In The New York Times The Upshot, Massachusetts General Hospital and Harvard Medical School resident physician, Dhruv Khullar, M.D., M.P.P., looks at how the field of behavioral economics contributes to improving provider performance and patient engagement in health care decisions and, in particular, the research of PRC Director Kevin Volpp, MD, PhD.
“A leader of this movement is Dr. Kevin Volpp, a physician at the University of Pennsylvania and founding director of the Center for Health Incentives and Behavioral Economics. He designs randomized trials around some of health care’s most important challenges: nudging doctors to provide evidence-based care; ensuring patients take their medications; and helping consumers choose better health plans.”
In the April 3 issue of JAMA, UPenn PRC Director Kevin Volpp, MD, PhD, and Jonathan S. Skinner, PhD, the Dartmouth Institute for Health Policy and Clinical Practice, discuss how research about behavioral economics in health care is useful when considering the challenges of replacing the Affordable Care Act.
Noting that “incentives to encourage healthy individuals to sign up for health insurance can be described as either carrots or sticks”, Volpp and Skinner observe that “the first principle from behavioral economics research is that carrots do not work nearly as well as sticks.” Research suggests that individuals tend to favor immediate gratification over long-term consequences, which is why young adults historically are less inclined to enroll in insurance plans and why many people are frustrated paying premiums for coverage they may never use. Volpp and Skinner note “health insurance is an 80-20 proposition; 20% of enrollees account for 80% of costs. If the least healthy patients can be moved off of the exchanges, this will allow for a substantial decline in premiums on the exchange for the 80% healthier people who remain” and that lowering health insurance premiums would make a difference.
University of Pennsylvania PRC Director Kevin Volpp, MD, PhD, and Namita S. Mohta, MD of Brigham and Women’s Hospital, analyze the second NEJM Catalyst Insights Council Survey on Patient Engagement.
The majority of the respondents to the online survey sent in July 2016 were clinicians (53%), with executives (22%) and clinician leaders (25%) nearly evenly split. Most describes their organizations as hospitals or health systems.
“Nearly half of respondents say their patient engagement initiatives are having a major (14%) to moderate (34%) impact on quality outcomes,” said Volpp. “That’s pretty remarkable considering we are still in the earlier stages of patient engagement and that many potential approaches have yet to be fully scaled and integrated into practice. Interestingly, clinical leaders (60%) feel more strongly than executives (47%) and clinicians (43%) that their efforts to engage patients are working.”
Volpp and Mohta note that with the shift to value-based payment models, there may be more of an imperative to design and test new ideas to engage patients between visits that will improve both cost and quality.
Kevin Volpp, MD, PhD. NEJM Catalyst Patient Engagement Talk
“Broadening Health Care’s Product Offerings.”
PRC Director Kevin Volpp, MD, PhD, and PRC Researcher David Asch, MD, MBA, were recognized for their significant contribution to the fields of health services research and health policy with the AcademyHealth Article-of-the-Year Award.
Volpp, MD, PhD, is the founding Director of LDI’s Center for Health Incentives and Behavioral Economics (CHIBE), a Professor of Medicine and Vice Chairman for Health Policy of the Department of Medical Ethics and Health Policy at Penn’s Perelman School of Medicine, and a Professor of Health Care Management at the Wharton School.
Asch, MD, MBA, is Executive Director of the Penn Medicine Center for Health Care Innovation, a Co-Director of the National Clinical Scholars Program, and a Professor of both Medicine at Penn’s Perelman School of Medicine and Health Care Management at the Wharton School.
Originally published in the Journal of the American Medical Association (JAMA) in November of 2015, the winning paper and its study were the latest to address the issue of how best to improve patient outcomes via financial incentives. The project’s different tack was to test pay-for-performance incentives on just doctors, just patients and then on doctors AND patients together.
The award, which recognizes the year’s “best scientific work in the fields of health services research and health policy” was presented at AcademyHealth’s Annual Research Meeting in Boston on June 28 .