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
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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