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Behavioral insights for whealth Behavioral insights for whealth

Behavioral insights for whealth - PowerPoint Presentation

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Behavioral insights for whealth - PPT Presentation

WEF Penn Conference May 9 2016 Department of Health Care Management Center for Health Incentives and Behavioral Economics Leonard Davis Institute University of Pennsylvania School of Medicine ID: 595903

health volpp loewenstein behavioral volpp health behavioral loewenstein choice active care rewards behavior enrollment enhanced quit halpern effective incentives center healthy university

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Slide1

Behavioral insights for whealth

WEF Penn ConferenceMay 9, 2016

Department of Health Care Management

Center for Health Incentives and Behavioral Economics,

Leonard Davis Institute

University of Pennsylvania School of Medicine

Kevin Volpp, MD, PhD

Kevin Volpp, MD, PhD – not for reproduction without permission

University of Pennsylvania Prevention Research CenterSlide2

Huge differences in life expectancy in US based on income mediated by behavior

Chetty et al JAMA 2016

2Slide3

Behavioral Economic concepts – design programs for humans that recognize common decision errors

Decision Error

Potential Response

Present-biased preferences (myopia)

Make rewards for beneficial behavior frequent and immediate

Framing and segregating rewards

$100 reward likely more effective than $100 discount on premium

Choice overload

Provide smaller number of choices or guidance on advantages/disadvantages of choices

Loss aversion

Put rewards at risk if behavior doesn’t change to frame as losses

Status quo bias/Inertia

Set up system so that default favors healthy behavior

Loewenstein, Brennan,

Volpp

, JAMA,

2007; Volpp

, Pauly, Loewenstein, Bangsberg, Health Affairs 2009Slide4

Default bias 

‘Opt out’ policies result in much higher rates for organ donation

Source:

Johnson

and Goldstein, Science, 2003

Level of effective consent

Denmark

Netherlands

United Kingdom

Germany

Austria

Belgium

France

Hungary

Poland

Portugal

SwedenSlide5

RCT of Default Options in Advance DirectivesSlide6

Defaults make a big difference in what people choose – even when stakes are high

Halpern SD, Loewenstein G, Volpp KG, et al. How ingrained are seriously ill patients’ preferences for end-of-life care?

Health Affairs 2013

Percent of

patients

choosing a comfort-oriented goal of care

p = <0.01Slide7

Patients understood their choices

Halpern et al.

Health Aff.

2013

Halpern SD, Loewenstein G, Volpp KG, et al. How ingrained are seriously ill patients’ preferences for end-of-life care?

Health Affairs

2013Slide8

Incremental Enrollment in Automatic Prescription Refills

Enhanced active choice: make easier for people to make decisions that support future health

Opt In

Press 1: If you would like to be transferred to a Customer Care Representative now.

Press 2: If you are not interested.

Enhanced Active Choice

Press 1: If you prefer to refill your prescriptions by yourself each time.

Press 2: If you would prefer us to do it for you automatically.

Opt In

Enhanced Active Choice

Keller, Harlam, Loewenstein, Volpp.

Journal

of Consumer Psychology.

2011 Slide9

Experimentally test:

Control arm (no message) Diabetes-specific messageProvider recommendation

Member recommendationEnhanced active choice

Enrollment in Healthy Food

25% discounts but low enrollment among diabeticsSlide10

Messaging approach influences enrollment

Conclusions:

Significant lift on engagement from low-cost messaging

Adding framed

active choice to a message most effective approach

“Yes! I want to activate the Healthy Food Benefit and get up to 25% cash back vs. “No, I’d prefer not to activate and continue paying full price for my healthy food purchases.”

Gopalan, Paramanund, Shaw, Patel, Friedman, Brophy, Troxel, Asch, Volpp 2016 under reviewSlide11

80% large employers using incentives to influence health behavior. . .

Section 2705 of ACA: employers may use 30-50% of premiums as penalties or rewards for outcome-based incentivesPremium adjustment doesn’t work very well in changing behavior – consider alternatives

Source: Volpp KG, Asch DA, Galvin R,

Loewenstein G. NEJM. 2011 365: 388-390, Slide12

Tiered, unbundled payments are effective: Long-term smoking cessation rates triple in incentive group

878 GE employeesusual careusual care + $750 (not part of premiums)GE implemented nationwide plan in 2010 with 152,000 employeesVolpp, Troxel, Pauly, Asch, Galvin et al, New England Journal of Medicine. 2009; 360(7): 699-709.

p-value for difference <0.0001

Sustained abstinence through 12 monthsSlide13

Rewards are better than deposits . . .

2,538 employees of CVS5-arm Randomized controlled trial Information about smoking cessation programs Individual or group rewards of up to $800 for confirmed quit at 6 mos.Individual or group deposit contract of $150 returned + $650 for confirmed quit at 6 mos.

Halpern, et al. NEJM 2015

Quit RatesSlide14

Launched nationwide June 1, 2015

700 Good Reasons to QuitSlide15

Behavioral Insights for Whealth”

Nudges: appealing because they gently push people in self beneficial directions but not overly heavy handedDefaults when interests of consumers/patients and choice architects alignEnhanced active choice when ongoing engagement is neededIncentives that encourage action now to improve future well being - with behavioral elements to augment motivationSlide16

Questions?

LDI Center for Health Incentives and Behavioral Economicswww.chibe.upenn.eduUniversity of Pennsylvania Prevention Research Center www.upennprc.org