Healthy Weigh Study Results

What strategy works better for weight loss in overweight employees?

  • Financial incentives
  • Environment change strategies
  • A combination of the two,
  • On-your-own weight-loss efforts

 

Drs. Karen Glanz and Kevin Volpp, along with the team at the UPenn PRC, found that participants in all groups lost weight. Incidentally, the financial incentives group lost slightly more weight, but none of the strategies netted significantly greater weight losses than the others. The results from their Healthy Weigh Study are currently published in the September 2021 edition of JAMA Network Open.

 

In 2015, the University of Pennsylvania Prevention Research Center (UPenn PRC) conducted a study to test strategies to achieve weight loss and maintain weight loss in urban worksites in Philadelphia.

First, researchers collected data on participants who earned daily financial rewards, in addition to those guided on positive changes to their environment.

Second, they compared each strategy, separately and together, to see which one helped the participants achieve weight-loss.

Third, the team compared that data to those who tried to lose weight on their own.

Ultimately, the goal of the study was to manage obesity by improving nutrition and physical activity, in order to reduce the risk of cardiovascular disease and other chronic health conditions.

 

 

 

 

JAMA Healthy Weigh_visual

Publication

Glanz K, Shaw P, Kwong P, Choi J, Chung A, Zhu J, Huang Q, Hoffer K, Volpp K. Effect of Financial Incentives and Environmental Strategies on Weight Loss in The Healthy Weigh Study: A Randomized Clinical Trial. JAMA Network Open 2021;4(9): e2124132. doi:10.1001/jamanetworkopen.2021.24132

AUDIO: Knowledge@Wharton:Kevin Volpp on How Behavioral Economics Could Solve America’s Health Care Woes

LISTEN TO THE PODCAST

by Kevin Volpp on Knowledge@Wharton

UPenn PRC Director Kevin Volpp, MD, PhD, appeared on Knowledge@Wharton with Dan Loney to discuss health care reform and how behavioral economics help explain the challenges of insuring the largest number of people possible. Dr. Volpp and Dartmouth professor Jonathan Skinner addressed these issues in a JAMA Viewpoint “Replacing the Affordable Care Act: Lessons from Behavioral Economics

“I think a big part of the Affordable Care Act, in terms of increasing coverage, was to think about the underlying incentives of why people are not buying coverage,” said Volpp. “For many people, it frankly just comes down to weighing the expected costs and benefits in the short term, and concluding that the short-term benefits to people who weren’t buying coverage were less than what their coverage would have cost.”

“The way the Affordable Care Act tried to deal with that was by subsidizing the cost of coverage by providing people who are low income with fairly generous subsidies. That’s a carrot-type incentive. In addition, they included a stick-type incentive in the form of an individual mandate, whereby people were required to buy insurance. If they didn’t buy insurance, they’d have to pay a financial penalty. One thing we could critique is that this mandate probably wasn’t strong enough. It started out at about $200. Eventually it became about $700. That’s much less than the cost of the cheapest plan. An individual could quite rationally conclude, “I’m willing to pay a $700 penalty. I’m not willing to pay $4,000 or more for my coverage.”

Volpp added,”There’s generally an acknowledgement that subsidies alone may not be enough to get people to sign up. There’s a well-documented literature in behavioral economics that carrots are weaker than sticks. People tend to be very loss-averse. Subsidies alone probably will not work in terms of getting sufficient people to enroll in these marketplaces.”

 

 

PRC Director Kevin Volpp featured in NYTimes The Upshot: How Behavioral Economics Can Produce Better Health Care

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.”

Replacing the Affordable Care Act – a JAMA Viewpoint by PRC Director Kevin Volpp

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.

Framing Financial Incentives For the Overweight & Obese – PRC Director Kevin Volpp, MD, PhD

A study by PRC Director Kevin Volpp, MD, PhD, and other health behavior researchers at the University of Pennsylvania shows that financial incentives for increasing physical activity are highly effective among the population of overweight and obese.

“Most workplace wellness programs typically offer the reward after the goal is achieved,” said senior author Kevin G. Volpp, MD, PhD. “Our findings demonstrate that the potential of losing a reward is a more powerful motivator and adds important knowledge to our understanding of how to use financial incentives to encourage employee participation in wellness programs.”

The study was reported on in the Knowridge Science Report and was published in the Annals of Internal Medicine.

 

 

NEJM Patient Engagement Insights Report: Kevin Volpp, MD, PhD

 

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.

 

 

 

 

Does Competition Positively Impact Physical Activity? : PRC Researchers Kevin Volpp and David Asch

PRC Director Kevin Volpp, MD, PhD, and PRC Researcher David Asch, MD, MBA, compare the effectiveness of different combinations of social comparison feedback and financial incentives to increase physical activity in a study in the July/August issue of the American Journal of Health Promotion.

In one of the first randomized trials to test different combinations of social comparison feedback and financial incentives, the researchers found that social comparison to the median with financial incentives was more effective than social comparison to the top quartile without incentives.  In the social comparison condition, participants, grouped by team,  were provided with feedback on their performance and the performance of other teams.  “By focusing social comparison feedback on performance relative to other teams,” the researchers suggest, “we leverage individuals’ competitive drive to motivate behavior change.” These findings may help to guide larger evaluations of interventions to increase physical activity using social comparison feedback and financial incentives.

 

Read more about this study at LiveScience.

AcademyHealth Article-of-the-Year Award: PRC Director Kevin Volpp and PRC Researcher David Asch

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 .

 

 

 

 

 

 

 

 

 

 

On NPR: PRC Director Kevin Volpp and New Strategies For Health Behavior Changes

On NPR’s Health News, PRC Director, Kevin Volpp, MD, discussed new strategies for changing health behaviors.

 

 

Volpp suggests that “commitment contracts” produce better results than traditional workplace rewards programs when it comes to tying financial incentives to goals. Reward programs usually offer a lump payment at the end of a full year.  Commitment contracts involve an upfront investment which participants recoup if they meet self-designed goals and forfeit if they do not.  Volpp and colleagues at the Center for Health Incentives and Behavioral Economics have found that short-term goals are more successful than long-term, when it comes to health behavior changes, and that immediate financial loss has greater impact than far-in-the-future financial gain.

 

 

 

 

 

Improving Patient Engagement: Kevin Volpp in NEJM Catalyst

PRC Director, Kevin Volpp, MD, PhD, analyzes the first NEJM Catalyst Insights Report on patient engagement.  Surveying the NEJM Insights Council, a group of distinguished and experienced health care executives, clinician leaders, and clinicians from around the United States, Volpp and colleague Namita S. Mohta, MD, look at the landscape of patient engagement, ranging from a working definition of the phrase to which strategies they feel are most helpful (and which are not).

The survey highlights that respondents view engagement levels among their patients as low and recognize that how engagement is measured is inadequate. This is a rapidly evolving field, and what is regarded as ineffective today — such as remote monitoring devices — may be viewed very differently in the future, as new technologies and service models that take full advantage of them emerge.

“These results highlight the challenges in front of us; while having patients who are engaged with their health and with the health system is important, low rates of engagement appear to be the norm,” according to Volpp. “We haven’t yet discovered optimal ways of achieving high rates of sustained patient engagement. We are also interested in highlighting approaches that don’t work, as both kinds of examples can highlight important learnings for the field.”