A new retrospective study in the journal Health Services Research shows that patients who are more activated -- who are more involved in the self-management of their health and score higher on the the commercially available Patient Activation Measure (PAM) test -- were less likely to be hospitalized or to develop a chronic condition than those with lower PAM scores.

Researchers looked at data from 98,142 patients at Fairview Health Services in Minnesota, an innovation-focused accountable care association. They limited their analysis to patients who took a PAM test in 2011 and had at least one clinic visit in each subsequent year: 2012, 2013, and 2014. PAM score was a statistically significant predictor of chronic disease development, ED visits, and hospitalizations for each subsequent year.

"The findings indicate that a baseline PAM score is still predicting clinical outcomes and utilization three years later," researchers wrote in the study. "This suggests that the relationships between activation and these outcomes are enduring, and therefore the potential benefits of investing in appropriate intervention could pay dividends over a longer period of time than the current budget cycle."

The study describes the interaction in terms of population health management, which involves segmenting patients based on clinical risk. Authors suggest that given the link between patient activation and future health risks, ACOs should take activation into account when segmenting populations based on risk. More than that, there's evidence that patient activation can be changed and improved using certain patient engagement technology, which could be used to reduce risks in those populations.

"PHM [patient health management] should focus on 'impactability' or segmenting populations based on not just clinical risk, but the likelihood that interventions can modify patient behaviors," researchers wrote. "Because there is a growing body of evidence that it is possible to increase activation levels, the patient’s PAM score can be used to target patients with appropriate interventions to help them achieve an adequate level of self-management skill. This may be a more efficient use of resources, as it refines the targeting of support to those who are most likely to benefit from it. Future research, using controlled studies, is needed to test whether targeting interventions based upon activation level as well as risk level reduces costs and risks."

Of course, the study makes it clear that further research is needed to see if these results are generalizable -- and if correlation necessarily implies causality.

"It should be noted that if there is a causal link, the direction of causality between patient activation and health outcomes likely goes in both directions," study authors wrote. "That is, those who have heavier disease burden likely find it more difficult to manage their health on a day-to-day basis than those with better health and therefore have lower PAM scores. At the same time, those who lack self-management skills and have low PAM scores are more at risk for further health declines."