PAM_description.pdf

What is PAM?

The Patient Activation Measure (PAM) is a Patient reported Outcome-based Performance Measure (PRO- PM). It is a 10- or 13-item survey that assesses a person’s underlying knowledge, skills and confidence integral to managing his or her own health and healthcare. PAM segments individuals into one of four activation levels along an empirically derived 100-point scale. Each level provides insight into an extensive array of health-related characteristics, including attitudes, motivators, and behaviors. Individuals in the lowest activation level do not yet understand the importance of their role in managing their own health, and have significant knowledge gaps and limited self-management skills. Individuals in the highest activation level are proactive with their health, have developed strong self-management skills, and are resilient in times of stress or change.

Why haven’t we used a PRO-PM, and why do we need it?

PRO-PM have only recently become a type of measure that has found to be a good measure for inclusion in clinical practice to determine clinical outcomes of care. Thus, CMS programs have not employed PRO-PM measures until recently, as they did not exist previously.

According to some recent literature published by Insignia there is a correlation between patient activation and healthcare cost. For the patients who improved two PAM levels, there was a 15 percent reduction in cost. When the PAM level declined, the cost rose 9 percent for each level.

Specific CMMI models seek to include a PAM as a quality performance indicator to assess whether model participants can improve the quality of care by improving their patient’s ability to self-manage their health.

The ideal measure is a patient reported outcome-performance measure (PRO-PM) that is endorsed by the National Quality Forum.

Who owns a NQF endorsed outcome measure that addressed patient activation?

Market research was conducted by the CMMI Quality Innovation Council (QIC) to determine available sources. The QIC looked at the National Quality Forum for endorsed outcome measures that address patient activation. Based on the research, there is only one measure that is endorsed, which is owned by Insignia Health. The QIC also explored CMS’ own inventory of measures and there is no other NQF endorsed measure on patient activation. Since this measure will be used in pay for performance advanced payment models, it is strongly preferred that it be NQF endorsed as this provides CMS assurance that the measure has been tested and found to be reliable and valid.

When do we need it, and why sole source?

Some, if not all models that have indicated they will use this measure, may use it for payment purposes. We currently have commitments for three models to use the measure (CKC, DC, and the MOM models). We have structured the contract with an option to expand to 10 models. The measure can be used in any patient population and in any setting so it is an ideal outcome measure for APMs to have readily available for use.

Because we have a constant flow of new models that are continually looking for new measures, this measure could be one that fills an immediate gap as needed.

Since PAM will be used for more than one model, and we are uncertain as to the individual model clearance/s and approvals, we wanted to make sure the measure is ready for use immediately. It is unlikely that there would be sufficient time for another measure developer to submit a new measure on patient activation to NQF for endorsement consideration, and obtain NQF endorsement within the timeframe that is needed for one of our models to use the measure in a pay for performance program. In addition, if we were to develop our own PAM using the MIDS IDIQ, it could take years before the measure would be available for use. Therefore, considering our timeline and need for a PRO-PM, we will need to sole source to Insignia Health who owns the only NQF endorsed PRO-PM.