Journal of General Internal Medicine

, Volume 33, Issue 12, pp 2106–2112 | Cite as

Patient Activation Changes as a Potential Signal for Changes in Health Care Costs: Cohort Study of US High-Cost Patients

  • Ann LindsayEmail author
  • Judith H. Hibbard
  • Derek B. Boothroyd
  • Alan Glaseroff
  • Steven M. Asch
Original Research



Programs to improve quality of care and lower costs for the highest utilizers of health services are proliferating, yet such programs have difficulty demonstrating cost savings.


In this study, we explore the degree to which changes in Patient Activation Measure (PAM) levels predict health care costs among high-risk patients.


De-identified claims, demographic data, and serial PAM scores were analyzed on 2155 patients from multiple medical groups engaged in an existing Center for Medicare and Medicaid Innovation-funded intervention over 3 years designed to activate and improve care coordination for high-risk patients.


In this prospective cohort study, four levels of PAM (from low to high) were used as the main predictor variable. We fit mixed linear models for log10 of allowed charges in follow-up periods in relation to change in PAM, controlling for baseline PAM, baseline costs, age, sex, income, and baseline risk score.

Main Measures

Total allowed charges were derived from claims data for the cohort. PAM scores were from a separate database managed by the local practices.

Key Results

A single PAM level increase was associated with 8.3% lower follow-up costs (95% confidence interval 2.5–13.2%).


These findings contribute to a growing evidence base that the change in PAM score could serve as an early signal indicating the impact of interventions designed for high-cost, high-needs patients.


medicare patient activation health economics return on investment 


Funding Information

Funding for the analysis reported in this article was provided from the Stanford Coordinated Care Team Training Account at the Stanford School of Medicine.

Compliance with Ethical Standards

Conflict of Interest

Ann D. Lindsay is a clinical advisor of Clover Health.

Judith H. Hibbard is a consultant and equity stakeholder for Insignia Health.

Alan Glaseroff is a clinical advisor for Cardinal Analytx, VIM, Omada Health, and Clover Health.

All remaining authors declare that they do not have a conflict of interest.

Supplementary material

11606_2018_4657_MOESM1_ESM.docx (21 kb)
ESM 1 (DOCX 21 kb)


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Ann Lindsay
    • 1
    Email author
  • Judith H. Hibbard
    • 2
  • Derek B. Boothroyd
    • 3
  • Alan Glaseroff
    • 4
  • Steven M. Asch
    • 5
  1. 1.Division of Primary Care and Population Health, Department of Medicine Stanford University School of MedicineMcKinleyvilleUSA
  2. 2.University of OregonEugeneUSA
  3. 3.Quantitative Sciences Unit, Department of MedicineStanford University School of MedicineStanfordUSA
  4. 4.Center for Excellence in Clinical ResearchStanford University School of MedicineStanfordUSA
  5. 5.VA Center for Innovation to Implementation, Department of MedicineStanford University School of MedicineStanfordUSA

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