Dr. Kevin Volpp shares behavioral insights on improving patient outcomes at CMMI panel
CHIBE Director Dr. Kevin Volpp offered his expertise on how to engage patients in healthier behavior at a Center for Medicare and Medicaid Innovation (CMMI) panel run by the Duke Margolis Center on May 19, 2025.
The event was part of CMMI’s newly released strategic initiative focused on helping Americans achieve better health outcomes and started with an introduction by former CMS Administrator Dr. Mark McClellan and an interview by Dr. McClellan of CMMI Director Abe Sutton.
The 3 pillars of the strategy are:
- promoting evidence-based prevention
- empowering people to achieve their health goals
- driving choice and competition
On how to help patients engage in healthier behavior at higher rates
“It’s really striking when you step back and think about how often we make patients swim upstream to improve their health,” Dr. Volpp said. He gave a few examples of how we can change systems to make the healthier choice the easy choice to make.
Improve medication adherence by switching to 90-day prescriptions with automatic refills
Dr. Volpp noted that a lot of patients with chronic conditions are on medications with a 30-day duration. Patients have to “opt in” 11 times a year to remember to refill their prescription.
“But we can very easily put everyone on 90-day scripts with automatic refills, and presto, you’re much more likely to have better medication adherence,” he said.
Improve chronic conditions through medically tailored meals paid for by insurance
“Another big area where I think there’s a lot of room for improvement is around Food Is Medicine. We know that tens of millions of Americans have diet-related chronic conditions, and rates of adverse outcomes are pretty high and often are related to diet,” said Dr. Volpp, who serves as the Scientific Lead of the American Heart Association’s Health Care by Food Initiative.
He talked about patients with heart failure who are frequently admitted to the hospital.
“We know they have more than a 50% readmission rate within 180 days. We know that nearly half of those patients may have moderate to severe malnutrition. And we also know from small pilots that the readmission rates can be lowered by 40% to 60% by putting them on a medically tailored meals program. But insurers don’t cover those, by and large, so we’re paying for a lot of expensive medical care when we could probably do better, from a health standpoint and an economic standpoint, in just making that easier,” he said.
He added that consumer engagement in that area would be relatively easy because patients who are struggling to stay out of the hospital are more likely to want additional support.
Focus on patient cost-sharing based on value, not cost
“More broadly, we should think about patient cost sharing from the standpoint on where the value is,” Dr. Volpp said. “We tend to have patient cost sharing based on the cost of care and not on the value.” He suggested we think more systematically about this.
On how CMMI can support and implement models that use financial incentives for better health outcomes
Make sure incentives are predictable
If we want to change behavior, incentives have to be predictable, Dr. Volpp said. He gave the example of a patient not knowing how much it would cost to go to the emergency room versus urgent care.
A few years ago, Dr. Volpp and a team worked with Humana on designing a new health plan called Humana Simplicity, which is a copayment only plan. On the plan, patients paid $100 to go to urgent care and $400 go to the emergency room (with the amount being waived if the patient was admitted).
“So now you have a completely transparent and predictable way of knowing what something’s going to cost, and I think we should think more about those kind of models,” he said.
Leverage incentives for smoking cessation
Dr. Volpp and colleagues have found that behaviorally informed financial incentives for smoking cessation tripled long-term smoking cessation rates for employees at General Electric and CVS and suggested consideration of using these approaches more widely.
Consider affordability and where to place health care dollars
“I think for people with chronic conditions, it’s important to recognize a lot of times what they are struggling with is not a knowledge issue, it’s an affordability issue,” Dr. Volpp said.
He also noted that for people with diet-related chronic conditions, around 45% of mortality from heart disease, stroke, and diabetes is related to diet, but less than 1% of health care dollars go there.
“This is obviously a huge mismatch,” he said. “The American Heart Association is trying to address this. We have 25 studies in the field, but we need more federal leadership on this to move forward faster. It’s a really critical issue to think about how we change some of these upstream incentives in ways that can have a lot of benefits, both to the patients and to the health care system.”