An interview with Chris Delaney at the NHS Health and Care Innovation Expo 2018, discussing the involvement of Insignia Health in providing a platform that promotes self-management and lifestyle changes for patients in the NHS, and the impact that this could have on patient outcomes.
Please can you introduce yourself and the role you carry out at Insignia Health?
I'm Chris Delaney and I'm the Chief Executive of Insignia Health. In my day-to-day role, I wear many hats, one of which is supporting our relationship with the NHS and with our other clients in the UK.
Image Credit: MichaelJung / Shutterstock
Disease awareness seems to be at the heart of everything you do. Why is it important for patients to take charge of their own health?
Research has shown that somewhere between 40 and 60% of all premature deaths are the result of lifestyle choices.
This means that the more effective we become at helping patients make good lifestyle choices and manage their health conditions, the more likely we are to reduce the burden of disease.
The benefits of this are obvious: reduced A&E waiting times, improved lifespan, improved quality of life, and even improved productivity and job satisfaction!
That’s why we are on a mission to help patients take a more active role in their health and wellbeing and to become better at self-management. It is clear that the largest impact on health outcomes is in our hands as individuals. Not the NHS, or the social care service, but us.
What is the Patient Activation Measure® (PAM®) and Coaching for Activation®?
PAM is a 10- or a 13-item assessment that produces a score on a 0-100 scale.
This activation score is something unique to PAM. Imagine it like a ruler with 100 equally-spaced points where we can easily understand the distinction and value of a single point change. This could represent a 2% decline in hospitalization, or a 2% improvement in treatment adherence, for example.
Layered on top of that 100-point scale, your PAM score will put you into one of four activation levels, which indicate the degree of your self-management capabilities.
About 45% of individuals managing a long-term condition have lower activation - PAM levels one and two. These patients are typically high utilizers of the health care system and account for around 70-80% of all health care costs.
Looking at a patient’s activation level, and tracking changes in PAM score over time, allows health care providers to tailor their support to the ability level of the patient, thus improving outcomes. It’s kind of like when you learn to swim; you don't start at the deep end!
Successful coaching programs rely on meeting people where they're at. That can mean teaching people to swim from scratch, or building on what they’re already capable of doing. It’s no different for healthcare.
NHS England uses the Patient Activation Measure® (PAM®) for Person-Centred Care
Coaching for Activation (CFA) is the next step in the process. It is the result of over a decade of work, aligning health goals and guideline behaviours for individuals with one or more of 14 conditions and diseases.
CFA provides health coaches – clinical and non-clinical – with goals and action steps that are proper, realistic and achievable whether they’re working with individuals on medication adherence, nutrition, physical activity, coping with stress, or condition knowledge.
What changes could be made to the current NHS system to improve access and support apps such as PAM and Coaching for Activation?
Every solution provider for the NHS has the challenge of integrating their technology with the appropriate Electronic Health Record (EHR), and then you have the challenge of making the data you collect interoperable with other systems around the world.
This is a global problem that we’re starting to address with a solution called SMART on FHIR, which aims to integrate PAM and CFA via apps with EHRs, portals, Health Information Exchanges, and other Health IT systems everywhere, kind of like a marketplace for apps. This would allow a Clinical Commissioning Group (CCG) to say “We want an app that can do X, Y, and Z.”
The problem with this is that EHR providers need to be capable of integrating their data with SMART on FHIR, and many of them aren’t quite there yet.
So if you’re a GP or a social worker, having to use a whole other tool that you are not familiar with is not likely to happen fast. I think that having this new app-based marketplace will make a difference in years to come, but at the moment it’s still in its infancy.
Nevertheless, the NHS is making huge strides toward integrating exciting new technologies into social and primary care delivery.
At Insignia Health, we are committed to providing an evolving and efficient system that can help allocate resources to the people who need them most, while still appropriately caring for those with higher activation who have less immediate need.
Where can readers find more information?
More information on Insignia Health can be found at insigniahealth.com or by writing to [email protected].
Just a few weeks ago, The Health Foundation published a very informative briefing titled: Reducing emergency admissions: unlocking the potential of people to better manage their long-term conditions.
It summarizes research that connected PAM scores on over 9,000 patients to how capable they feel to manage their long-term conditions such as asthma, diabetes and depression, and their use of health care.
About Insignia Health
Insignia Health specializes in helping commissioning groups, trusts, clinics, pharmacies, social sector providers and other health care organisations around the world assess an individual’s activation level and develop strategies to effectively use healthcare services and resources.
Insignia Health applies its proprietary family of health activation assessments to measure each individual’s self-management competencies. The Patient Activation Measure® (PAM®), Coaching for Activation® and a decade of health activation research form the cornerstones of a complementary suite of Insignia solutions, which have been proven to reduce utilisation and improve cost controls.