Unlocking 15% Savings: The Critical Role of Patient Activation in Disease Management

Wellinks’ Dr. Abi Sundaramoorthy and Phreesia’s Dr. Christina Suh discuss the importance of activating patients in their care.
In the high-stakes world of healthcare, executives are constantly seeking innovative solutions to reduce costs and improve patient outcomes. One of the most powerful yet underutilized strategies is patient activation.

In this informative Q&A (Watch the full interview here), Wellinks' Dr. Abi Sundaramoorthy and Phreesia's Dr. Christina Suh share how empowering patients with COPD and other chronic conditions to manage their health can lead to substantial financial savings and better clinical outcomes.

Explore how patient activation can revolutionize disease management and unlock significant cost savings for your organization.

Key Takeaways:

Massive Cost Savings

A one-level increase in patient activation can reduce downstream healthcare costs by approximately 8%, with a two-level increase leading to a 15% cost reduction.

Improved Health Outcomes

Activated patients experience fewer hospitalizations and emergency department visits, leading to better overall health and reduced healthcare utilization.

Strategic Resource Allocation

Understanding patient activation levels allows healthcare providers to deploy resources more effectively, ensuring high-need patients receive the necessary support.
Shanoor Seervai, MPP, Person-Centered Care Research Manager at Phreesia, sat down with two industry experts to discuss the urgent need for healthcare leaders to prioritize patient activation, offering a clear path to substantial cost savings and improved care delivery.

Dr. Abi Sundaramoorthy

Dr. Abi Sundaramoorthy, MD, MBA, is a practicing physician with over 10 years of experience promoting high-value care for hospital systems and private companies. She is Chief Medical Officer at Wellinks.

Dr. Christina Suh

Dr. Christina Suh, MD, MPH, is a general pediatrician with over 15 years of experience delivering primary care to low-income children in Aurora, Colorado. She is a Director of Clinical Content at Phreesia.

Q&A:

Seervai: Can you tell us a little about what Wellinks does?

Dr. Sundaramoorthy: Wellinks is a technology-enabled care delivery organization for patients with underlying COPD and cardiopulmonary conditions. We excel in partnering with Medicare Advantage plans and value-based providers to manage COPD and chronic conditions through a specialized approach. Our model integrates virtual pulmonary rehab and tailored clinical coaching, enhancing self-management and overall well-being for patients.

Seervai: Could you explain what patient activation is and why it's important to engage patients in their care?

Dr. Suh: Patient activation is the best-kept secret we have. Patient activation is defined as an individual's knowledge, skills and confidence to manage their own health and care. It's been used for over 20 years and is well-studied across disease conditions and specialties.
"When you can engage a person and help them be more activated, you can help them reach better clinical and health outcomes."
Patient activation is also associated with decreased ED utilization, hospitalization and readmission. More activated patients are also found to be more satisfied with their care.

Seervai: Tell us what the value of patient activation and the Patient Activation Measure (PAM) is to providers.

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Dr. Suh: Consider it a spectrum of activation, with individuals on the lower activated end being more passive recipients of their care. The PAM gives the care team information and insight into where the patient is in terms of activation. These individuals aren't asking questions; they get overwhelmed, frustrated, and disengage very easily.

On the flip side, highly activated individuals are more proactive in their care. When I think back to families I cared for I often think about these more active individuals as kind of “gold star families,” the ones who came for their follow-up visits, and whatever treatment plan we established, they went home and did it.
Knowing where a patient is in activation helps the care team and provider understand how to best support this patient.

Seervai: Dr. Sundaramoorthy, from your perspective, why is patient activation so important to your work at Wellinks?

Dr. Sundaramoorthy: Wellinks’ philosophy is founded on the fact that behavior change produces results, whether those results are related to quality or reducing cost and utilization. Patient activation takes that philosophy to the next level and makes it measurable regarding how to change behavior. Health coaching has traditionally gotten a reputation for being conversational, with a lot of variation. We wanted to ensure the process was standardized and validated through years of research. PAM has been validated time and time again over several years, and it's measurable. Once we see behavior change in a patient, we can measure that through the PAM and say, ‘there's a cause-and-effect relationship,’ not just that they're correlated with each other.

Seervai: What makes patient activation and care management for COPD patients particularly important?

Dr. Sundaramoorthy: When you think of the healthcare landscape right now, we have a tremendous amount of completely unmanaged populations. I like to use the analogy of when you have a bleeding vessel. You first start by stopping the bleeding, and then you go back and fix the vessel. You can think of healthcare right now as a rapidly bleeding vessel.

Even though we want to ensure everybody gets their preventive care, we're dealing with it right now by stopping the bleeding. But, as we see patients deteriorating, how can we reach them at the beginning of that deterioration process and perhaps divert them from the emergency room or hospitalization to a more appropriate site of care?  Certain disease processes lend themselves better to that kind of redirection. COPD is a great example. First, the deterioration has a symptom associated with it—breathing. So, you get very early symptoms that you are going to deteriorate. Second, the disease process needs to lend itself to de-escalation. When you use the right inhaler or steroid pack, you can de-escalate that process.

Seervai: Can we draw lessons from the COPD space to other medical conditions that are also complicated and costly to treat?

Dr. Sundaramoorthy: If you have an activated patient, we can start the management process early on, before a patient starts deteriorating, making sure that they're on the right meds or eating the right types of foods. We never need to get to that clinical deterioration: you can see that in chronic kidney disease (CKD), hypertension, diabetes, and obesity.

The key to the healthcare problem is this:  
"We can engage the payers, we can engage the providers, but if you have an engaged and activated patient, we can get ahead of the problem."
Dr. Suh: We also know from the research that activation can predict which patients will develop a new chronic condition. It can predict which patients are going to worsen in a chronic condition. The fact that activation is predictive is a strength of this measure because, in a value-based care kind of arrangement, one of the fundamental concepts is risk stratification—looking at those patients who will be high-risk patients, who are high utilizers, and high-cost.

Seervai: At Wellinks, how would your approach differ with a higher-activated COPD patient versus a lower-activated COPD patient?

Dr. Sundaramoorthy: A common intervention used in the COPD world is a COPD action plan–how do you identify your symptoms, and which categories do they fall under? And then, what is a specific intervention, and how can you appropriately use that intervention to de-escalate yourself if you feel like there's an impending exacerbation?

In a higher activated patient, I can defer to that COPD action plan. You don't even need a health coach. Patients can put their symptoms into our app, and it'll tell them the intervention needed. I can trust this patient will act on that and likely de-escalate themselves. They may need an appointment with their physician within the next few days. The physician may alter medications, but this patient never has to go to the emergency room or get hospitalized.

With a lower activated patient, even though they have the app and a COPD action plan at home, they're likely to reach out to one of our coaches, and we will walk them through one-on-one what to do to de-escalate themselves or go to the right site of care.

It's the same situation, but two very different types of patients based on their activation. PAM tells us how to allocate resources toward that. You can see that the higher-activated patient needed a lower-touch resource, which is often less costly. The lower-activated patient required a much more intense touch from an actual human resource, which can be much more costly to the healthcare system.

Seervai: It's also costly to save lives and the intensive care a patient needs. What are the results regarding health outcomes or hospital admissions, for example?

Dr. Sundaramoorthy:
"Studies show that a one-level increase in PAM amounts to approximately an 8% reduction in downstream costs."
At Wellinks, we’ve seen a seven-point improvement in PAM over the course of 12 months in the patients we care for, on average. In many cohorts we've been studying, and following the PAM process, we've seen an all-cause re-admission rate reduction of about 23%, and a 100% reduction in COPD-cause readmissions.

Seervai: Numbers are important, but healthcare is ultimately about improving the lives of patients who are living with health conditions that can be life-threatening. Do you have any stories about patients whose lives changed because of patient activation?

Dr. Sundaramoorthy: We had a patient who had six hospitalizations in the past two years when we first engaged her in the Wellinks program. She had a lot of difficulty with motivation, understanding the disease process, etc. Her last hospitalization was so severe that she was ventilated and admitted to the ICU for six days. Upon discharge, she ended up joining the Wellinks program. We did a lot of work with her in terms of the interventions that are specific to COPD but also focused on getting her motivated and getting her activated through PAM goal setting. We saw a change in PAM score of greater than 29 points. She also quit tobacco use and joined our group coaching classes.

Today, she has gone 14 months without any hospital admissions. We're very proud of that story. We have a very satisfied patient and a very satisfied physician because they feel like the patient listened to the instructions they'd given, and that’s changed her quality of life.

Seervai: More broadly, where does patient activation fit into value-based care, and how CMS is looking at integrating patient-reported outcome measures into more of its programs?

Dr. Suh: We have heard from CMS that they are very interested in amplifying the patient voice in more of their programs, including quality and VBC programs. Therefore, CMS is starting to incorporate patient-reported outcome measures like the PAM into more of their models and payment programs. For example, the PAM has been a part of the Kidney Care Choices Model, a CMMI innovation payment model in the CKD management space for several years.

PAM has now been named a quality measure for this year's Merit-based Incentive Payment System (MIPS) program. We're seeing CMS take concrete steps to incorporate patient-reported outcome measures like PAM into these programs. Everyone can expect to see more of this and PAM in more models and programs through CMS.

Patient activation can help providers deliver patient-centered care and shift away from a one-size-fits-all model. Understanding activation at an overall population level can help an organization determine which patients to focus resources on first.