San Mateo County Health partners with Insignia Health to reduce high-cost utilization

The Patient Activation Measure® (PAM®) and Coaching for Activation® (CFA) are helping San Mateo County Health decrease emergency department visits and reduce inpatient discharges with at-risk patients.
PORTLAND, Ore. - June 15, 2021 - PRLog -- San Mateo County Health (SMCH) has implemented the Whole Person Care (WPC) pilot as part of California section 1115 Medi-Cal Waiver to provide coordinated and efficient care to San Mateo's most vulnerable Medi-Cal beneficiaries.

SMCH created the Bridges to Wellness Team (BWT) to serve clients considered to be the highest utilizers of services and who have multiple comorbidities, such as complex medical conditions, mental health challenges, substance use disorders, multiple incarcerations, and experiencing homelessness insecurity. The team is composed of care navigators, supervising social workers, a nurse, nurse practitioners and a medical director who engage the clients and link them to the services based on need.

In early 2019, the BWT program implemented the Patient Activation Measure® (PAM®) survey to risk-stratify clients according to activation level, determine the needs of the population, and then tailor additional health coaching support to those with lower activation. The team also implemented use of Insignia Health's Coaching for Activation® (CFA) program in late 2019. Initial results indicate that among those clients with improvements in PAM scores, average monthly emergency room visits and inpatient stays dropped by 18% and 52% respectively, confirming that PAM can be used as a tool to predict client behavior and health outcomes.

"The PAM survey is scientifically proven to measure activation and predict a broad range of health-related behaviors and outcomes produce good results in various health conditions," said Lucinda Dei-Rossi, Whole Person Care Manager, San Mateo County Health. "PAM was recommended to us as a tool to identify and understand the self- management readiness and skills of our clients right now, instead of where we think they should be. The PAM survey has enabled us to stratify our clients and more efficiently examine caseloads based on activation levels. In addition, the CFA materials have been effective in supporting clients with life-changing results."

About Insignia Health: Insignia Health is a global provider of PAM-based health activation solutions that help organizations rigorously measure a person's self-management ability and then align resources and tailor support accordingly. The Patient Activation Measure® (PAM®) is a predictive powerhouse backed by over 15 years of health activation research and insight gained from supporting hospitals, health systems, insurers, life science companies and government health agencies around the globe. The company's products and services have proven through extensive published research to increase activation resulting in declines in preventable utilization, lower costs and improved health outcomes. Insignia Health is headquartered in Portland, Oregon. Visit ( to learn more.
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