University of Pennsylvania LDI CHI | Center for Health Incentives at the Leonard Davis Institute of Health Economics | Home of the UPHS Innovation in Healthcare Financing Center & Penn CMU Roybal P30 Center on Behavioral Economics and Health

Principal Investigator: Volpp

Co-investigators:  Asch, Duggan, Kolstad, Pauly, Werner

Due to concerns about increasing health care costs, health insurers are looking to the field of behavioral economics to offer solutions to some of the most serious problems facing health care; obesity, medication non-adherence, and ineffective provider payment models. To this end, Horizon Healthcare Innovations established an Academic Research Consortium to address these issues. The goals of the academic research consortium is to independently study new health care and consumer engagement pilot programs. The Consortium members will advise Horizon Healthcare Innovations on pilot designs and adjustments to produce improved results in health quality, cost and patient engagement. The Consortium will test new ways of trying to improve health and address the nation's problems of high rates of growth in health care costs.

Funder: Horizon Healthcare Innovations (a Horizon BCBS subsidary)

Principal Investigator: Karlawish 

This line of research is examining the implications of the psychology and neurology of aging on theories of behavioral economics with attention to the clinical, ethical and policy issues.

Principal Investigator: Abrams 

There is concern in the medical community that payments to physicians by pharmaceutical companies may distort prescribing behavior, whether through a conscious or unconscious mechanism. By combining a proprietary dataset covering 80 million individual prescriptions with payment data collected by state agencies the goal of this research is to produce the first empirical estimates of the relationship between pharma payments and prescription choice.

Funder: LDI CHIBE Pilot Project

Principal Investigator: Halpern

Patients 65 or older with terminal lung diseases will be randomized to receive 1 of 3 advance directives which differ in terms of the default framing of the standard of care. Specifically, we are evaluating how people's "preferences" for plans of care focused on comfort vs. those focused on prolongation of life are influenced by how these options are presented.

Principal Investigators: Loewenstein / Acquisti / John 

Dominant theories proposed by economists and psychologists assume that people have stable, coherent, attitudes toward privacy, but this research has found that people are extremely inconsistent in their concern about privacy. A large number of field and laboratory studies have found that people are often protective of their privacy in situations in which there is no need to be, and even more often not concerned about privacy or even motivated to reveal information in situations in which caution would be warranted.

This project aims to test whether financial incentives and/or choice architecture improve the uptake of comparative effectiveness research findings related to reducing cardiovascular disease risk among physicians and patients.

Funded by: National Institutes of Health / National Institute on Aging

Principal Investigators: Asch / Volpp

Co-investigators:  Bellamy, Halpern, Glanz, Goldberg, Groeneveld, Karlawish, Kimmel, Kuna, Loewenstein, Rozin, Shea, Troxel, Zauberman

David A. Asch, MD, MBA and Kevin G. Volpp, MD, PhD are developing IT infrastructure that will deploy clinical and behavioral research studies to advance the science at the intersection of behavioral economics and health.  The project is called Way to Health. For more information see: waytohealth.org

Funded by: National Institutes of Health / National Institute on Aging

George Loewenstein, PhD is leading a team in pilot studies to explore different ways of encouraging consumption of healthier food items by framing caloric content using various formats.

 Funded by: Aramark

Principal Investigator: Lindsay Jubelt, Kevin Volpp

A substantial portion of health care costs derives from a relatively small subset of the population. These high-cost members often suffer from multiple chronic conditions and may struggle with behavioral health issues and low health literacy. Given these challenges, these members are vulnerable to the inefficiencies and poor coordination of services in the current fee-for-service health care system.

Disease management and care coordination programs are designed to counter these challenges by engaging members, identifying their needs, and providing additional support, education, and services tailored to the specific goals of the individual. However, the effectiveness of such programs is often compromised by low rates of engagement and ongoing participation. More information is required to understand why certain people never fully participate in disease management programs and why others stop after initially participating. Understanding barriers to enrollment and participation is necessary for such programs to achieve their full potential to improve the health and reduce the health care expenditures of the patients they are serving.

Funder: Humana

Principle Investigators: Kevin Volpp, Shivan Mehta 

The purpose of this study is to examine the effect of cost-sharing reduction for colonoscopy and other preventive services among Humana beneficiaries. The Affordable Care Act mandates no preventive care cost-sharing for commercial insurance plans starting September 23, 2010 and Medicare plans starting January 1, 2011. We expect the impact of reduced cost sharing to be greater for vaccinations and mammography than for colonoscopy, given the nature of the test. The results would guide future policy by defining the role that cost-sharing has on the utilization of preventive services, as compared to patient factors and other preventive care.  We also intend to study additional patient and organizational factors that affect response to cost-sharing reduction such as age, location, education, income, and race/ethnicity.

Funder: Humana

Principal Investigators: Rachel Werner

Co-investigators:  Glick, Shea, Small, Volpp

As US policy makers, health care providers, and consumers seek ways to bend the health care cost curve while improving the quality of care and efficiency of health care delivery, one model of primary care delivery that has garnered increasing attention and support is the Patient-Centered Medical Home (PCMH). Focused on primary care, improved coordination of care, and incorporation of health information technology (HIT), the PCMH model holds promise for improving patient outcomes and health care quality. Because of these potential advantages over the fragmented delivery system that currently dominates US health care, PCMH demonstrations have been implemented in practices across the country, and the medical home has received increasing attention at both the federal and state levels.

Even with these recognized standards and best practices, PCMH practices vary in terms of which aspects of the PCMH model they implement. Evaluations of PCMH demonstrations are necessary to identify specific aspects of the model that may influence patient outcomes and efficiency, and maximize the potential benefits of the PCMH in existing and future demonstrations and practices. As private payers, state, and federal programs continue to invest more in the PCMH model, the need for empirical evidence identifying the features of the model that improve health outcomes and reduce costs becomes greater.  The overall objective of this study is to determine the effectiveness of an existing PCMH pilot implemented in the State of New Jersey on selected quality measures.

Funded by: Horizon Healthcare Innovations

Principal Investigators:  Saulsgiver / Halpern

Co-investigators:  Stearman

This pilot study examines the effectiveness and feasibility of an intervention for promoting increased consumption of fruits and vegetables by incenting their purchase where the overwhelming majority of food is sold: grocery stores.  Two incentive designs are compared.

Funded by:  National Institutes of Health / National Institute on Aging

Principal Investigator:  Milkman

People intend to exercise and diet later but frequently lack the necessary willpower to act on those good intentions.  Tying devices offer a new method for motivating people to engage in a healthy behavior by linking this behavior to an addictive activity, such as watching television.  This pilot study tests whether a tying device in a gym setting can help people to develop good exercise habits.

Funded by:  National Institutes of Health / National Institute on Aging

Principal Investigator:  Loewenstein

Research on the effectiveness of calorie and nutrition labeling of food in propelling individuals toward healthier food choices has revealed weak and inconsistent findings.  Four potential mechanisms to induce perverse effects -- causing people to increase calorie intake -- are tested in this pilot study.

Funded by:  National Institutes of Health / National Institute on Aging

Principal Investigator:  Halpern

Available evidence suggests intensivist management of critically ill patients improves patient outcomes.  The objective of this study is to evaluate the comparative effectiveness and cost effectiveness of nocturnal staffing with and without intensivist coverage in a large academic medical hospital's medical ICU.

Funded by:  National Institutes of Health / National Institute on Aging

Principal Investigators:  Schmidt / Volpp

Provisions included in the 2010 health reforms substantially increased the permissible levels of wellness incentives paid by employers.  This pilot study tests public attitudes towards different ways of implementing financial incentives in the workplace to build evidence regarding how such programs would be perceived by employees.

Funded by:  National Institutes of Health / National Institute on Aging

Principal Investigator: Volpp

Co-investigators:  Kolstad

Due to concerns about increasing health care costs, health insurers are looking to the field of behavioral economics to offer solutions to some of the most serious problems facing health care; obesity, medication non-adherence, and ineffective provider payment models. To this end, Humana Inc established a Behavioral Economic Academic Consortium to address these issues. This is a consortium of experts in behavioral economics and insurance benefit design to design, implement and evaluate various behavioral economic interventions to improve health among the Humana member population. Findings from the Consortium may be applied to national health care issues.

Funder: Humana

Principal Investigator:  Volpp

Co-investigators:  Chernew, Loewenstein, Saulsgiver, Troxel

CHIBE is collaborating with the New York State Health Department to design, implement and evaluate multiple financial incentive interventions to reduce smoking, improve diabetes management and blood pressure control in the state's Medicaid population.  This is one of 10 demonstration projects in states across the U.S. being funded under a mandate in the Patient Protection and Affordable Care Act.

Funder:  Centers for Medicare and Medicaid Services