consumer Education Demands More Consumer Engagement).
  2. Second, ensure consumers understand you—When you explain health care matters to consumers, do they understand you? This can be a particularly important step for complex consumers with comorbid mental and physical health issues. An important method for gauging this is to ask them to repeat back your instructions, in their own words, known as the “teach-back” method (see Consumers Don’t Know What They Don’t Know).
  3. Third, build consumer-driven educational plans—Work to meet consumers where they are, not where you are. Think about language and format choices to make sure that the information you are sharing with consumers is convenient to access, easy to understand, and designed from the consumer-perspective. Consumer activation is important, but it can’t be overly complex to explain, or consumers will tune out.
  4. Finally, utilize technology—A big key to convenience is technology options. Provider organizations need to adopt consumer-enabling tech options that can empower consumers to participate more fully in their care. This may mean making it easier for consumers to access to their own health data (see CMS Shifting Data Control To Consumers: Are You Ready To Share?), providing access to more tech-enabled treatment options (see Building Your Own Tech-Enabled Consumer Base), or updating service delivery models to enhance consumer convenience through digital platforms (see ‘Going Digital’ For A Better Consumer Experience).

Last year I had a chance to speak with James Schuster, M.D., Chief Medical Officer, Medicaid and Behavioral Services and Vice President, Behavioral Integration, UPMC Insurance Division, Community Care Behavioral Health Organization, about his work with consumer activation (see Looking For A Tech Strategy? Try Consumer Engagement). UPMC worked with several counties and the Pennsylvania Department of Human Services in a Patient-Centered Outcomes Research Institute (PCORI) funded comparative effectiveness study of two behavioral health home model approaches—self-directed and provider-supported—to improve the health status of consumers with serious mental illness by supporting consumer wellness, engagement, and self-management. The self-directed intervention used a secure web portal to support consumer access to personal health information, self-guided wellness interventions, and trackers for smoking cessation, weight management, and improved nutrition and sleep hygiene. The provider-supported intervention provided consumers with a full-time registered nurse at each community mental health provider organization to provide a wellness consultation.

Since then, Dr. Schuster and his colleagues have published this study on consumer activation (see A Payer-Guided Approach To Widespread Diffusion Of Behavioral Health Homes In Real-World Settings). What they found was that the self-directed approach worked, but the provider-supported approach worked faster, noting in the study: “Provider-Supported participants experienced a more rapid initial [activation] increase that was then sustained over time…[but] findings show a nearly two-point increase in the Patient Activation Measure score for both approaches.” This suggests that organizations who can dedicate staff (even if it isn’t a full-time registered nurse) to help consumers actively manage their health care will be more likely to see better consumer outcomes over a shorter period of time.

For more on informing your consumer engagement strategies, check out these resources from the OPEN MINDS Industry Library:

  1. Social Media Listening As Consumer Engagement Strategy
  2. Consumer Satisfaction, Consumer Engagement & Shared Decisionmaking
  3. Is Consumer Engagement A Habit At Your Organization?
  4. Consumer Engagement Is The Missing Piece In Population Health
  5. Looking For A Tech Strategy? Try Consumer Engagement
  6. The Dollars & Sense Of Consumer Experience
  7. The Big Rewards Of Health Care Through The Consumer Lens
  8. Customer Service, Consumer Experience & Consumer Engagement: Keys To Competitive Advantage
  9. Would Your Consumers Choose You? How To Measure Customer Service & Consumer Engagement
  10. Will Your Consumers Miss You If You Are Gone?

For more, join my colleague Ken Carr on October 23 at The 2018 OPEN MINDS Technology & Informatics Institute, when he leads the session, The Digital Substitution Effect: A Guide To Supporting Consumers In The Community Through Technology.

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