Impact

Our research team has conducted a number of impactful studies that have been translated into practice by a range of entities positively influencing health for millions of people. We have designed programs based on our findings that improve both the value and quality of care provided by health plans, employers and health systems.

Health Plans & Consumer Companies

  • Despite the development of automatic refill programs to increase medication adherence, uptake rates for these programs has been low. Working with CVS Health, our team developed a solution that made the advantages and disadvantages of signing up for this type of program more salient: enhanced active choice. This new approach more than doubled the rate at which consumers enrolled in the automatic refill program. Our manuscript about this work won the Best Paper Award at the American Marketing Association Annual Conference. CVS Health has now implemented this approach across much of their business nationally and by CVS estimates, this intervention has influenced medication adherence for more than 10 million CVS Health members.
  • Working with Humana, our researchers investigated major consumer misunderstandings about health insurance in order to recommend a behaviorally-informed plan. We found that copayments were better understood by consumers than deductibles or coinsurance. Insights from this research were translated into practice in 2013 through the launch of Humana Simplicity, a copayment-only plan in which all health services are grouped into one of 7 categories.
  • In another project in collaboration with Humana, we tested the effects of a refill synchronization program – in which patients received all prescription refills at the same time – on medication adherence. We found that this program increased medication adherence by an average of three to five percent compared to a control group. This program was particularly impactful for people with low rates of baseline medication adherence, as adherence improved by about 10 to 13 percentage points relative to controls. Based on the success of our study, Humana has implemented a refill synchronization program for their members.
  • Throughout 2017, our team has provided guidance and conducted research to inform the roll-out of a new HMSA (Blue Cross Blue Shield of Hawaii) provider payment initiative that shifted primary care provider payment from a fee-for-service model to a new value-based framework. This payment model, which incentivizes providers for both efficiency and effectiveness, has now been implemented throughout most of the state of Hawaii.

Employers

  • Our researchers tested behaviorally-informed financial incentives for smoking cessation among employees at General Electric (GE) and found a tripling of long-term smoking cessation rates. Published in the New England Journal of Medicine, this project won the British Medical Journal Group Award for Translating Research into Practice, chosen out of more than 200 nominees, as this research led to a benefit design innovation adopted by GE for all 152,000 employees in the United States in 2010.
  • In the largest randomized controlled trial to date of financial incentives and smoking cessation in workplace settings, we replicated the finding of our GE study with 2,538 CVS Health employees, tripling long-term smoking cessation rates. In addition, we learned that participants who agreed to put $150 of their own money at risk (matched roughly 4:1) quit smoking 52% of the time; however, only 13.9% of participants were willing to do this. This paper was published in the New England Journal of Medicine with an accompanying editorial written by Cass Sunstein. As a result of our research, CVS launched a new benefit design innovation for more than 200,000 US employees called “700 Good Reasons.”

Health Systems

  • Within Penn Medicine, we changed the default electronic health record (EHR) choice from brand-name prescriptions to generics in a number of practices and found the percentage of generics prescribed increased overnight from about 75% to 98%, saving millions of dollars annually. This study and others like it formed the foundation of the Penn Medicine Nudge Unit, the world’s first health system-based nudge unit, a joint initiative of CHIBE and the Penn Medicine Center for Health Care Innovation.

Other Penn Medicine Nudge Unit highlights include an active choice intervention in the EHR that led to a 37% relative increase in vaccinations; secure text messaging among provider teams leading to a 14% decrease in patient length of stay in the hospital; a change in defaults in radiation oncology leading to a 40% decline in daily CT scan imaging among palliative care patients; and a default change for cardiac rehabilitation that increased referral rates from 15% to 80%.

  • Working with data from Baptist Health System in Houston, we conducted an observational study following patients who had joint replacement surgery under a bundled payment program offered by CMS, determining that average Medicare expenditures for joint replacement episodes declined 20.8%. Baptist Health was able to drive savings though reductions in internal costs such as artificial joint implants as well as episode management such as reduced institutional post-acute care.

If you are looking for assistance with designing and testing solutions to improve health behavior, consumer engagement, or the value of care through provider payment interventions please contact us here.