Adding a Measure of Patient Self-Management Capability to Risk Assessment Can Improve Prediction of High Costs

Synopsis

Patients with the knowledge, skills, and confidence needed to manage their health conditions are sometimes referred to as “activated.” Health care systems can use patient activation scores to help predict use of costly services, like the emergency department (ED). Knowing who is most at risk for incurring high costs enables systems to tailor their outreach efforts and better manage overall health care costs.

The Issue

Identifying patients who have a heavy disease burden and are likely to incur sizable costs is key to successfully managing health care spending. Currently, health systems rely on past medical claims data and diagnosis information to identify high-risk patients. Commonwealth Fund–supported researchers posit that this formula is missing an important element: patient activation. For a study published in Health Affairs, they theorized that knowing a patient’s activation level can help predict whether he or she will be likely to use costly services. The research team looked at information from patients enrolled with Fairview Health Services, an accountable care organization (ACO) in Minnesota.