Author: Jennifer Chesak   |    Medical review by: Alicia Cowley, MD

Great clinicians and providers are everything in the healthcare industry. But even with the best of the best administering care, sometimes patients don’t feel empowered to take charge of their health.

Patient activation is a patient’s ability and willingness to participate in their health and care. It is crucial for more favorable outcomes and optimal health. Patient activation also translates into greater efficiency for healthcare organizations.

Yet patient activation isn’t all on the patient. The healthcare system is complex, and many patients need support to become effective self-managers of their health. The goal of patient activation is to galvanize individuals to take independent, proactive actions to maintain and improve their well-being.

In this article, we explore 10 ways for increasing patient engagement and overall activation.

1. Define patient activation and how it fits within patient engagement

Patient activation means a patient is willing, able and confident enough to manage their own care, often in the following ways:

• They know their role in their health is important.
• They feel empowered with knowledge about their conditions, medications and symptoms, and how to manage these aspects.
• They have the skills and drive to take actionable steps for health improvement.
• They remain committed to improving their health, even in the face of obstacles or setbacks.

“An able and willing patient will generally enjoy better health or health outcomes and spend less healthcare dollars in order to achieve this goal,” says Rebecca Herrero, MD, MBA, the president and CEO of Women’s Health Associates of Southern Nevada. “And the opposite is true for those unable or unwilling to manage their health through our complicated and disparate healthcare system.”

Activated patients:

• Are more likely to engage in preventive care and self-management behaviors
• Maintain positive habits over time
• Experience better health outcomes, lower costs and improved care experiences

For healthcare organizations, patient activation is associated with better clinical outcomes, reduces avoidable care costs and boosts performance in value-based care (VBC) arrangements. Activated patients are more likely to show up for appointments, follow referrals and avoid unnecessary emergency room visits.

By equipping patients with the right tools and resources, providers can improve community health while benefiting operationally and financially.

The definition of patient engagement is when a patient takes actions that are related to their activation to improve their health. For example, when a patient understands why they need a certain medication and how it helps their condition, that’s patient activation. Patient engagement is when the patient picks up the medication from the pharmacy, sets reminders to take the medication and follows through with taking it.

2. Measure patient activation before trying to improve it

Healthcare organizations can’t assess the effectiveness of patient activation initiatives without measuring the degree of patient activation already present. That’s where the Patient Activation Measure (PAM) comes in.

PAM is a 10- or 13-item validated survey that segments patients into four activation levels along a 100-point scale. It serves as a tool for measuring baseline patient activation, and it tracks a healthcare organization’s progress when leveling up.

PAM helps providers:

• Identify risk: PAM recognizes patients with low activation levels that may otherwise be missed by traditional risk models.
• Tailor support: PAM results can help care teams tailor education and coaching to meet patients where they are.
• Measure impact: PAM tracks improvements in patient activation over time.

Research shows that as activation levels increase, patients are more likely to develop self-management skills and achieve better health outcomes.

More than 800 peer-reviewed journal articles highlight PAM as a key variable. Patient self-management improves significantly as patient activation increases. Additionally, PAM Performance Measure (PAM-PM) is a Consensus-Based Entity (CBE)-endorsed performance measure (#2483). This endorsement means the tool meets rigorous national standards as a trusted and validated method for evaluating the quality of healthcare.

3. Use patient activation and engagement models to segment patients

After patients take the PAM questionnaire, their results place them in one of four segments based on their knowledge, skills and confidence in managing their health.

4 PAM levels:

• Level 1: Disengaged and overwhelmed: Patients are passive participants in their care, and they lack knowledge and confidence. Their care adherence is poor, and they have weak goal orientation.
• Level 2: Becoming aware but still struggling: Patients have some healthcare knowledge but with large gaps. They do not feel empowered, but they can set simple goals.
• Level 3: Taking action and gaining control: Patients understand the key facts about their health and care and are building their self-management skills. They are goal oriented.
• Level 4: Maintaining behaviors and pushing further: Patients have adopted new behaviors, but they may still struggle with setbacks. They are focused on maintaining a healthy lifestyle to improve their health.

“Individuals have varying levels of activation,” Dr. Herrero says. Segmentation helps healthcare organizations avoid taking a one-size-fits-all approach when empowering patients.

4. Start with realistic next steps for each activation level

With a better grasp on which patients fit into which levels, healthcare organizations can tailor patient activation approaches appropriately to each segment.

The basic next steps for each level:

• Level 1: Build trust, reduce confusion, outline the patients’ role in their own care and set a few simple but actionable goals. These tactics help set the foundation for further empowerment and goals.
• Level 2: Strengthen patients’ knowledge with easy-to-digest information and help them build confidence with goal progression. Encourage the use of self-monitoring tools, such as symptom- and habit-tracking options. These additional steps help layer on self-confidence as patients build consistency.
• Level 3: Involve patients in problem-solving. If previous goals have been met, brainstorm ways to expand or set longer-term initiatives. At this level, patients are becoming their own care leaders, while clinicians continue in a supportive role.
• Level 4: Further refine goals while encouraging autonomy. As clinically appropriate, care teams may adjust visit frequency to solidify that patients are in control of their own health, while maintaining appropriate monitoring and access. Use shared decision-making to lock in patient empowerment.

5. Tailor education to activation level and health literacy

Patients are more likely to succeed when care teams provide education and coaching that aligns with their activation level. By systematically assessing a patient’s knowledge, skills and confidence, providers can create personalized care plans that:

• Focus on actionable steps to build confidence
• Highlight measurable goals to track progress
• Celebrate successes to reinforce positive behaviors

A study published in the American Journal of Managed Care found that coaching tailored to activation levels led to improved biometrics, better regimen adherence and reduced hospitalizations.

6. Use shared decision-making to turn information into action

Encouraging patient involvement in care decisions serves as a cornerstone of patient activation.

“Shared medical decision-making provides patient education, forces patient engagement and empowers patients to make autonomous decisions,” Dr. Herrero says.

Shared decision-making strategies:

• Without condescension, use plain language and teach-back methods to ensure patients understand clear next steps.
• Ask about barriers to care and work with the patient to problem-solve in ways that meet them where they are.
• Personalize education or coaching practices to each patient and their unique needs, including their preferred ways of engaging with their healthcare.

7. Support patients between visits with digital outreach

Patient engagement doesn’t end when their appointment does. Post-visit communication is crucial for improving activation levels and strengthening the patient-provider relationship.

Patient surveys serve as valuable tools for gathering insights about patients’ thoughts, feelings and perceptions of their care experience. This feedback provides actionable data for healthcare organizations to fine-tune their processes and improve patient experience.

Research has shown that post-visit engagement builds confidence and improves activation. A guide by Ipsos MORI and The Strategy Unit found that reflective surveys helped patients feel more confident about their care, boosting their activation levels. Patient satisfaction is directly linked to activation. Organizations that use survey feedback to make meaningful changes see higher satisfaction scores and more engaged patients.

Additionally, digital tools like secure messaging platforms allow patients to ask follow-up questions, clarify instructions and discuss concerns from the convenience of their home. This ongoing communication helps patients feel supported and encourages them to take an active role in their health.

Automation tools, including text- and phone-based appointment reminders, help reduce gaps in care. A Phreesia case study found that no-show rates dropped by 14% when patients received text reminders in addition to phone calls. And self-scheduling empowers patients to book their own appointments, increasing their engagement and sense of responsibility for their care.

Patients benefit from better outcomes, lower healthcare costs and a stronger relationship with their provider. Healthcare organizations benefit with satisfied patients, reduced no-shows, less unnecessary back-and-forth communication for staff, and improved patient loyalty and retention.

8. Remove access friction that weakens activation

Care access barriers weaken patient activation, whereas addressing these friction points can help empower patients to engage with care as appropriate.

Patients’ overall access to care can present a hurdle, Dr. Herrero says. They may have difficulty finding a provider, scheduling an appointment, seeing their provider and engaging with necessary testing or screening where applicable. The additional outreach options and digital and automation tools mentioned in the previous section can help.

9. Address financial and social barriers alongside activation

Social drivers of health (SDOH) and the financial aspects of healthcare are key pain points that can hinder patient activation.

SDOH

Patients with unmet social needs often lack the motivation, skills or confidence to manage their health effectively. Research shows a reciprocal relationship between SDOH and activation.

Higher activation may help some patients navigate barriers, but organizations should also address structural and social needs directly. For example, individuals with higher activation are more likely to access needed care and fill prescriptions, even when facing financial challenges or insurance hurdles.

Lower activation can amplify the effects of SDOH. Patients with low activation levels may delay care, miss medications or fail to engage in preventive measures, worsening their outcomes.

SDOH screening tools can help identify needs, and healthcare organizations can address specific needs by matching support with a patient’s PAM level.

Financial barriers

Even highly activated patients can face challenges navigating insurance requirements, prescription costs and out-of-pocket expenses.

“Patients don’t understand insurance and the many nuances of navigating the system and paying for their healthcare services,” Dr. Herrero says.

To address these challenges, healthcare organizations can use technology to:

• Verify insurance and assess financial needs: By collecting accurate patient demographic and insurance information, providers can identify patients who may qualify for financial assistance, Medicaid or sliding-scale fees.
• Offer flexible payment solutions: Payment plans or other options can help patients manage their financial responsibilities without delaying care.
• Provide proactive education: Patients can be automatically informed of their copays, deductibles and benefits before appointments, helping them prepare financially.

10. Build a team-based activation strategy and measure impact over time

Too often, healthcare fragmentation is a hindrance to patient activation. Care teams can be complex. They consist of the patient and the clinician, but also nurses, pharmacists, support groups, and dozens of other caregivers and staff members who help patients navigate care.

If care teams don’t communicate effectively, patient outcomes suffer. By fostering collaboration among providers, nurses, pharmacists and support staff, organizations can elevate patient activation.

How AI is changing patient activation

The thread running through every AI capability in patient activation is the same: less friction means more engagement. When patients can schedule, check in, pay and get questions answered without barriers or delays, they’re more likely to participate, which is what drives activation.

Here’s how AI supports patient activation:

• Conversational AI: Voice agents handle every inbound patient call–scheduling, refills, billing and records requests–end-to-end, 24/7, in the patient’s preferred language. No hold times. No staff involvement. Patients get what they need when they need it, making it easier to stay engaged with their care.
• Intelligent reminders and self-scheduling: Automated reminders and self-scheduling tools reduce no-shows and give patients easy options to confirm, cancel or reschedule on their own time, removing the friction that causes patients to disengage.
• Intelligent digital intake: Logic-driven intake tailors screenings and questions to each patient, making the process faster and more relevant, so patients are more likely to complete it and providers get better data.
• Personalized content: AI analyzes patient data and helps providers deliver personalized educational information and timely reminders that empower patients at every touchpoint.
• Automated administrative tasks: Administrative tasks, such as scheduling, check-in and paying bills, are friction points for patients. AI automates these tedious tasks for friction-free patient interaction, enhancing engagement and follow-through.
• Real-time feedback: AI-customized post-visit communication collects patient feedback, which can be used to improve patient activation.

The takeaway

• Patient activation is a patient’s ability, knowledge and willingness to participate in their health and care; higher activation supports better patient and clinical outcomes.
• Patients engage with their healthcare at different levels, and organizations that customize communication to each level achieve higher patient activation.
• Providers leverage shared decision-making to guide patients as they make preventive care and condition management a part of everyday life.
• A stepped-up approach to patient activation builds empowerment and shifts patients into the role of managing their own health while placing the provider into a coaching role.