Loss Aversion and Social Pressure in Physician Pay-for-Performance (P4P)
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Use of Individual Provider Performance Reports by U.S. Hospitals
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In another poster, CHIBE trainee
Joshua Rolnick, MD, JD (profiled below) and colleague Kira Ryskina, MD presented the results of their recent study
modeling how the odds of individual provider performance use differs as a function of hospital characteristics, including ownership, geographic region, teaching versus nonteaching status, size, expenditures per bed, proportion of patient days covered by Medicaid, and risk-sharing models of reimbursement.
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Designing Medicaid Health Incentives
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CHIBE affiliated faculty member
Charlene Wong, MD led an AcademyHealth ARM panel in which investigators discussed the latest evidence on the impact of incentives on healthy behaviors among Medicaid beneficiaries. As a number of states experiment with health incentives as an element of their Medicaid programs,
our recent blog post sums up the panel's findings.
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September 17 - 18, 2018
University of Pennsylvania
Goals:
- Assemble stakeholders from institutions that have launched or are interested in launching a nudge unit within their health system
- Share insights on lessons learned from existing nudge units in health care
- Engage in a design session to help programs outline important next steps at their health system
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Hungry, Hungry Hippocampus: Why and How We Eat
Why Wellness Programs Don’t Work so Well
Cold, Hard Cash and a Fitness Device Could Help Motivate People to Exercise: Study
The Magic Number of People Needed to Create Social Change
How Police Killings Lead to Poor Mental Health in the Black Community
How to Know When it's Time for Hospice
EHRs Exacerbate the Pen and Paper Problems They Were Meant to Solve: Study
Looking to Quit Smoking? Here’s One Way
CHIBE Combats the Opioid Crisis, One ‘Nudge’ at a Time
Hearts, Minds and Money: Maximizing Charitable Giving
Adam Grant: Understanding People Who Aren’t Like You
Money, Not E-Cigs May Be the Key to Helping People Quit Smoking
After High School, Young Women's Exercise Rates Plunge
How the ACA Legal Challenge Could Hurt Insurers and the Insured
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How did you become involved in the field of behavioral economics and end-of-life care?
My interest in end-of-life care grew out of my clinical experiences, first as a resident and then as a hospitalist. Working as a hospitalist at a safety net hospital, I saw many seriously ill patients who had never had any form of advance care planning. Sometimes, they had no family or friends, and were too ill to make their own decisions. By default, the health system would provide aggressive end-of-life care that was not necessarily driven by the wishes of patients. Individual clinicians had good intentions, but the system was not serving patients well.
Behavioral economics was not a focus of mine until I came to Penn. However, I did have an interest in cognitive science, and I had also taken a seminar in behavioral economics and law while a law student. The appeal of applying behavioral economics to health is that health systems can apply evidence from behavioral science without changing laws. Many other suggested applications of health services research to the law would require a literal Act of Congress.
At the AcademyHealth ARM, you presented a poster describing your research on the association between location of death and patient characteristics and quality of life. What were your main takeaways from this work?
Location of death has become a common marker of quality in end-of-life care, with the objective of having patients die at home rather than in a hospital. Without a doubt, this is a worthy goal in many situations. However, for all the attention on this topic, there is actually not a large body of research on how the patient and family experience varies by site of death. This is a small study of a nationally representative Medicare population. However, it is consistent with the idea that “global” measures of the end of life experience (e.g. overall care, sense of being treated with respect, etc.) are highest for patients who die at home. At the same time, there is a suggestion that care for symptom management may sometimes be better in inpatient hospice.
I caution to add, however, that there are many unmeasured differences between patients who die in home as opposed to acute care hospitals and post-acute settings. In addition, the small sample size of this research limited inference. This study is a bit of a teaser for a larger study I am finishing that looks in greater depth at the patient and family experience in acute care for veteran patients who die in VA acute care hospitals.
You have worked in global health in the past. Do you see yourself applying behavioral economics in an international setting in the future?
I do have an interest in returning to global health at some point in the future. I think there are many opportunities to apply some of the topics and techniques used to study U.S. health care, such as behavioral economics, to improving health services research in the developing world. I also think there is a need for more research comparing health care in developed countries, including end-of-life care.
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- Armstrong, S., Wong, C. A., Perrin, E., Page, S., Sibley, L., & Skinner, A. Association of Physical Activity With Income, Race/Ethnicity, and Sex Among Adolescents and Young Adults in the United States. JAMA Pediatrics. 2018.
- Chokshi, N. P., Adusumalli, S., Small, D. S., Morris, A., Feingold, J., Ha, Y. P., Patel, M. S., et al. Loss‐Framed Financial Incentives and Personalized Goal‐Setting to Increase Physical Activity Among Ischemic Heart Disease Patients Using Wearable Devices: The ACTIVE REWARD Randomized Trial. Journal of the American Heart Association. 2018; 7(12).
- Linnemayr, S., Huang, H., Luoto, J., Kambugu, A., Thirumurthy, H., Haberer, J. E., Mukasa, B., et al. Text Messaging for Improving Antiretroviral Therapy Adherence: No Effects After 1 Year in a Randomized Controlled Trial Among Adolescents and Young Adults. American Journal of Public Health. 2017; 107(12), 1944-1950.
- Mehta, S. J., Khan, T., Guerra, C., Reitz, C., Mcauliffe, T., Volpp, K. G., Doubeni, C. A., et al. A Randomized Controlled Trial of Opt-in Versus Opt-Out Colorectal Cancer Screening Outreach. The American Journal of Gastroenterology. 2018.
- Navathe, A. S., Liao, J. M., Polsky, D., Shah, Y., Huang, Q., Zhu, J., Emanuel, E. J., et al. Comparison of Hospitals Participating In Medicare’s Voluntary and Mandatory Orthopedic Bundle Programs. Health Affairs. 2018.
- Venkataramani, M., Pollack, C. E., Decamp, L. R., Leifheit, K. M., Berger, Z. D., & Venkataramani, A. S. Association of Maternal Eligibility for the Deferred Action for Childhood Arrivals Program With Citizen Children’s Participation in the Women, Infants, and Children Program. JAMA Pediatrics. 2018.
- Wong, C. A., Kulhari, S., Mcgeoch, E. J., Jones, A. T., Weiner, J., Polsky, D., & Baker, T. Shopping on the Public and Private Health Insurance Marketplaces: Consumer Decision Aids and Plan Presentation. Journal of General Internal Medicine. 2018.
- Yancy, W. S., Shaw, P. A., Wesby, L., Hilbert, V., Yang, L., Zhu, J., Volpp, K. G. Financial Incentive Strategies for Maintenance of Weight Loss: Results From an Internet-Based Randomized Controlled Trial. Nutrition & Diabetes. 2018.
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