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Learning How Behavioral Economics Impacts Health Decisions

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Center for Health Incentives and Behavioral Economics Research

CHIBE researchers apply concepts from the field of behavioral economics to design, implement, and evaluate interventions that improve health and build knowledge about efficacy, cost and effectiveness. 

Basic Science Core Request for Applications

The Basic Science Core aims to support laboratory or low-cost field studies that will shed light on mechanisms that can generate behavior change.  In contrast to previous large-scale field studies, which have often combined multiple mechanisms into one intervention in order to maximize impact on behavior, basic science projects supported by the Core focus on disentangling and precisely identifying the impacts of individual mechanisms.  CHIBE researchers interested in applying for project support can click here for more information.



Health Incentives and Behavioral Economics Research Studies

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Using Behavioral Economics to Promote Medication Adherence and Habit Formation

Principal Investigator: Judd Kessler

Poor adherence to medication regimens is a significant problem in healthcare. This study will investigate simple behavioral economics interventions to overcome cognitive and motivational barriers to medication adherence. The goals of this study are to analyze which interventions are most effective in promoting medication adherence; to analyze which interventions are most effective in promoting long-term habits that persist even when the interventions are removed; and  to understand how various patient characteristics predict adherence or treatment receptivity. 

Funder: The Robert Wood Johnson Foundation and the Donaghue Foundation

Tags: Judd Kessler

Social Goals and Individual Incentives to Promote Walking in Older Adults

Principal Investigators: Karen Glanz, Jason Karlawish

Evidence from behavioral economics suggests that people have short time horizons and difficulty trading off immediate for delayed health benefits. Little is known, however, about whether financial incentives can be effective in encouraging higher levels of physical activity among older adults, particularly when they are in the form of social goals. The goal of this pilot randomized controlled trial is to test whether a financial incentive of a donation to achieve a social goal is more effective to motivate and sustain a daily walking habit than the same dollar value given to an older adult. This study will recruit adults 65 and older to use Way to Health with a digital pedometer-internet interface. 

Funder: The Robert Wood Johnson Foundation and the Donaghue Foundation

Cost Sharing Impact on Uptake and Attendance Among People in a Workplace Weight Watchers Program

Principle Investigator: Kevin Volpp, Leslie John

An important unresolved question in the incentive literature is how to optimally set patient cost-sharing for services that require ongoing patient engagement. Standard economic theory would suggest that lowering prices to zero (or even below zero) would maximize program attendance; however, the goal of the Weight Watchers program is not attendance per se but weight loss and it is possible that people who come to the program because it is lower cost or free will value it less and thereby exert themselves less and be less successful in losing weight. It is also unclear how much attendance would change with changes in price and whether the increased attendance would be worth the cost of the subsidies. Our study will test the uptake of four different cost sharing discounts for enrolling in an employer-based Weight Watchers weight loss program as well as program attendance and weight loss over 12 months among those participants who sign up for the program.

Funded by: Weight Watchers, Inc

Tags: Kevin Volpp

Why Join a Walking Program?

Principal Investigator: Jason Karlawish

The federal healthcare reform bill includes provisions for Medicare and Medicaid to provide incentives to beneficiaries to complete behavioral modification programs. This pilot study assesses whether relevant differences exist in different age groups' views on the acceptability of behavioral economic interventions, with particular emphasis on whether differences exist between older versus middle ages to younger adults.

Funder: National Institute on Aging

Participation in Clinical Management Programs

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

The Influence of Cost-sharing and Socioeconomic Factors on Preventive Care

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

Evaluation of a Patient-Centered Medical Home

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

Randomized Trial of Healthy Eating Interventions

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

Can Tying Tempting Experiences with Gym Visits Increase Exercise and Improve Health?

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

Can Calorie Labels Increase Caloric Intake?

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

The Effects of 24-hour Intensivist Coverage in the Medical ICU

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

Attitudes on Wellness Incentives: Carrots and Sticks

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

Behavioral Economics Academic Consortium

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

Academic Research Consortium

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)

New York State Medicaid Incentives for the Prevention of Chronic Disease Demonstration Project

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

Tags: Kevin Volpp

Improving Diabetes Glucose Control Through Peer Counseling and Incentives

Principal Investigator:  Long

Prior research has established that patients achieving good glucose control can reduce their likelihood of diabetes mellitus micro-vascular complications, including blindness, renal failure, neuropathy and amputations. The growing epidemic of diabetes mellitus disproportionately affects low income and racial minority populations. This pilot study tests whether in a cohort of low-income U.S. veterans with poor diabetes mellitus control peer counseling or financial incentives can help improve glucose control compared with usual care.

Funder:  National Institute on Aging

New Ways to Increase Patient Understanding of Diabetes Control and Disease Severity

Principal Investigators: Gopalan / Volpp

Patients with diabetes mellitus can find it hard to understand their lab test results related to glycemic control, and thus many are not fully aware of how well they are keeping their diabetes under control. The goal of this pilot study is to examine ways to make provider feedback about glycemic control and severity of diabetes based on individual blood sugar levels easier for patients to understand.  Two different formats for the design of a "diabetes report card" will be evaluated.

Funder:  CHIBE Pilot Study

Making Calories Count: Information Format and Food Choice

Principal Investigators:  Downs / Loewenstein

Government policy aimed at promoting healthy eating habits has tended toward strategies based on information provision, though there is little evidence that this strategy is maximally effective. This pilot study involves a cross-sectional test of the impact of calorie labeling and a heuristic cue on customers' choice of lunch item on-site at a chain restaurant, as well as a cohort study which assesses lunch item choices over time based on real-time nutritional feedback.

Funder:  National Institute on Aging

Helping People to Exercise Regularly

Principal Investigators: Hafalir / Xiao 

Regular gym visits might prevent health problems that occur later in life, but many people find it hard to maintain a commitment to attend regularly. Pre-commitment devices are one possible tool which could help sustain commitment to healthy behavior. This project seeks to improve methods for helping older individuals exercise regularly. 

Using Technology to Promote Mental Acuity

Principal Investigator:  Loewenstein

A rapidly aging population is faced with a growing number of technological advances which offer to improve quality of life and health, but many of these may seem inaccessible to those with little exposure to them. This pilot study is testing interventions involving financial incentives to encourage senior citizens to engage in long term use of technologies which promote health and wellness, specifically, computer programs designed to improve memory and mental acuity.

Funder:  National Institute on Aging