Gains in Patient Activation Measure (PAM) Scores at 12 Months

Measure Specification

The Patient Activation Measure (PAM®) assesses an individual’s ability to manage their own health and health care. The measure is not disease specific; it has been successfully used with a wide variety of chronic conditions, as well as with people with no conditions. The PAM® is predictive of most health outcomes, including such diverse outcomes as how a patient fares after orthopedic surgery; remission of depression over time; the likelihood of hospital re-admission or ambulatory care sensitive (ACS) utilization; the trajectory of a chronic disease over time; and even the likelihood of a new chronic disease diagnosis in the coming year.

The PAM® surveys the knowledge, skill, and confidence necessary for self-management on a 0-100-point scale that can be broken down into 4 levels from low activation to high activation. The 13 (or 10) item survey has strong measurement properties and is predictive of most health behaviors and many clinical outcomes. PAM® scores are also predictive of health care costs, with lower scores predictive of higher costs.

The PAM® is in use both in the US and internationally in research (including more than 800 peer-reviewed journal articles) as well as clinical settings. It has been translated into more than 30 languages. Because researchers all over the world use PAM®, we have been able to validate the instrument with people of different racial and ethnic backgrounds, and with people from different socio-economic levels.

The measure has been shown to be valid and reliable in different clinical settings and under different payment models. A performance measure assessing average changes in PAM® scores has been endorsed by CBE. The Patient Activation Measure-Performance Measure, the PAM®-PM, requires that PAM® be measured at two points in time. The difference in PAM® score from time 1 to time 2, or the change score is the PAM®-PM.

This measure, as well as the PAM® survey, is used in a number of federal quality and payment programs.

While there are a few other measures that seek to assess patient engagement and activation, they do not possess the strong measurement properties of PAM® and do not have the depth of research supporting their validity and reliability. PAM® is the only measure of self-management capability endorsed by CBE to measure performance. While PAM® is built upon a true equal interval scale, as is the case with measures in the natural sciences (e.

g. temperature, weight, HbA1c, blood pressure), competing measures of patient engagement utilize ordinal measurement (a lower form of measurement), that lacks the precision and consistency of interval level measurement Because of these strong measurement properties, researchers from all over the world chose to utilize the PAM® when assessing activation or self-management ability in their studies.

This measure contains three strata defined by three submission criteria. This measure produces two performance rates. There are 3 Submission Criteria for this measure: 1) All patients aged 14 years and older who had two PAM® scores 4 to 12 months apart AND 2) All patients aged 14 years and older who achieved a net increase in PAM® score of at least 3 points AND 3) All patients aged 14 years and older who achieved a net increase in PAM® score of at least 6 points Submission Criteria 1 is used to satisfy the Minimum Performance Threshold Requirement for Submission Criteria 2 and 3.

Therefore, there is no Performance Rate to be submitted for this Submission Criteria. This measure will be calculated with 2 performance rates: 1) Percentage of patients aged 14 years and older who achieved a net increase in PAM® score of at least 3 points in a 4 to 12 month period 2) Percentage of patients aged 14 years and older who achieved a net increase in PAM® score of at least 6 points in a 4 to 12 month period For accountability reporting in the CMS MIPS program, Performance Rate 1 will be used for performance.

For the purposes of MIPS implementation, this patient-periodic measure is submitted a minimum of once per patient per timeframe specified by the measure for the performance period. The most advantageous quality data code (QDC) will be used if the measure is submitted more than once for the specified timeframe. Unique to this measure is the Minimum Performance Threshold Requirement.

This measure-based threshold includes two requirements: 1) Clinicians must have collected a follow-up PAM® survey on at least 25% of all eligible patients during the performance period. 2) Clinicians must have administered a follow-up PAM® survey to a minimum of 50 unique patients. Therefore, if the performance rate for Submission Criteria 1 is below 25% and does not include 50 unique patients, the MIPS eligible clinician would not be able to meet the denominator of the Submission Criteria 2 and this measure CANNOT BE SUBMITTED.

CMS anticipates the performance rate for Submission Criteria 2 and Submission Criteria 3 will be calculated using 100% of patients that met performance in Submission Criteria 1. The survey will be available at https://www.phreesia.com/mips. Clinicians will be able to administer the PAM® on paper, via phone, electronically via email, or through a free web portal provided by Phreesia Inc.

The portal will allow users to administer the PAM® survey to patients and record a patient’s responses to the survey questions that were administered using other modalities. These responses will be automatically scored. In addition, clinicians will be able to view reports on patient PAM® responses.