The field of behavioral economics (BE) has established that individuals make decisions in predictably irrational ways. While BE principles have been tested extensively to improve patient behaviors, our team extends applications to clinician and hospital financial and non-financial incentive design. Our portfolio of work includes a mix of pragmatic policy trials and quasi-experimental analyses with the goal of informing clinician practice change.
Hawaii Medical Services Association (HMSA), is an independent licensee of Blue Cross Blue Shield of Hawaii. In this partnership, principles of behavioral economics are integral to the design and development of initiatives to facilitate the provision of high value care. The Payment Insight Team partnered with HMSA to conduct a cluster-randomized controlled trial to examine the impact of providing peer comparisons feedback on the quality of care among primary care providers shifting from fee-for-service to population-based payment (Health Affairs, 2020). The effectiveness of peer comparison feedback offers promise of the use of scalable behavioral economics tools to improve health care quality. Further, behavioral economics provides a framework to understanding clinician perception of and response to recent Payment Transformation Initiatives as evidenced by ongoing quantitative and qualitative analyses.
In this project, we’re using historical data and behavioral economics principles, and designing an incentive and benefit program that encourages healthcare providers to refer their patients to lower-cost labs/imaging centers/specialists, or performing some medical procedures at lower-cost facilities; thus, to reduce the healthcare spending of patients as well as the health systems without hurting quality-of-care.
In this recently awarded R61/R33 project, funded by the National Institute on Aging (NIA) and BE IMMUNE, we will pilot nudge interventions among older adults – including racial/ethnic minorities, low SES individuals, and other high-risk groups identified using novel analytic methods – and tailor nudges to overcome screening barriers facing these patient groups.
The REDUCE Trial is a Randomized Trial of Behavioral Economic Approaches to Reduce Unnecessary Opioid Prescribing. It is large-scale, pragmatic trial of approximately 50 emergency departments and urgent care centers at the Sutter Health System in Northern California. The goal of this quality improvement initiative is to optimize clinician opioid prescribing behaviors. The program uses two behavioral economic interventions: monthly individual audit feedback and/or monthly peer comparison feedback sent to clinicians with data on their opioid prescribing patterns. A cluster randomized, factorial design will be used to evaluate the effect of the intervention and qualitative surveys and interviews will provide context to understand the factors associated with performance.