Only Talk Patient Engagement When Activation Is Involved

Only Talk Patient Engagement When Activation Is Involved
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In health care, where jargon abounds like pagers in a hospital, I couldn't stop myself from including "patient engagement" in the title of this piece. In terms of being famous, it's safe to say that patient engagement is currently the Justin Bieber of health care catchphrases. With all due respect to Bieber, I'd like to shift the spotlight to a less popular term: "patient activation." In health care, when it comes to concepts central to achieving the "triple aim" of improved health outcomes, better patient care, and lower costs, patient engagement really doesn't mean anything without patient activation.

Activation and Engagement Defined

As explained in Health Affairs, "Patient activation refers to a patient's knowledge, skills, ability, and willingness to manage his or her own health and care. Patient engagement is a broader concept that combines patient activation with interventions designed to increase activation and promote positive patient behavior." In essence, activation means something very specific to a patient's internal view of how he interacts with his health care; engagement means just that plus any intervention under the sun that might help a patient to better interact with his health care.

Admittedly, patient engagement is a term still very much in flux. There was even a grant from the Robert Wood Johnson Foundation awarded to the Center for Advancing Health in 2012 to define engagement and disseminate that definition to key stakeholders. Nonetheless, the definition of engagement above highlights a rather serious problem in health care: While everybody wants patient engagement, nobody really knows what it is or how to measure it.

Activation Is at the Core of Engagement

As suggested in the above definition, activation is the core concept underlying patient engagement. This is good, because not only is activation well defined, but research has also produced a clinically validated measurement for activation, the Patient Activation Measure (PAM). The beauty of patient activation is that it helps to identify where a specific individual is with respect to being interested and able to manage his health. Repeated testing of a person's activation level to identify changes over time is a crucial measurement, for increased activation has been shown to improve adherence and is associated with reduced overall health care costs. In other words, when talking about patient engagement, engagement is not the outcome people should be measuring, activation is.

While there is strong and convincing research proving the importance of patient activation and the positive health outcomes associated with higher activation, research on which interventions best increase activation is, in comparison, in its infancy. As a runner, I view this dynamic as similar to the dynamic between training and racing. The end result of a race -- a specific time over a specific distance -- is a clear measurement that all can understand and agree upon, much like patient activation. The real question -- and the challenge that we're faced with today -- is determining which workouts, runs, sessions in the gym, and nutrition tweaks produce the best race times for different types of runners. That is, which health interventions are most successful at improving activation levels for different types of patients.

Integrating Activation with Engagement Strategies

The original PAM was a 22-question assessment, which now has a validated 13-question version. That's a lot of questions. This makes it nearly impossible for us and other engagement-focused startups to integrate the full measure into practice. However, that doesn't mean we can't and shouldn't focus heavily on the core concepts found within activation. These core concepts were noted in the definition of activation I started this article with: "a patient's knowledge, skills, ability, and willingness to manage his or her health."

PAM or not, those are the metrics that companies focusing on patient engagement should be measuring and developing interventions to improve upon. They're clinically validated behavioral determinants that impact how we as people interact with our health care. Just like time is the common denominator in running, activation is the common denominator in patient engagement. By realizing that activation is at the heart of engagement, entrepreneurs are less likely to waste their time building things that engage purely for the sake of engagement. Engaging interventions that systematically improve patient activation; that's the jargon I'm talking about.

Stan Berkow is the co-founder and CEO of Sense Health, a New York City based healthcare startup. Sense Health offers the simplest way for healthcare providers to create, deliver, and monitor patient support plans in between appointments. Sense Health helps providers efficiently and effectively support their patients with over 1,000 premium health messages written by experts and a behaviorally based process for creating individualized health support plans in seconds.

Sense Health is one of the two finalists in the Merck | Heritage Provider Network Innovation Challenge. The sponsors have called on entrepreneurs, data scientists, designers, health care providers, and big thinkers to create the products or services that will support patients with diabetes and/or heart disease in adhering to their care plans and ultimately improving health. Finalists will be entering the pilot phase in March 2014. Check out their progress, watch their Demo Day presentations, and find additional open innovation challenges by visiting Health Data Challenges.

This blog series is produced in partnership with Health Data Challenges, creators of The Health Data Challenge Series, a formal initiative of the Health Data Consortium, powered by Luminary Labs. The platform seeks to foster the use of data to drive innovation that will ultimately transform health and healthcare through high-stakes innovation challenges. Learn more at

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