Fillingame used the PAM assessment to customize his team's approach to each patient's care. Low-scoring, less-activated patients with more-complex healthcare needs, for instance, received more-intensive care coordination and coaching services, while high-scoring patients received a more hands-off approach. He used the grant funds to hire a full-time medical office assistant who helped with coaching, as well as a half-time behavioral health specialist.
Fillingame gave the example of a former male patient who suffered from a number of chronic illnesses, including hypertension and early diabetes, and who was a Level 2 on the PAM scale. “He was overwhelmed, but we worked with him to set small, attainable goals, which we kept modifying as he made progress,” Fillingame said, adding that the patient lost 40 pounds and saw marked improvement in his health.
During the pilot, the average number of quarterly ER visits dropped more than 40%. Fillingame's team also saw improvements in patient-satisfaction scores and in the percentage of patients with controlled hypertension.
Unfortunately, when the pilot concluded, the practice didn't have the resources to keep the intensive approach in place, said Fillingame, who has since left for a job in public health.
That's not surprising, said Chris Delaney, CEO of Insignia Health, Portland, Ore., which has exclusive licensing rights for the PAM tool and currently has 130 clients, including 40 to 50 hospitals and health systems. He says the PAM tool is a difficult sell in a fee-for-service environment where keeping patients well reduces revenue. Still, he expressed optimism that the move to value-based care will heighten the focus on activation.
“Raising a PAM score by just 1 point is worth a 2% decline in ER use, a 2% improvement in A1c levels and a 2% improvement in medication adherence,” he said. “It's a very powerful metric.”
PeaceHealth is still using the PAM tool in its ambulatory-care-management program and has plans to eventually employ it across the system, said Shelley Buettner, PeaceHealth's patient-centered medical home program manager. “It's a work in progress and there are challenges, of course, but if we can work with commercial payers and CMS to try to change incentives, that's all the better.”
Follow Maureen McKinney on Twitter: @MHMMcKinney