Engaged patients have been referred to as “the blockbuster drugs of the 21st century.” Under the Affordable Care Act, accountable care organizations (ACOs) are required to engage patients in their own health care decisions and treatments. ACOs are incentivized to improve patients’ engagement in their own health and health care because health plan contracts involve global payment and substantial financial risks and rewards., As a result, adult primary care practices affiliated with ACOs are beginning to adopt and learn from a range of patient activation and engagement (PAE) strategies, including motivational interviewing, shared decision-making, shared medical appointments, health risk assessments, and the inclusion of patients in quality improvement and clinic governance. Health systems and ACOs are emphasizing the use of PAE for adult patients with diabetes and/or cardiovascular disease (CVD) because engagement with care, self-management, treatment adherence, depression, and social function may affect disease progression and prognosis.
