By Mitesh Patel, Stacey Chang, Kevin G. Volpp Physicians often struggle to help patients change their health behaviors. Patients may know that they need to quit smoking, lose weight, or exercise more, but summoning the will to change is hard. It’s particularly difficult for the highest-risk patients who may have life circumstances — challenges such as unemployment or homelessness — that make it harder for them to focus on the long-term. But combining behavioral economics and “gamification” — putting game elements such as points and achievement levels into non-game contexts — holds promise for driving behavior change when a doctor’s advice, and patient’s good intentions, are not enough. Other industries have long used game elements that leverage behavioral science to drive desired customer behavior (think airline loyalty programs that award points and status for miles traveled). And indeed gamification is increasingly being incorporated into health insurance design and wellness programs. However, despite its growing use, there’s only limited evidence of its effectiveness in health care, and in particular whether existing gamification makes the best use of behavioral economic principles. Members of our group recently evaluated 50 of the most popular smartphone applications for health and fitness and found that while nearly two-thirds of the apps used game elements in their design, none incorporated several key insights from behavioral economics that could effectively influence desired actions and address predictable barriers to behavior change. A central challenge for all health-related gamification programs is engaging participation, particularly among high-risk patients. Several design elements commonly found within gamified health and wellness programs could be made more engaging by incorporating behavioral insights. For example, most programs invite patients to join, framing their choice as an opt-in decision. But we have found that opt-out framing significantly improves participation. In a randomized trial, our group tested how to engage adults with uncontrolled diabetes in a remote-monitoring program. In the traditional, opt-in approach, only 13% signed up. But when the introductory letter framed the program as standard care, but allowed patients to opt out if they wished, enrollment rates nearly tripled to 38%. We’ve found similar results when testing ways to engage patients in a medication adherence program after a heart attack. Read more at Chicago Booth.