Professor of Medicine and CHIBE Associate Director Jalpa Doshi, PhD, was instrumental in a change to the Medicare Part D prescription drug benefit design under the Inflation Reduction Act.

She and her team worked on a series of papers that demonstrated that patient out-of-pocket costs (that were “too much and too soon” in the calendar year) under Part D are associated with markedly higher rates of abandonment of new specialty drug prescriptions; reductions and delays in treatment initiation following a new diagnosis or disease progression; treatment interruptions; and earlier discontinuation of specialty drug treatments.

The Inflation Reduction Act includes two key provisions that were first proposed by Dr. Doshi’s team in two papers that won back-to-back awards in 2016 and 2017. Specifically, the two provisions based on the ideas first recommended by her team that have become part of the law are the following:

• People with Medicare Part D drug plans will for the first time have an annual out-of-pocket maximum and not pay more than $2,000 per year for medications, effective 2025.
• Part D plans will offer enrollees the opportunity to spread out and pay their out-of-pocket costs for prescription medications in monthly installments (“smoothing”), including a monthly limit, effective 2025.

CHIBE Associate Director Amol Navathe, MD, PhD, is Vice Chair of the Medicare Payment Advisory Commission (MedPAC). This year, he and the Commission sought to bring down prescription drug costs in the Medicare Part B program, making recommendations to Congress such as reducing add-on payments for Part B drugs (to remove a potential incentive for clinicians to prescribe higher-priced drugs). The Commission also recommended increasing the Medicare base payment rate for clinicians and providing financial incentives to those caring for low-income Medicare beneficiaries. MedPAC also took on foundational work on providing payments to the safety-net and reforming that financing system.

CHIBE Director Kevin Volpp, MD, PhD, is leading a new American Heart Association (AHA) “Food is Medicine” initiative. Food is Medicine brings together the health care sector with efforts to increase access to and consumption of healthy diets to prevent, manage, or treat clinical conditions. About 85% of chronic disease is related to diet, and while there is a clear sense of what diets are healthy, changing behavior to help people eat healthy at higher rates has been considerably more challenging. The initiative brings together a coalition of partners to work together to build evidence on the effectiveness and cost effectiveness of interventions that facilitate healthy eating. The initiative will be supporting research in settings around the United States with a goal of bringing together human-centered design and behavioral science to significantly increase the efficacy and effectiveness of existing programs, with a goal of informing potential coverage decisions of such services. There will also be an accompanying effort on advocacy to support health-promoting policies at both the national and state level.

Serving as a witness on behalf of the AHA last winter, Dr. Volpp appeared before the Senate Committee on Agriculture, Nutrition, and Forestry’s subcommittee on food and nutrition to talk about the connection between chronic disease and nutrition and to call for continued federal support for nutrition research and Food is Medicine programs.

In April of 2023, the AHA, with inaugural partners the Rockefeller Foundation, Kroger, Instacart, America’s Health Insurance Plans, and Kaiser Permanente, held an event describing the new research initiative at the National Press Club in Washington, DC.

How has behavioral economics contributed to public policy, and what are the guiding principles for future work in this area? This was a question that a National Academies of Sciences, Engineering, and Medicine committee discussed, researched, and crafted a report on this year. The report delves into how behavioral economics has been used in retirement benefits, social safety net benefits, climate change, education, criminal justice, and health, and it cited several landmark studies by CHIBE faculty in the health domain.

The report also offers suggestions for how to advance the field such as encouraging more collaboration between behavioral economists and implementation scientists or those trained in public management and more integrated work between policymakers and behavioral scientists so that research ideas can be translated into policy. CHIBE’s Scientific Director and Penn Professor of Nursing and Health Policy Alison Buttenheim, PhD, MBA, served as co-chair of this committee alongside Robert Moffitt, PhD, the Krieger-Eisenhower Professor of Economics at Johns Hopkins University. CHIBE Director Kevin Volpp, MD, PhD, also served as a committee member.

In partnership with the Palliative and Advanced Illness Research (PAIR) Center, CHIBE held its 2022 Roybal Retreat for faculty, trainees, and staff at Camelback Lodge. In addition to research presentations and team-building exercises, the retreat featured a keynote from Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor-in-Chief of the Journal of the American Medical Association (JAMA) and the JAMA Network, and the Lee Goldman, MD Endowed Professor of Medicine and Professor of Epidemiology and Biostatistics at the University of California, San Francisco.

Dr. Bibbins-Domingo spoke about improving representation in clinical trials and research and building research equity for women and underrepresented groups. The Joint Research Practices (JRP) group, a joint initiative between CHIBE and PAIR, also facilitated a workshop for Roybal attendees. The team led small group discussions on topics related to 1) community engagement; 2) payment and incentives; 3) measurement, treatment, reporting and dissemination; and 4) recruitment, retention, eligibility, and representativeness.

In an event co-hosted with the Leonard Davis Institute, CHIBE Director Kevin Volpp, MD, PhD, interviewed former Secretary of the Department of Health and Human Services Alex Azar, JD about his recent service. The discussion focused on the preparation and launch of Operation Warp Speed, the government’s effort to accelerate development of a COVID vaccine, as well as the challenges the HHS team faced. Secretary Azar also addressed topics such as drug pricing, the Affordable Care Act, opioids, and value-based care.

Launched with support from CHIBE and the Penn Medicine Center for Health Care Innovation, the Penn Medicine Nudge Unit is the world’s first behavioral design team embedded within the operations of a health system. The team, which is led by CHIBE Associate Director Dr. M. Kit Delgado, leverages insights from behavioral economics and psychology to design and test approaches to steer medical decision-making and daily health behaviors toward higher value and improved patient outcomes.

Since launching in 2016, the team has worked on more than 100 projects including nudging clinicians and patients, predicting decision-making and health behaviors, and behavioral phenotyping. Many of these projects have been scaled either throughout Penn Medicine or implemented in other health systems. The Nudge Unit’s work has been published in leading medical journals including NEJM, JAMA, and the Annals of Internal Medicine. It has also been featured in a wide range of media outlets including The New York Times, Wall Street Journal, Economist, Harvard Business Review, and Freakonomics.

In the past year the Psychology of Eating and Consumer Health lab (PEACH lab), directed by CHIBE Associate Director Dr. Christina Roberto, has continued to advance the evidence base on food and nutrition policies to support health.

The lab’s new study found that the Philadelphia sweetened beverage tax was associated with reductions in dental caries among Medicaid patients. This is one of the first studies demonstrating that such taxes can improve health among groups with lower income. In an effort to disseminate their work on beverage taxes more broadly, Drs. Roberto and Laura Gibson co-authored an opinion piece making the case that sweetened beverage taxes are a much needed public health policy that can reduce health disparities in diet-related diseases and lead to cost savings among lower income groups.

The lab has also generated multiple studies to directly inform international policy on sugary drink warning labels, national policy on sugar warnings and disclosure requirements for fruit drinks, and a new policy to require restaurants to place added sugar warnings on menus. The lab has also advanced the science of portion size interventions and interventions that incentivize the purchase of fruits and vegetables among consumers with low-income. The Lab has also worked closely with the City of Philadelphia to study the impacts of water insecurity to inform local policy solutions to address it. Drs. Roberto and Gibson co-authored an opinion piece in the Philadelphia Inquirer calling for the City to stop shutting off water access for households that cannot afford to pay. In recognition of Dr. Roberto’s commitment to mentoring scholars in food and nutrition policy research, she was also honored this year with the Thomas A. Wadden Mentoring Award from the Obesity Society.

Way to Health is an integrated, cloud-based platform that blends behavioral science with scalable digital technology to conduct randomized controlled trials of healthy behavior interventions and strategic telehealth programs. Operated as a partnership between CHIBE and the Center for Health Care Innovation, the platform provides both remote monitoring and engagement solutions as well as tools for developing and deploying new interventions. The platform has supported hundreds of clinical and research projects that focus on facilitating improvements in a wide range of clinical contexts including blood pressure, medication adherence, weight loss, physical activity, and more.

During FY23, the Way to Health team worked on close to three projects per month, helping with design, requirements, implementation, testing and go-lives. The team actively supports 121 projects currently. Way to Health also supports key health system-wide initiatives and core research studies such as the Penn Healthy Heart program. The Way to Health program has now touched close to 1.6 million individuals in various health improvement efforts and has supported more than 290 projects involving researchers from more than 15 universities.

Accelerate Health Equity (AHE), led by Drs. Kevin Volpp, Meghan Lane-Fall, and Erica Dixon is a collaboration with Independence Blue Cross and health systems across Philadelphia, including AmeriHealth Caritas, Children’s Hospital of Philadelphia, the City of Philadelphia, Drexel University, Independence Blue Cross, Jefferson Health, Main Line Health, Philadelphia College of Osteopathic Medicine, Temple Health, and Trinity Mid-Atlantic, all “working together for a healthier Philadelphia.”

Among other efforts, the initiative has partnered with the EconomyLeague of Greater Philadelphia for the Well City Challenge—a socialimpact competition focused on mental health and heart health withcommunity partners—and with the Colorectal Cancer Alliance for “Cycles of Impact” to increase colorectal cancer screenings for Black Philadelphians. AHE also launched its inaugural grants program focused on health system-based gun violence prevention initiatives across the city and funded projects led by investigators at Temple, Jefferson, CHOP, and Penn in the summer of 2023.

Led by CHIBE Associate Director Dr. Amol Navathe, the Payment Insights Team is an interdisciplinary team of experts based in the Perelman School of Medicine whose mission is to utilize insights from economics and behavioral science to analyze existing policy effects and design, test, and evaluate financial and nonfinancial interventions that can improve health care in pragmatic, real-world settings. The Payment Insights Team is committed to doing so in collaboration with health insurer, health system, physician practice, and policymaker partners in order to achieve organizational and societal goals of greater health care valueand equity.

Current projects within the Payment Insight Team’s portfolio focus on bundled payments, large-scale redesign of physician and hospital payment, improving identification of the health care safety net, optimal use of nudges in health care, and design of predictive models to drive behavior change. The Payment Insight Team’s work has been featured in JAMA, Science, Health Affairs, Journal of Hospital Medicine, Annals of Internal Medicine, and The New York Times, as well as in many other high-profile and impactful, scientific journals and media outlets.

The Joint Research Practices Working Group (JRP) is chartered by the leadership at CHIBE and the Palliative and Advanced Illness Research (PAIR) Center to develop and disseminate best practices and guidelines for the conduct of inclusive and anti-racist research that advances the science and practice of health equity. This year, the team’s work was recognized with an honorable mention for Penn Medicine’s Champion in Inclusion, Diversity, and Equity Award.

The JRP has developed a toolkit of evidence-based resources andprovides hands-on training on how to practice research equitablyas a resource for faculty and staff at CHIBE and PAIR and more broadly. This includes guides for readability and plain language, interpretation and translation, payment and incentives, and participant-centered research.

The JRP also recognized the potential value of cultivating a community of knowledge-sharing around ways to practice equitable research and has begun to offer PERKS calls (i.e., Practicing Equitable Research & Knowledge Sharing). CHIBE affiliates are encouraged to schedule a PERKS call if they are facing a barrier to practicing equitable research, such as implementing an inclusive research program, recruiting a representative sample, or incorporating a health equity lens into a grant proposal.

CHIBE Scientific Director Dr. Alison Buttenheim and Associate Director Dr. Harsha Thirumurthy continue to play a leadership role in Indlela, the first-of-its-kind nudge unit they co-founded in 2020 in South Africa. Based at Wits University, Indlela has strengthened local capacity to do applied behavioral economics research and partnered on research projects with several organizations that deliver HIV services in the public sector. Indlela’s work has included several evaluations of nudges and other behavioral interventions to improve HIV prevention and treatment outcomes in the country with the world’s largest HIV epidemic.

Earlier this year, Indlela received four years of additional funding from the Bill & Melinda Gates Foundation to help develop behaviorally informed HIV programs. The additional funding will also help Indlela expand its work in eastern and southern Africa, establish a behavioral economics fellowship program, and host nudgeathons to identify promising behavioral solutions. Now led by Wits University, Drs. Buttenheim and Thirumurthy continue to be part of Indlela’s senior leadership team.

CHIBE Scientific Director Dr. Alison Buttenheim and Associate Director Dr. Harsha Thirumurthy launched the Behavioral Economics and Global Health Insights (BEGIN) Lab. The BEGIN Lab seeks innovative solutions to persistent challenges that limit healthy lifespans globally. In pursuit of these solutions, the BEGIN Lab and its collaborators design and evaluate behavioral, structural, and policy interventions that have the potential to improve health outcomes. The overarching goal of the BEGIN Lab is to change behavior, impact policy, and end epidemics. Ongoing projects are taking place in partnership with researchers and organizations in several countries in Africa, South Asia, and Latin America. Learn more about the Lab at beginlab.upenn.edu.

Behavior Change for Good (BCFG), founded by Drs. Katy Milkman and Angela Duckworth, launched in 2017. This initiative, housed at The Wharton School and the School of Arts and Sciences at the University of Pennsylvania, unites a world-class, interdisciplinary team of academic experts with leading organizational partners to help advance the science and practice of behavior change. BCFG’s pioneering “megastudy” approach simultaneously tests dozens of ideas for changing a behavior, proposed by a diverse array of scientists, to identify which strategies work best and for whom, and how to most effectively create enduring behavior change to transform people’s lives for the better.