Beneficiary Activation in the Medicare Population
Patient-centered care, including an emphasis on patient engagement and activation, is being pushed to the forefront of health policy in part due to the Affordable Care Act (Millenson & Macri, 2012). Patient engagement is characterized as actions that individuals must take to obtain the greatest benefit from the health care services available to them (Center for Advancing Health, 2010) or, more generally, the relationship between patients and health care providers as active patient involvement in healthcare is promoted (Coulter, 2011). Patient activation is a component of patient engagement, focusing specifically on the patient’s understanding of his or her role in the care process and empowering the patient with the knowledge, skills, and confidence to manage his or her care (Hibbard, Stockard, Mahoney, & Tusler, 2004; Carman et al., 2013; Hibbard, Greene, & Overton, 2013; Cunningham, Hibbard, & Gibbons, 2011; Hibbard & Greene, 2013; Hibbard & Mahoney, 2010).
In today’s health care environment, it may be insufficient for a patient to be discharged from outpatient surgery with instructions for recovery and prescription medications. The patient should (a) have confidence in their ability to understand their doctor’s instructions and to know when they should seek further medical care, (b) feel they can effectively communicate with their doctor, and (c) have the ability and motivation to educate themselves or seek more information on health care (such as medical conditions, symptoms, treatments, and test results), all of which would indicate high patient activation. The success of health care reform-related programs and initiatives in Medicare, such as patient centered care, the Chronic Care Model (Wagner et al., 2001), and medical homes, may ride on how involved patients are in their own health care. The usefulness of public reporting initiatives comparing quality of health plans, hospitals, and other health facilities depends on a patient’s ability and motivation to interact with health care as a more involved and educated consumer.
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