Consumer Engagement in Health

Patient engagement is another theory about a miracle that will transform the health system–consumers who pay more attention to their health behaviors and to the costs and quality of health care providers will save us a lot of money and improve quality.  Several articles in the current Health Affairs are devoted to this notion.  One summarizes the research on engaged patients.   (HA Article)   The authors find that, using a measure of patient activation, patients who score highly are significantly more likely to engage in preventative health care behaviors, like getting regular exams, and to have a good diet and get enough exercise.  They also avoid unhealthy behaviors more often than low scorers.  Patients whose activation scores improve over time also improve their health behaviors.  High-scoring patients also express greater satisfaction with their health care, which is increasing important to providers in an era of pay-for-performance.  As detailed more below, these patients may also have lower health care costs, although some circularity is likely at work here.  The tricky thing, of course, is how to get consumers to become “activated” in their health.

A second article reports on a study of the effect of patient engagement on health spending.  Using the Patient Activation Measure, the researchers sought to ascertain whether engagement was correlated with spending in a population of about 33,000 patients at a health system in Minnesota.   (HA Article)   After adjusting for demographic characteristics and health care risk, patient activation levels were negatively associated with spending.  For example, patients at the lowest level on the activation scale had average predicted costs 8% higher than patients with the highest scores.  Low activation scores from one year were a good predictor of spending in the next year.  It should be noted, however, that the spending difference in all these analyses exists only for patients with the very lowest activation scores.   Overall one is left with the impression that the association is very weak and likely mediated by other factors.  While patient engagement is a worthy and important goal, particularly since what it really reflects is a degree of responsibility for self that is an important component of social life, it is as yet unclear that it actually lowers health spending.