Year-End Quality Initiatives: How Member Activation Can Generate Better Health Outcomes

December 12, 2019 Anne Davis

After the first half of the year, health plans typically know which member cohorts need additional attention. The second half of the year can be a good time to focus on engaging with members and closing care gaps.

One promising approach may be to focus on member activation. Researchers at the University of Oregon define “patient activation” as “understanding one’s role in the care process and having the knowledge, skill, and confidence to manage one’s health and health care.” While compliance focuses on motivating individuals to follow medical advice, activation focuses on a person’s willingness to take the initiative on their own and engage in actions that will be beneficial for their health.

Studies have found that patient activation can be measured, thoughtfully crafted interventions can increase patient activation, and that individuals with higher levels of activation have better health outcomes.

How Is Patient Activation Measured?

Although patient activation can’t be directly measured, it can be assessed using a tool based on 13 items that offer insights into a person’s beliefs and health knowledge, as well as their confidence with regard to managing health. Patient Activation Measure scores fall on a 0 to 100 scale. Results are categorized into four levels:

  • Level 1 (least activated): Believes active role is important
  • Level 2: Has confidence and knowledge to take action
  • Level 3: Is taking action
  • Level 4 (most activated): Stays the course under stress

As health plans strive to understand their members better, it may be helpful to ask members to complete a health risk assessment. The results could shed light on how much additional support members may need in order to engage in healthy behaviors that could close gaps and move the quality needle.

Why Strive to Increase Member Activation?

Research conducted worldwide has revealed that individuals with higher Patient Activation Measure scores are significantly more likely to exhibit preventive health behaviors, such as check-ups, vaccinations, or health screenings. In contrast, people with lower Patient Activation Measure scores are three times as likely to have unmet medical needs and they are two times as likely to delay medical care, when compared to individuals with higher scores.

On the cost front, studies have also found that highly activated people had lower rates of hospitalization and emergency room visits — even after controlling for disease severity and demographic characteristics. At a large healthcare system in Minnesota, over 25,000 patients were studied. For every 10-point increase in their Patient Activation Measure score, the predicted probability of visiting the emergency room decreased by one percentage point.

Methods for Increasing Member Activation

A variety of different types of programs have been shown to increase Patient Activation Measure scores. Two examples include:

  • Programs that focus on skill development, problem solving, and peer support. Researcher Michael Parchman discovered that when patients suffering from diabetes and their providers use participatory decision making, it increases baseline Patient Activation Measure scores. These improvements were correlated with higher levels of medication adherence and lower levels of HbA1c and LDL cholesterol.
  • Programs tailored to the individual’s activation level. If a health plan knows that members have low levels of activation, it may urge them to take small steps that seem more manageable. Members with high levels of activation, in contrast, may be encouraged to embrace larger behavioral changes. When members are discharged from the hospital, plan care managers might also refer to their activation scores to determine how much support they might require to recover fully.

As health plans explore strategies to close gaps in care and improve quality, measuring activation could be a promising way to connect with members and understand what types of programs could increase their engagement in their health.


To learn about additional techniques for reaching members and encouraging healthy behaviors, download our white paper — Charting the Course for Quality Improvement: Six Strategies for Boosting Quality Scores at Year-End.

Download White Paper

About the Author

Anne Davis

Anne Davis is the Director of Quality Programs & Medicare Strategy at HMS where she focuses on the company's Population Health Management product portfolio. Anne has spent the last 20 years focusing on healthcare quality, care and evaluation. Prior to joining HMS, Anne was responsible for care management, utilization review, and population management at a five-star Medicare Advantage plan and integrated delivery system. Since 2015, Anne has worked as a consultant, focused on HEDIS and Stars, quality programming, and reporting & evaluation. When she isn’t working, you’ll find Anne at the beach with her family, teaching yoga classes and hiking in her beautiful home state of Maine.

Follow on Linkedin More Content by Anne Davis
Previous Article
 Medicare Chart Reviews: Should You Be Concerned About Fraud?
Medicare Chart Reviews: Should You Be Concerned About Fraud?

See more
 How Shifting the Focus from Claim to Member Is Improving Payment Accuracy
How Shifting the Focus from Claim to Member Is Improving Payment Accuracy