Improving Population Health Management Strategies: Identifying Likely Users of Avoidable Costly Care

Key Questions Answered
  • How can a patient’s “activation level” (a measure of one’s knowledge, skills, and confidence to manage one’s own health and health care) be used to determine risk for poor health outcomes and preventable utilization of costly care?
  • How can providers measure a patient’s activation level?
  • How can providers help improve a patient’s low activation level?
Key Themes and Takeaways

This resource explores how measuring patients’ activation levels can help identify those individuals at higher risk for poor health outcomes and utilization of avoidable costly care.

  • Population health management strategies include tailoring interventions to patients based on their levels of risk and likelihood of being responsive to an intervention, which is described as “impactability.”
  • One indication of impactability is a patient’s activation level, which can be assessed by the Patient Activation Measure.
  • When controlling for baseline chronic disease status, a patient’s activation level can predict future progression of disease burden and use of costly, avoidable care.
  • For patients with low activation levels who may already feel overwhelmed, providers can suggest small steps toward making behavioral changes.
Judith Hibbard
Jessica Greene
Rebecca M. Sacks
Valerie Overton
Carmen Parrotta
Population Addressed
People with Multiple Chronic Conditions
Level of Evidence
Rigorous Observational Study; Moderate Evidence
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