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Case Managers a Catalyst for Patient Activation.

Hospitals, health care systems, and health care plans are rapidly moving from a symmetrical health care model to an asymmetrical health care continuum. Community, ambulatory, and hospital health care providers have put their collective ideas and projects into practice. They share a common aim of engaging patients and their partners to improve health and treat chronic disease. It is through the dissemination of their research and evaluative projects that likeminded caregivers begin to discuss their work. They share their ideas on how to prevent unnecessary hospital admissions and improve the patient experience. There is a heightened awareness among case managers that once the patient identifi es a goal and the case manager identifi es health-related action steps to reach the goal, the work has just begun. Health care systems recognize the need to enhance and assist their patients’ transition from hospital to home, both while in the hospital and after discharge. Patients do not respond to uniform teaching styles and require disease education tailored to their specifi c needs. “Patient activation” is a term used to describe the knowledge, skills, confi dence, and resources patients possess to manage their disease state in an active and informed manner. This patient-centered approach meets patients at their personal level of readiness to learn and accomplish the health-related goals. Patients with the highest level of activation display interest and involvement and actively decide their best course of action. A high patient activation level is associated with decreased health care costs ( Hibbard, Greene, & Overton, 2013 ; Hibbard, Stockard, Mahoney, & Tusler, 2007 ). Case managers have long understood the value of patient-centered care. It is central to the Case Management Society of America (CMSA) Standards of Practice for Case Management . However, as with all initiatives, case managers need the education and tools to engage patients as a partner to prevent further health deterioration and to improve their wellbeing. Case managers will benefi t from learning about the patient activation concepts and about the tools needed for implementation. The relationship-based care model informs case managers that a relationship occurs every time a case manager makes a connection with the patient. Case managers, through the intentional presence with their patients, create an atmosphere of mindfulness and a human-to-human connection ( Manthey, 2012 ). Case managers meet their patients at their level, aware of the importance of patient activation. Utilizing this strategy to prepare patients for an active role in their care demonstrates that meaningful relationships are at the heart of case managers’ purpose. This approach enables the patient and the case manager to perform important work together to achieve shared goals. The case manager’s willingness to individualize each patient’s care plan validates his or her commitment to that particular patient. Patient-centered care must also be patientdirected care for patients to be fully engaged. This is more than a subtle difference in direction and focus. Patients benefi t from an education plan tailored to their current level of understanding and their acceptance of their medical condition. Dr. Hibbard and her colleagues found that activated patients play an important role in managing their own health. They accomplish this through collaborating with their providers and maintaining their health. ( Hibbard et al., 2007 ). Case managers achieve this process by embracing the patient relationship and viewing both the patient-centered plan and patient education from patients’ perspective. It is the case managers who can coach and lead patients toward a higher level of learning and subsequent confi dence in their ability to self-manage Case Managers a Catalyst for Patient Activation