What is the Patient Activation Measure® (PAM®) Survey?

PAM®Patient Activation Measure®

Patient Activation Measure® (PAM®) Survey

Achieving positive outcomes in healthcare in part depends on the level of engagement the patient has in their own healthcare journey. The Patient Activation Measure® (PAM®) was created to identify which patients may need additional resources to manage their health. The PAM® is a validated patient-reported outcome measure owned by Insignia Health®, a Phreesia company. It consists of 10- or 13-survey items that assess three (3) key areas related to managing one’s own health and healthcare: knowledge, skills and confidence. It can be administered in a variety of mediums and is available in over 35 languages. 

How the Patient Activation Measure® is Scored 

The PAM® score is calculated by a proprietary survey scoring algorithm, which produces an interval-level scale from 0-100 that correlates to one of four levels of patient activation (Figure 1). A lower patient activation score indicates a patient who is less active in managing their health, whereas a higher patient activation score indicates a patient who is more active in managing their health. 

Figure 1

PAM® Scoring

PAM® Scoring – Owned by Insignia Health, a Phreesia Company



The PAM® survey is rooted in science and research. There are hundreds of peer-reviewed studies worldwide that have demonstrated the survey’s ability to measure activation, and subsequently predict a broad range of health-related behaviors and outcomes. It only takes 3-5 minutes to complete, so the burden on the patient is minimal. Another strength of the PAM® tool is the simplicity of the 1-4 activation level, making it easy to interpret. 


The PAM® survey requires a license to use. They have three (3) license types: 

  • Standard Commercial – designed for health systems, hospitals, health plans, government programs, care management programs and life science/pharma organizations..
  • Limited Commercial – for Federally Qualified Health Centers, clinics, rural hospitals, Area Agencies on Aging, community-based organizations (CBOs), social sector organizations, clinics within hospitals/UK Trusts, and select health research programs, serving fewer than 10,000 individuals. 
  • Research License – for university-affiliated academic healthcare researchers only.


Overall, the PAM® tool is a valid and reliable way to measure activation. There are three (3) things to consider before using the PAM® survey:  licensing requirements, IT/technical burden, and infrastructure that supports the utilization of the data. 

Licensing Requirements – like any tool that requires a license to use, there are financial and administrative burdens associated with use. It is important to understand the nuances associated with the contract, such as reporting requirements, pricing model, and renewal terms before entering into the agreement. 

IT and FTE Resources – the PAM® survey scoring is proprietary. To score the survey, you must enter the question answers via their portal, which is manual in nature, or build an API with their system, which requires IT resources to implement and maintain.  For many organizations, sending PHI to a third party via API will also require a security assessment. In addition to the license fee, there are indirect costs associated with the IT resource(s) needed to implement and maintain the PAM®. 

Infrastructure – analyzing the PAM® score provides guidance for aligning resources, such as health coaches, case managers, telehealth providers, training videos, and informational materials – with an emphasis on assisting individuals with lower activation. To maximize the value of the tool, organizations need the infrastructure/ability to execute on the insights/guidance the tool renders. For example, if you are a total joint surgeon and your patient scores a 1 on the activation score…do you operate on the patient? Or, do you hold off on surgery until the patient scores a 3? (refer to Figure 1)  The company does offer other products designed to help with the utilization of the PAM® data, such as the Coaching For Activation® (CFA®) and Flourish® Consumer.


  1. Insignia Health Products – PAM®
  2. Insignia Health Products – CFA®
  3. Insignia Health Acquired by Phreesia
  4. Medical Group Management Association – Building Patient Activation for Value-Based Models of Care
  5. What is the Patient Activation Measure in Patient-Centered Care?