Operationalizing Wellness

In a previous paper (available here) we discussed the importance of psychosocial wellness and its enormous impact on healthcare costs and outcomes. Patient Activation, a key metric that looks at how patients feel about their health and how involved they are, predicts health outcomes better than ethnicity or age. And the patients at the lowest levels of activation cost the system 8 to 21 percent more than patients with the highest levels of activation. In this paper, we take the next step, and look at how to make wellness metrics the basis of change in the health and social care systems, focusing specifically on the English National Health Service system.

Measuring patient activation

For our purposes, we found that the Warwick-Edinburgh Mental Wellbeing Scale was both feasible and useful in the present landscape in England. Once we understand where patients fall along the activation continuum, we can focus on the practical questions of how to move the patients at level one to level two, the patients at level two to level three, and so forth, using the full range of medical and social institutions, from hospitals to government agencies, workplaces, and schools.

Levels of patient engagement in the Patient Activation Measure

1You stress the importance of having metrics that cut across sectors. Why?

We’ve learned that the patient’s sense of wellness, engagement, and empowerment is extremely important in achieving good health outcomes and controlling costs. But to achieve this, services need to be centered around the patient not the provider. These wellness metrics provide a means of driving convergence across all relevant sectors: primary, community and acute healthcare, mental healthcare and social care, as well as other sectors such as education and crime prevention.
2So are you focusing on “soft” metrics?

It may superficially appear that way when you look at the questionnaire, but by the time we’ve taken the insights of measuring wellness and used them to build new reimbursement systems and integrated service systems, it doesn’t seem soft at all. We’re encouraging the health and social system to focus on things that have the highest impact. The same approach has been used quite successfully in treating chronic diseases in emerging economies.
3What are the first steps that need to be taken?

Well, first measure. Patient engagement questions need to be built into existing patient questionnaires, and we need to use simple well-proven technologies to start to capture a more real time view of how patients are feeling. This includes using NHS data in new ways. Then it becomes a question of identifying opportunities and creating mechanisms and incentives to get participants across the whole system to see wellness as a major focus.