Insignia Health: Improving Patient Activation for Improved and Sustainable Health Outcomes
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Insignia Health: Improving Patient Activation for Improved and Sustainable Health Outcomes

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Chris Delaney, Founder and CEO, Insignia HealthChris Delaney, Founder and CEO, Insignia Health
If there is one feeling that many of us can relate to, it is the struggle to feel confident in managing our health and healthcare. Too often, the support we receive assumes that we are fully ready and able to engage in “best practice” health behaviors. It is like being thrown into the deep end of the pool before learning how to swim. Addressing health self-management based on patient activation, however, takes a completely different approach.

Patient activation is defined as the knowledge, skills, and confidence that each of us has to self-manage our own health. It directly relates to how well an individual can effectively handle health-related issues and then utilize the most appropriate healthcare services for improving one’s overall health.

The rigorously-validated Patient Activation Measure® (PAM®) survey from Insignia Health is disrupting traditional health coaching and education models by building the foundation for person-centered care based on a person’s level of activation. Since its inception in 2007, Insignia Health has been working closely with healthcare organizations worldwide to inspire their constituents— patients, members, employees—to become more successful managers of their health.

“PAM provides an important vital sign to guide more effective and efficient use of healthcare resources. This allows healthcare professionals to craft care plans that truly understand how best to support the selfmanagement ability of each patient,” according to Insignia Health’s CEO, Chris Delaney. “Research consistently shows that patients with lower activation (i.e., lower PAM scores) have significantly higher incidence of emergency department use, unplanned hospital admissions, and poor medication adherence among other health behaviors. However, when these same patients receive appropriate support based on their specific level of activation, they tend to have comparatively better health outcomes and lower costs over time.”

The PAM survey was developed by a team of researchers at the University of Oregon, led by Dr. Judith Hibbard and Dr. Bill Mahoney. Over the past 17 years, PAM has been a key outcome measure in more than 500 peer-reviewed published studies. Concurrently, the team at Insignia Health has been innovating to integrate PAM into the latest patient care technologies, such as their new SMART on FHIR platform for electronic health records (EHR) systems.

Insignia Health also offers PAM-based Coaching for Activation® (CFA): a proven program for clinicians and health coaches with goals and action steps tailored to the self-management abilities of each individual.


PAM provides an important vital sign to guide more effective and efficient use of healthcare resources


CFA recognizes that patients lower in activation need more comprehensive support to help them continually improve their health self-management knowledge and skills. This customized approach focuses on closing the gaps and achieving desired guideline health behaviors at the pace of the patient, not the institution, which is contrary to the generally inefficient, one-size-fits-all approach that is typical of today’s condition and care management practices. Through CFA, resources can be allocated more effectively to support patients who are known to struggle with self-management and who are high utilizers of healthcare services.

“With over a decade of practical and clinical experience with PAM and CFA, we know that connecting resources to a person’s self-management ability or activation outperforms traditional coaching models that pursue the same general guideline behaviors for all patients, regardless of what they can handle. When support is tailored to PAM levels, 75 percent of those patients who are low in activation gain more than a full level of activation within six months,” adds Delaney.

To bring it all together, Insignia Health has developed an interactive online e-health platform called Flourish®, through which healthcare organizations can directly support patients with both PAM and CFA, plus generate a number of reports and analyze PAM-based data. PAM can also be integrated into a variety of EHR systems using Insignia’s SMART on FHIR solution or more traditional implementation methods.

A number of recent studies demonstrate the merits of PAM based patient support. Delaney cites the instance of Washington State’s Health Homes program, where the state runs a dual eligible program created via the Affordable Care Act. The Health Home program utilizes a patient’s activation score and level to help guide health action care plans with more person-centered goals. The total savings for approximately 40,000 patients was over $105.3 million as reported by Centers for Medicare and Medicaid Services (CMS).

With its focus on supporting value-based and personalized care around the world, Insignia Health has a multi-year partnership with the CMS to support up to 5 million beneficiaries in select Alternative Payment Model (APM) programs, and with England’s National Health Service (NHS). Insignia is also making inroads with health systems in Australia, Singapore, and the Middle East. The company will continue to innovate to enable seamless integration of PAM, CFA, and new patient education solutions into evolving population health value focused systems.