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:
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.
This year CHIBE held its 12th annual Behavioral Science and Health Symposium, which brings together leading academics to discuss cutting-edge research in health-applied behavioral economics and goals for advancing the field forward. This year, CHIBE welcomed Max H. Bazerman, PhD, Jesse Isidor Straus Professor of Business Administration at the Harvard Business School, and Susan Athey, PhD, Economics of Technology Professor at Stanford Graduate School of Business, as our keynote speakers. The event also featured a lively panel discussion between George Loewenstein, PhD; Hazel Markus, PhD; and Katy Milkman, PhD, that highlighted a number of important questions regarding focus of behavioral interventions on individual (i-frame) vs. structural (s-frame) factors.
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.
In a recent meeting, one of our board members was talking about the old days of TV where television shows catapulted actors into movie stars [think George Clooney in ER], and she said CHIBE acted in a similar way—it makes stars. We serve as a talent incubator and support the incredible intellect, passion, and curiosity of our investigators. Over the years, we have cultivated and supported the development of many impactful programs that collectively have made the University of Pennsylvania a special place for work at the interface of behavioral science, medicine, and public health.
If you aren’t familiar with CHIBE, we use principles of economics and psychology to help improve people’s health here in the United States and globally. In this year’s report, you’ll learn about the discoveries our researchers made in a variety of areas. For example, this year our faculty and staff found that cash transfer programs in low- and middle-income countries are associated with a 20% reduced risk of death in adult women and an 8% reduced risk in children younger than 5 years old. They also developed interventions to increase the rate of serious illness conversations 4-fold among patients with cancer, found ways to steer people away from consuming sugary beverages, made headway in lowering patients’ blood pressure and cholesterol, and much more.
One of our associate directors, Dr. Jalpa Doshi, achieved what many researchers dream of—having their research translated into practice for widescale impact on health. Her work, which over the past 15 years highlighted the adverse effect of patient cost-sharing on medication adherence and outcomes, is now instantiated in the Inflation Reduction Act of 2022 through two important provisions that protect Medicare beneficiaries from high drug costs: 1.) a $2,000 out-of-pocket cap in Part D and other drug benefit charges; and 2.) a provision that allows for smoothing of out-of-pocket drug costs so that high costs early in the year don’t result in prescription abandonment, delays in treatment initiation, or treatment interruptions. These provisions will help millions of Americans afford their prescriptions each year.
In other news, I recently had the honor of being selected to be the scientific leader of a major new research initiative on “Food is Medicine” for the American Heart Association and Rockefeller Foundation. While we know what constitutes a healthy diet, most Americans have relatively unhealthy diets and developing cost-effective interventions to systematically improve this will be both a substantial challenge and opportunity for behavioral science to positively impact health.
This year, we are also excited to announce that we have a new CHIBE website and a new logo. Please check out the new site at chibe.upenn.edu, and let us know what you think.
We sincerely thank you for your continued support, interest, and contributions.
Kevin Volpp, MD, PhD
Mark V. Pauly President's Distinguished Professor
Perelman School of Medicine and the Wharton School University of Pennsylvania
Our faculty affiliates from various universities—primarily the University of Pennsylvania but also Carnegie Mellon, Northwestern, Harvard, Yale, and Johns Hopkins—and disciplines, including medicine, law, business, nursing, communication, and computer science.
Total Award for Fiscal Year 2023 Active Projects
CHIBE-authored publications in 2022
Media mentions of our faculty
H-index for CHIBE-authored articles
years since CHIBE's founding
Healthy Nudge subscribers
CHIBE spoke with Dr. @CassSunstein about i-frame, s-frame, and the use of behavioral economics in the government space. Read our Q&A.
Check out @phillymag's coverage of @Eugenia_South's work showing that investments in the environment can lower gun violence in the surrounding Philly blocks by as much as 29%.
A program nudging emergency department clinicians to identify and treat opioid use disorder was found to double the assessment for opioid withdrawal and increase initiation of evidence-based treatment. @PennMedicine
Learn about some of our important discoveries this year, ranging from what may help decrease mortality, to how to improve end-of-life care, how to nudge healthier food choices, and even how to find more meaning in life.
If you want to improve mortality in low- and middle-income countries…consider cash transfer programs. One CHIBE study found in examining data from 37 countries that cash transfers were associated with a reduced risk of death in adult women and children younger than 5 years old.
If you want to increase serious illness conversations…one paper found that nudges to oncology clinicians combined with machine learning mortality predictions quadrupled the rates of conversations between patients and their clinicians about patients’ end-of-life care preferences.
If you want to steer people away from sugary drinks…one paper found that displaying images of the amount of added sugar in cubes, teaspoons, or packets plus health-related warning text may deter people from choosing sugar-sweetened beverages.
If you want to increase statin prescribing during primary care visits…one study found that electronic health record–based nudges to clinicians significantly increased initiation of a statin prescription during visits.
If you want to deter unsafe driving…one paper offered evidence that state handheld phone bans could improve traffic safety.
If you want to control portion sizes in restaurants…consider changing how portions are described on menus; in an online simulated menu-ordering study, researchers found options like “standard/large,” or “just right/large” nudged people to select lower-calorie, smaller portions without restricting their choice.
If you want to solve some of society’s most pressing problems…one CHIBE faculty member argued in a paper that behavioral scientists have focused too much effort on changing individual behavior — the i-frame —and should instead address systemic or structural issues — the s-frame.
If you want to increase meaning in your life…consider seeing your life story as a “Hero’s Journey.” One study found that prompting people to see the events of their life in terms of quests, challenges, transformation, and legacy, etc, can increase meaning in life by reflecting on important moments in their life and developing them into a narrative.
CHIBE’s research makes a real difference. Our faculty helped make prescription medications more affordable for patients in numerous ways this year, and they worked with policymakers and other partners to advocate for more access to and consumption of nutritious food.
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.
CHIBE Associate Director Amol Navathe, MD, PhD, and the Commission made recommendations to Congress.
CHIBE Director Kevin Volpp, MD, PhD, is leading a new American Heart Association (AHA) “Food is Medicine” initiative.
A committee co-chaired by CHIBE’s Scientific Director and Penn Professor of Nursing and Health Policy Alison Buttenheim, PhD, MBA, crafted a report exploring the influence of behavioral economics on public policy.
CHIBE hosted 24 events this year—many of which were research seminars with the leading minds in behavioral economics, health, and policy. Each year, we also host a team retreat and a symposium to share the latest research and create new connections.
Our faculty lead many initiatives ranging from food policy, to global health, health equity, technology infrastructure, and health care payment policy. Learn more about our faculty members’ expertise and research interests below.
Designing and testing approaches to steer medical decision-making and daily health behaviors toward higher value and improved patient outcomes.
Advancing the evidence base on food and nutrition policies to support health.
Blending behavioral science with scalable technology to conduct randomized controlled trials.
Addressing health equity and racism and advancing health through a unified approach.
Analyzing policy effects and testing and evaluating interventions that can improve care.
Conducting inclusive and anti-racist research that advances the science and practice of health equity.
Developing behaviorally informed HIV programs in South Africa through a first-of-its kind nudge unit.
Finding innovative solutions to persistent challenges that limit healthy lifespans globally.
Developing behavior change programs to improve daily decisions about health, education, and savings.
CHIBE salutes the following faculty members for their impressive achievements. These awards showcase CHIBE’s culture of innovation and excellence.
Named to National Cancer Policy Forum
National Academies of Sciences, Engineering, and Medicine
Excellence in Equity Award
American Society for Clinical Oncology
Named Hastings Center Fellow
Baruch A. Brody Award and Lecture
Baylor College of Medicine Center for Medical Ethics and Health Policy, the Houston Methodist Hospital System, and the Rice University Department of Philosophy
Top 100 Most Influential People in Philadelphia
10 Innovators Shaping the Future of Health
Named Hastings Center Fellow
Distinguished Researcher Award
American Society of Nephrology
Thomas A. Wadden Award for Distinguished Mentorship
The Obesity Society
30 Great Chief Innovation Officers to Know
Becker’s Hospital Review
American Heart Association
CHIBE is the leading scientific organization using behavioral economics to improve health. Drawing on the expertise of faculty from across the University of Pennsylvania and beyond, CHIBE conducts behavioral economics research aimed at reducing the burden of disease from major public health challenges and seeking to advance health equity worldwide.
Our mission is to advance the science of applied behavioral economics in pursuit of knowledge, interventions, and policies that lead to higher-value health care, equal access to health care, and healthier lives for all.
CHIBE receives project-specific funding from foundation, corporate, and federal sponsors. Diversification of our portfolio has been a strategic priority over the past several years, and we have been successful in securing funding from several commercial entities and foundations. In addition, CHIBE receives support from the University of Pennsylvania Health System and the Perelman School of Medicine that has enabled us to make strategic investments, strengthen our infrastructure, and support junior faculty and trainees.
We are also grateful to the Otto Haas Charitable Trust, whose gifts allow us to continue strengthening the infrastructure of Way to Health, making it more accessible to junior faculty and trainees by increasing the ease of use and reducing the cost. Generous support from the Otto Haas Charitable Trust has also allowed us to continue to contribute to CHIBE’s permanent endowment fund. In addition, we received a generous gift from an anonymous donor for a Director’s innovation fund for the support of high priority, quick-turnaround initiatives.
Total Grant Activity in Fiscal Year 2023