Kevin Volpp Research Cited in Medical Resident Work Hour Debate
Forbes, November, 8, 2016

Mitesh Patel Comments on Value of Wearable Fitness Trackers
Time, November 2, 2016

CHIBE Holds Largest-Ever Penn-CMU Roybal Retreat & Conference
Penn LDI eMagazine,
November 2016

Optimizing Electronic Health Records with Behavioral Economics
Forbes, October, 25, 2016

Mitesh Patel: Further Study Needed on Reliability of Heart Rate Wearables
US News & World Report, October 13, 2016

Connecting Social Comparisons of Physician Performance to Norms Increases Value
Huffington Post, September 29, 2016

Mitesh Patel Comments on Wearables Weight Loss Studies
NPR, Men's Journal,
September 20, 2016
CHIBE Forges Research Partnership with National University of Singapore
Penn LDI eMagazine, August 2016
Psychiatr Serv. 2016 Oct. Epub ahead of print. 

When Payment Undermines the Pitch: On the Persuasiveness of Pure Motives in Fund-Raising. Barasch A, Berman JZ, Small DA. Psychol Sci. 2016 Sep 8. Epub ahead of print.  

Estimating Acceptability of Financial Health Incentives. Bigsby E, Seitz HH, Halpern SD, Volpp K, Cappella JN. Health Educ Behav. 2016 Aug 17. Epub ahead of print.

Community pharmacies as sites of adult vaccination: A systematic review. Burson RC, Buttenheim AM, Armstrong A, Feemster KA.
Hum Vaccin Immunother. 2016 Aug 15:0. Epub ahead of print.

Bored in the USA: Experience Sampling and Boredom in Everyday Life. Chin A, Markey A, Bhargava S, Kassam KS, Loewenstein G. Emotion. 2016 Oct 24.  Epub ahead of print.

A Randomized Trial of Expanding Choice Sets to Motivate Advance Directive Completion. Courtright KR, Madden V, Gabler NB, Cooney E, Kim J, Herbst N, Burgoon L, Whealdon J, Dember LM, Halpern SD. Med Decis Making. 2016 Aug 10. Epub ahead of print. 
Generating Good Research Questions in Health Professions Education. Dine CJ, Shea JA, Kogan JR.  Acad Med. 2016 Oct 4. Epub ahead of print. 

A Synchronized Prescription Refill Program Improved Medication Adherence. Doshi JA, Lim R, Li P, Young PP, Lawnicki VF, State JJ, Troxel AB, Volpp KG. Health Aff (Millwood). 2016 Aug 1;35(8):1504-12.

Video for Adolescent Pregnancy Prevention: Promises, Challenges, and Future Directions. Downs JS, Ashcraft AM, Murray PJ.  Am J Public Health. 2016 Sep;106(S1):S29-S31.

Variation in the Intensity of Care for Patients with Uncomplicated Renal Colic Presenting to U.S. Emergency Departments. Elder JW, Delgado MK, Chung BI, Pirrotta EA, Wang NE.  J Emerg Med. 2016 Oct 5.  

Predicting prolonged dose titration in patients starting warfarin. Finkelman BS, French B, Bershaw L, Brensinger CM, Streiff MB, Epstein AE, Kimmel SE. Pharmacoepidemiol Drug Saf. 2016 Nov; 25(11):1228-1235.

A systematic analysis and comparison of warfarin initiation strategies. French B, Wang L, Gage BF, Horenstein RB, Limdi NA, Kimmel SE.  Pharmacogenet Genomics. 2016 Oct;26(10):445-52. 

Home visiting and perinatal smoking: a mixed-methods exploration of cessation and harm reduction strategies. Griffis H, Matone M, Kellom K, Concors E, Quarshie W, French B, Rubin D, Cronholm PF. BMC Public Health . 2016 Aug 11;16(1):764.  
Evaluation of a Mobile Health Approach to Tuberculosis Contact Tracing in Botswana. Ha YP, Tesfalul MA, Littman-Quinn R, Antwi C, Green RS, Mapila TO, Bellamy SL, Ncube RT, Mugisha K, Ho-Foster AR, Luberti AA, Holmes JH, Steenhoff AP, Kovarik CL.  J Health Commun. 2016 Oct;21(10):1115-21.

Recurrent violent injury: magnitude, risk factors, and opportunities for intervention from a statewide analysis. Kaufman E, Rising K, Wiebe DJ, Ebler DJ, Crandall ML, Delgado MK.  Am J Emerg Med. 2016 Sep;34(9):1823-30.  

Decision-making and goal-setting in chronic disease management: Baseline findings of a randomized controlled trial. Kangovi S, Mitra N, Smith RA, Kulkarni R, Turr L, Huo H, Glanz K, Grande D, Long JA. Patient Educ Couns. 2016 Sep 25. pii: S0738-3991(16)30447-5. Epub ahead of print.

A randomized trial of lottery-based incentives and reminders to improve warfarin adherence: the Warfarin Incentives (WIN2) Trial. Kimmel SE, Troxel AB, French B, Loewenstein G, Doshi JA, Hecht TE, Laskin M, Brensinger CM, Meussner C, Volpp K. Pharmacoepidemiol Drug Saf. 2016 Nov;25(11):1219-1227.

Leveraging corporate social responsibility to improve consumer safety of dietary supplements sold for weight loss and muscle building. Kulkarni A, Huerto R, Roberto CA, Austin SB. Transl Behav Med. 2016 Aug 29. Epub ahead of print. 

Overcorrection for Social-Categorization Information Moderates Impact Bias in Affective Forecasting. Lau T, Morewedge CK, Cikara M. Psychol Sci. 2016 Aug 18. Epub ahead of print.

Increasing the Value of Social Comparisons of Physician Performance Using Norms. Liao JM, Fleisher LA, Navathe AS. JAMA. 2016 Sep 20;316(11):1151-1152.

Six health care trends that will reshape the patient-provider dynamic. Liao JM, Emanuel EJ, Navathe AS. Healthc (Amst). 2016 Sep;4(3):148-50.

A mixed methods study of individual and organizational factors that affect implementation of interventions for children with autism in public schools. Locke J, Beidas RS, Marcus S, Stahmer A, Aarons GA, Lyon AR, Cannuscio C, Barg F, Dorsey S, Mandell DS.  Implement Sci. 2016 Oct 10;11(1):135.

Can brain games help smokers quit?: Results of a randomized clinical trial. Loughead J, Falcone M, Wileyto EP, Albelda B, Audrain-McGovern J, Cao W, Kurtz MM, Gur RC, Lerman C. Drug Alcohol Depend. 2016 Nov 1;168: 112-118. 

National Differences in Regional Emergency Department Boarding Times: Are US Emergency Departments Prepared for a Public Health Emergency? Love JS, Karp D, Delgado MK, Margolis G, Wiebe DJ, Carr BG. Disaster Med Public Health Prep. 2016 Aug;10(4):576-82.

Participation Rates With Opt-out Enrollment in a Remote Monitoring Intervention for Patients With Myocardial Infarction. Mehta SJ, Troxel AB, Marcus N, Jameson C, Taylor D, Asch DA, Volpp KG.  JAMA Cardiol . 2016 Oct 1;1(7):847-848.   
Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System. Mehta SJ, Jensen CD, Quinn VP, Schottinger JE, Zauber AG, Meester R, Laiyemo AO, Fedewa S, Goodman M, Fletcher RH, Levin TR, Corley DA, Doubeni CA.  J Gen Intern Med. 2016 Nov; 31(11):1323-1330.  
Bundled Payment for Gastrointestinal Hemorrhage. Mehta SJ. Clin Gastroenterol Hepatol. 2016 Dec;14(12):1681-1684.  
No Evidence of Reciprocal Associations between Daily Sleep and Physical Activity. Mitchell JA, Godbole S, Moran K, Murray K, James P, Laden F, Hipp JA, Kerr J, Glanz K.  Med Sci Sports Exerc. 2016 Oct;48(10):1950-6.  

New strategies for aligning physicians with health system incentives. Navathe AS, Sen AP, Rosenthal MB, Pearl RM, Ubel PA, Emanuel EJ, Volpp KG. Am J Manag Care . 2016 Sep;22(9):610-2.
Physician Peer Comparisons as a Nonfinancial Strategy to Improve the Value of Care.
Navathe AS, Emanuel EJ. JAMA. 2016 Nov 1;316(17):1759-1760.

Influence of Cartoon Media Characters on Children's Attention to and Preference for Food and Beverage Products. Ogle AD, Graham DJ, Lucas-Thompson RG, Roberto CA. J Acad Nutr Diet. 2016 Oct 25. Epub ahead of print.

Framing Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults. Patel MS, Asch DA, Volpp KG.  Ann Intern Med. 2016 Oct 18;165(8):600.  

Using a Mystery-Caller Approach to Examine Access to Prostate Cancer Care in Philadelphia. Pollack CE, Ross ME, Armstrong K, Branas CC, Rhodes KV, Bekelman JE, Wentz A, Stillson C, Radhakrishnan A, Oyeniran E, Grande D. PLoS One. 2016 Oct 10;11(10):e0164411.

Applying the Policy Ecology Framework to Philadelphia's Behavioral Health Transformation Efforts. Powell BJ, Beidas RS, Rubin RM, Stewart RE, Wolk CB, Matlin SL, Weaver S, Hurford MO, Evans AC, Hadley TR, Mandell DS. Adm Policy Ment Health. 2016 Nov;43(6):909-926.

Patient and Partner Feedback Reports to Improve Statin Medication Adherence: A Randomized Control Trial. Reddy A, Huseman TL, Canamucio A, Marcus SC, Asch DA, Volpp K, Long JA. J Gen Intern Med. 2016 Sep 9. Epub ahead of print.

States Worse Than Death Among Hospitalized Patients With Serious Illnesses.  Rubin EB, Buehler AE, Halpern SD.  JAMA Intern Med. 2016 Oct 1;176(10):1557-1559.

Community-wide Interventions to Prevent Skin Cancer: Two Community Guide Systematic Reviews. Sandhu PK, Elder R, Patel M, Saraiya M, Holman DM, Perna F, Smith RA, Buller D, Sinclair C, Reeder A, Makin J, McNoe B, Glanz K; Am J Prev Med. 2016 Oct;51(4):531-9.

How Patients View Lung Cancer Screening: The Role of Uncertainty in Medical Decision Making. Schapira MM, Aggarwal C, Akers S, Aysola J, Imbert D, Langer C, Simone CB 2nd, Strittmatter E, Vachani A, Fraenkel L. Ann Am Thorac Soc. 2016 Sep 27. Epub ahead of print.

Longitudinal changes in smoking abstinence symptoms and alternative reinforcers predict long-term smoking cessation outcomes. Schnoll RA, Hitsman B, Blazekovic S, Veluz-Wilkins A, Wileyto EP, Leone FT, Audrain-McGovern JE. Drug Alcohol Depend. 2016 Aug 1;165:245-52.

Effects of a risk-based online mammography intervention on accuracy of perceived risk and mammography intentions. Seitz HH, Gibson L, Skubisz C, Forquer H, Mello S, Schapira MM, Armstrong K, Cappella JN. Patient Educ Couns. 2016 Oct;99(10):1647-56.  
The design and conduct of Keep It Off: An online randomized trial of financial incentives for weight-loss maintenance. Shaw PA, Yancy WS Jr, Wesby L, Ulrich V, Troxel AB, Huffman D, Foster GD, Volpp K. Clin Trials. 2016 Sep 19. pii: 1740774516669679. Epub ahead of print.

Perceptions of Family Participation in Intensive Care Unit Rounds and Telemedicine: A Qualitative Assessment. Stelson EA, Carr BG, Golden KE, Martin N, Richmond TS, Delgado MK, Holena DN. Am J Crit Care. 2016 Sep;25(5):440-7.

The Art of Health Promotion: ideas for improving health outcomes.
Terry PE, Brown N, Arnett DK, Cushman M, Spring B, Halpern SD, Burke LE, Grossmeier J, Goetzel R, Lang J, Calitz C, Terry PE, Sanchez E. Am J Health Promot. 2016 Sep;30(7):563-82.

A Call for Research on Individuals Who Opt Out of Living Kidney Donation: Challenges and Opportunities. Thiessen C, Kulkarni S, Reese PP, Gordon EJ. Transplantation. 2016 Aug 4. Epub ahead of print.

Efficacy of the READY-Girls Program on General Risk-Taking Behaviors, Condom Use, and Sexually Transmitted Infections Among Young Adolescent Females With Type 1 Diabetes. Thurheimer J, Sereika SM, Founds S, Downs J, Charron-Prochownik D.  Diabetes Educ. 2016 Sep 14. pii: 0145721716668651.

Rationale and design of a randomized trial of automated hovering for post-myocardial infarction patients: The HeartStrong program. Troxel AB, Asch DA, Mehta SJ, Norton L, Taylor D, Calderon TA, Lim R, Zhu J, Kolansky DM, Drachman BM, Volpp KG. Am Heart J. 2016 Sep;179:166-74.

Make the Healthy Choice the Easy Choice: Using Behavioral Economics to Advance a Culture of Health. Volpp KG, Asch DA. QJM. 2016 Nov 1. pii: hcw190. Epub ahead of print.

Evidence supports the superiority of closed ICUs for patients and families: No. Weissman GE, Halpern SD. Intensive Care Med. 2016 Sep 1. Epub ahead of print.

Physicians' Participation In ACOs Is Lower In Places With Vulnerable Populations Than In More Affluent Communities. Yasaitis LC, Pajerowski W, Polsky D, Werner RM. Health Aff (Millwood). 2016 Aug 1;35(8):1382-90

Dear Colleague,

We are happy to present to you the Fall issue of CHIBE's newsletter.

In this issue, we discuss recent findings on the impact of synchronized prescription refills on medication adherence, CHIBE's contribution to Penn's MacArthur 100 & Change proposal, and an exciting new online degree program offered by CHIBE's home department at the Perelman School of Medicine. You'll also learn about our research overseas, participation in the Hawaii Medical Service Association Blue Ribbon Panel, and read an in-depth Q&A with faculty member, Dr. Jalpa Doshi.

As always, be sure to check out our latest news and publications - including a recap of our most recent Roybal Retreat & Conference - on the sidebar of this newsletter. We also recommend you take a moment to download the new  NEJM Catalyst article collection: Patient Engagement: Driving Behavior Change for Better Health. The free collection provides actionable insights and practical strategies for involving patients in their own care and wellness through collaboration and new technologies, highlighting some of CHIBE's recent findings.

For more frequent updates on our work uncovering key behavioral insights to address complex public health problems, follow CHIBE on Twitter @PennCHIBE.
Kevin Volpp, Director
Scott Halpern, Deputy Director

CHIBE's Academic Home Launches Penn's First Online Master's Degree

This month, the Department of Medical Ethics and Health Policy at the Perelman School of Medicine received formal approval from the University of Pennsylvania Board of Trustees to launch a new online Master of Health Care Innovation - the first online Master's degree at the University of Pennsylvania.

The degree program is an initiative to address the rapidly changing health care landscape by advancing innovation among mid-career health care professionals worldwide. This program is intended to bring the benefits of a Penn education to people who either do not want to or can not afford to enroll in an on-campus graduate program full time. A selective cohort will engage in an 18-month program of online education led by faculty from the Perelman School of Medicine, the Wharton School, the Law School, and the Nursing School. The program will also include two week-long sessions in Philadelphia. Learn more at .  
Synchronized Drug Refills May Improve Prescription Adherence

Approximately 4.3 billion prescriptions were written in the United States in 2014, yet research has consistently shown that many patients do not take their medications according to their clinicians' instructions. The challenge is even greater for patients taking multiple medications.

Prescription synchronization programs, which adjust refill schedules so that all medications are due for renewal on the same date, were developed to help patients keep track of their medication supply in the hopes of improving medication adherence.
A recent CHIBE study suggests the approach is effective, particularly among patients who struggle most with adherence.
Despite the popularity of synchronization programs - they are now available at almost two dozen U.S. drugstore chains and 2,000 independent pharmacies - few prior studies had examined their effectiveness. The CHIBE study, published in Health Affairs in August 2016, assessed a 12-month pilot refill synchronization program for Medicare Advantage patients enrolled in health insurer Humana's mail order pharmacy. Nearly 700 Medicare Advantage patients who were taking multiple drugs to treat high blood pressure, diabetes and/or high cholesterol participated in the synchronized refill program.
Researchers examined pharmacy records in the 12 months before and after enrollment in the synchronized refill program and compared program participants to a control group of patients who received "usual care" from the same mail order pharmacy. Among patients in the intervention group, medication adherence increased by three to five percentage points over the control group. Among patients with the lowest levels of adherence before the intervention, adherence improved by nine to 13 percentage points over the control group.
According to lead author Jalpa A. Doshi, director of CHIBE's Value-Based Insurance Design Initiatives, these results are encouraging.
"I wasn't surprised, but I was pleased," said Doshi. "Many adherence interventions have shown modest results, so we had conservative expectations. We were especially pleased that this relatively simple intervention led to substantial improvement in the group with the lowest levels of adherence at the start of the study. This suggests that reducing logistical demands, such as the need to keep track of multiple refill dates throughout the month or to make multiple calls to the pharmacy to arrange refills, can make a real difference for patients."
CHIBE faculty were particularly excited that, based on this research, Humana is now offering prescription synchronization on a wide scale. "It is encouraging that adherence improved, but the next step will be to examine how participation in synchronization programs impacts health outcomes - that is, does improved adherence translate into better health? It will also be important to examine the cost-effectiveness of this type of intervention," said Doshi.
"We need to try to figure out ways to fit these intervention s within the lives of patients," Doshi said. 

- Dinah Wisenberg Brin 
CHIBE Contributes to Penn's MacArthur 100 & Change Proposal

S olving the problem of enduring behavior change is our single greatest opportunity to improve lives. Why? Countless daily acts-whether we show up for class, how we spend our money, and even what we eat for breakfast-cumulatively shape our destinies. Behavioral scientists have isolated the situational and psychological factors that hold sway over what we repeatedly do, leading to successful and scalable interventions to change short-term behavior for the better. Unfortunately, this behavior change rarely endures.

A team led by CHIBE faculty members Angela Duckworth, Penn Psychology Professor who runs the Character Lab; Katy Milkman, Wharton Professor and co-director of Wharton People Analytics; and CHIBE Director Kevin Volpp address this challenge through a submission to the MacArthur 100 & Change competition. The proposal was recently selected by the President and Provost of the University of Pennsylvania to represent the University as its submission to the global competition. " We think that using tools from behavioral economics to make behavior change stick has the potential to improve an enormous number of lives," says Milkman.
MacArthur 100 & Change: Making Behavior Change Stick
MacArthur 100 & Change: Making Behavior Change Stick

There is stiff competition, but the winning team will receive $100 million to fund their project. Ultimately, the Penn proposal aims to reduce high school and college dropouts, financial insecurity, and premature deaths by 10%, with a tripartite focus on making behavior change stick in educational attainment, financial savings behavior, and health. Other CHIBE faculty involved in the project include George Loewenstein, David Asch and Judd Kessler.  
Transforming Payment: Reflections from Hawaii Medical Service Association's Blue Ribbon Panel 
Zirui Song, MD, PhD
In September, a research team from the University of Pennsylvania led by Dr. Kevin Volpp, Dr. Amol Navathe, and Dr. Zeke Emanuel traveled to Hawaii for the Payment Transformation Blue Ribbon Panel hosted by the Hawaii Medical Service Association (HMSA). This two-day conference was an opportunity for leaders from academia, health policy, and the provider community to come together with HMSA and discuss the future of payment reform in Hawaii.
The conference was co-chaired by Dr. Mark McClellan, formerly the head of the Centers for Medicare and Medicaid, and now a Professor at Duke University, and the leaders of HMSA. The panel began with an overview of the vision of payment reform in Hawaii towards creating a healthier, more value conscious, and more sustainable health care system. Current progress in transforming primary care payment was presented by the University of Pennsylvania team, and smaller breakout sessions tackled issues surrounding the structure of primary care physician compensation, benchmarks for total cost of care, and the strategic design of the model with an eye towards behavioral economics. Two outpatient practices from Hawaii that have experimented with the primary care capitation model provided valuable first-hand accounts of how the model is working to date.
A range of discussion topics surrounding specialist and hospital payment was taken up by the panel. These included strategies for increasing the value of spending on specialty care, the interaction between primary care and specialty care, and how to design bundled payment contracts. Panel discussions were lively and educational, and many reflected on the work and lessons learned from delivery system reforms within their own organizations. The final portion of the conference focused on improving population health within alternative payment models. Unifying themes among the panelists' suggestions included strengthening community-level interventions and extending the reach of the traditional health care system to help patients and communities better monitor and prevent disease.
It was a privilege for me to participate on the panel. Learning from the other panelists and from HMSA allowed me to understand the dedication and ingenuity of the Penn team in their efforts to help HMSA transform the payment landscape in Hawaii and improve the health and wellbeing of its population. The Penn team's use of behavioral economics principles to guide the design and implementation of this work was innovative and impressive. As payment reform expands across the nation, the experience of patients and providers in Hawaii will offer valuable insights for similar efforts elsewhere.  
- Zirui Song, MD, PhD

Dr. Song is an Internal Medicine resident at Massachusetts General Hospital and a visiting scholar at CHIBE/PSOM Health Policy this month.
CHIBE's Expanding Global Reach

Since CHIBE was founded in 2008, our research has provided policymakers and clinicians with scalable evidence to drive health behavior and health policy change. While the majority of CHIBE studies are conducted domestically, our faculty also works collaboratively with institutions and investigators abroad.
This August, CHIBE forged a partnership with the National Unive rsity of Singapore (NUS), ranked the top university in Asia by the United Kingdom's QS World University Rankings. CHIBE Director Kevin Volpp, MD, PhD says: "The similarity between the issues faced in Singapore and in the US in terms of switches in provider payment toward value - and concerns about the role of non-communicable diseases such as obesity and diabetes as a major driver of health costs and poor outcomes - is quite striking."
CHIBE leadership and faculty meet in Singapore to finalize their partnership agreement with NUS. 
The CHIBE-NUS partnership will launch a number of joint behavioral economics pilot studies. Main focus areas will include better management of diabetes, medication adherence, the promotion of healthier lifestyles, and the use of wearable monitoring devices for chronic disease management. The issue of diabetes management is particularly important in the project because, much like the U.S., Singapore has a rapidly aging population and surging rates of diabetes. "We are very excited to be working with CHIBE," says Ho Tek Hua, Deputy President for Research and Technology at NUS. "There is no doubt that this collaboration will result in research that is cutting-edge, and that can be translated into practical and positive healthcare outcomes."
In another international collaboration, CHIBE-affiliated faculty member, Heather Schofield, PhD is partnering with the Institute for Financial Management and Research to run a behavioral economics lab in Chennai, India. The lab, co-founded by Dr. Schofield and Frank Schilbach, PhD of the Massachusetts Institute of Technology, investigates the impact of health factors on economic wellbeing and decision-making, ranging from savings rates to consumption patterns. Active research studies examine whether various aspects of health such as chronic pain, malnutrition, or poor sleep may lower incomes and impede decision-making. This could lead to negative feedback loops and the potential for "poverty traps," wherein poor health associated with poverty lowers productivity, earnings, and cognitive function, feeding back into poor health and further poverty.

Schofield's lab conducts randomized trials in Indian workers' natural environments while applying rigorous methodological approaches and precise measurements, combining the benefits of both fieldwork and controlled laboratory settings. For example, her studies examine the relationship between health, productivity, and decision-making among a variety of professions including rickshaw drivers (bike-taxis), flower-stringers (women who string jasmine into garlands), and data entry workers in Chennai. "We refer to this as a 'lab in the field'," says Dr. Schofield. "You have this control that you wouldn't get from a lot of large field experiments, but at the same time, people are doing their normal daily [routine], so you get a lot more external validity."

Similarly, CHIBE's partnership with the Vitality Group in South Africa has created an opportunity to test behavioral economics health interventions in the field while expanding the Center's impact globally. The Vitality Group is an incentive-based wellness program of South Africa's largest private health insurer, Discovery Ltd. In July 2013, CHIBE began a partnership with Vitality to develop new approaches to drive change in health promotion, leading to disease prevention, improved health and reduced medical costs for individuals, businesses and society. As part of a Global Center of Excellence, researchers from CHIBE are working alongside Vitality's team on pilot studies to develop and test solutions to reduce major risks for chronic diseases, with a focus on weight loss, smoking cessation, and medication adherence. "As Vitality continues to innovate in developing its global wellness program, our partnership with CHIBE ensures an evidence-based approach to health behavior change," says Craig Nossel, Head of Vitality Wellness.

This summer, CHIBE's Alison Buttenheim, PhD, MBA, connected Vitality to Stephen Jean, a University of Pennsylvania Master of Public Health student. Jean joined Vitality at their office in Johannesburg, applying CHIBE's evidence base to weight loss rewards and tobacco cessation programs. "They wanted to know how best to deliver these incentives and rewards for their they were going to engage people," said Jean. Jean's main role was in helping Vitality integrate CHIBE's behavioral economic insights into decisions like what incentives to provide to participants, how frequently to generate rewards, and how much and what kind of feedback to give as part of their program. The partnership will ultimately incorporate CHIBE's nuanced and wide-ranging evidence-based strategies into Vitality's wellness programming while pilot studies produce new evidence to inform similar programs globally.

Through cross-cultural collaboration in populations as diverse as Singapore, India and South Africa, CHIBE is expanding the breadth of its research and increasing impact. As an international leader in the field of health behavioral economics, CHIBE is committed to furthering the reach of its work to influence policy, health care delivery and individual wellness on a wide scale. 

-Melissa Ostroff 
Research Spotlight: Jalpa A. Doshi, PhD
Jalpa A. Doshi PhD
Jalpa A
.  Doshi, Ph.D. is an Associate Professor at the Perelman School of Medicine. She is also Dir ector of Value-Based Insurance  Design Initiatives at CHIBE and Director of t he Economic Evaluations Unit of the Center for Evidence-Based Pr actice at  the Univers ity of Pennsylvania Health Syst em. 

In her research, 
Dr. Doshi focuses on three areas: (1) the effects of prescription drug policy, (2) the appropriateness of prescr iption drug use, and (3) the improvement of methods for pharmaceutical outcomes and cost-effectiveness. Her work uses methodologic approaches from multiple disciplines including hea lth economics, pharmacoepidemiology, econometrics, biostatistics, and policy analysis.

What drives your interest in prescription drug policy?

The introduction of new prescription drugs and biologics over the last few decades has transformed medical care for chronic and life-threatening diseases, significantly improving lives. Yet many patients do not benefit from these advances due to lack of prescription access, high costs, and suboptimal use or poor quality of care. What complicates matters is that while many drugs are underused, others are overused. The overall goal of my research program is to understand how pharmaceuticals can be better accessed and utilized by patients to improve health care quality while balancing costs.
Prescription benefit design is an important policy tool to strike the optimal balance between prescription access, costs, and quality. Hence, my research in the prescription drug policy arena has aimed to advance our understanding of the impact of cost-sharing policies among patients across the spectrum of public and private insurers; the differential effects of cost sharing across drug classes and disease conditions; and the tension between aspects of insurance design that can both deter access to needed drugs and promote use of unnecessary drugs.
What is your role as the Director of Value-Based Insurance Design Initiatives at CHIBE?

CHIBE's mission is to contribute to reducing the disease burden from major U.S. public health problems including medication nonadherence. Cost-related nonadherence has been widely documented in the literature. Value-based insurance design (VBID), wherein patient cost sharing would be reduced for high-value medications, is one approach to addressing this problem. I work with colleagues at CHIBE and across Penn to study how cost sharing and VBID-based approaches, as well as other behavioral economic interventions, impact patient medication adherence and outcomes.
Can you talk about your recent cost-sharing research? 

My more recent work in this area has focused on the impact of high levels of cost sharing for prescription drugs. For example, my team has shown the suboptimal trade-offs that elderly Medicare beneficiaries make when faced with large increases in cost sharing (i.e. 25% to 100%) as they enter into the Medicare Part D coverage gap otherwise known as the "donut hole." We've shown that many patients prioritize and continue to fill prescriptions for drugs for symptomatic conditions, such as pain killers and proton pump inhibitors for acid reflux, over drugs such as anti-hypertensives and statins that treat asymptomatic conditions.
My research program has also expanded from examining traditional drugs to specialty drugs, which have been increasingly subject to high cost sharing. Our team was the first to report lower biologic initiation and higher rates of treatment interruption in Medicare Part D patients with rheumatoid arthritis who face specialty tier coinsurance levels of 25% to 33%. In another paper, we found that high Part D cost sharing for specialty drugs (~$2,600 or more out-of-pocket cost for the first 30-day prescription) seems to be reducing or delaying use of a lifesaving class of leukemia therapies. That paper won first prize in a national research challenge sponsored by the Patient Access Network Foundation and the American Journal of Managed Care. Our team has proposed several policy solutions including VBID to alleviate these access barriers under Medicare Part D, which we have also documented in other conditions such as psoriasis, multiple sclerosis,
In addition to cost sharing, what else are you working on?

Better access to necessary prescription drugs alone will not improve patient health. Suboptimal use and poor medication adherence sharply mitigate the effectiveness and cost-effectiveness of available therapies. For those reasons, in a related area of appropriateness of prescription drug use, I have been developing a body of work documenting the prevalence, causes, outcomes, and costs of suboptimal medication use in chronic diseases. Additionally, I have been involved in developing innovative behavioral economic and policy interventions for improving medication adherence and management, while testing clinical and economic impact. For instance, in a recently published project with other CHIBE faculty, we evaluated the effects of a medication refill synchronization intervention. This approach aligns all of a patient's prescriptions so that they can be refilled at the same time and aims to reduce patient burden related to tracking and maintaining adequate supplies of their medications.
What did refill synchronization achieve?

The short answer is that it improved adherence significantly, especially among the study participants who were less adherent at the study outset. (Editor's note: For more details on the synchronization study, see "Synchronized Drug Refills May Improve Prescription Adherence.")
The improvement we observed was comparable to other systems-level interventions. It's important to find adherence interventions that would be practical to implement on a wide scale, and medication synchronization could fit that bill. Of course, more work is needed to determine if patients enrolled in synchronized refill programs have better health outcomes and if prescription synchronization results in economic benefits, but these findings are a solid first step.
What are you looking forward to in your work?

I look forward to continuing work with my CHIBE colleagues to determine if refill synchronization can be combined with VBID and other behavioral economic interventions to improve adherence to lower-cost and widely prescribed medications, and if increased adherence can improve health outcomes. With regard to more expensive treatments within the specialty drug sector, the stakes for creating an incentive system that can better align medication use and spending with value have never been higher. I hope that my research in this arena will help inform more sustainable strategies to promote access, affordability, and adherence to specialty drug treatments for life-threatening, chronic, and rare diseases.

-Christine Weeks 
CHIBE Work-In-Progress Speaker Series
Doctoral Candidate, Harvard T.H. Chan School of Public Health, Harvard University 
12/15/16 - 12:00 pm
1311 Blockley Hall

Associate Professor of Medicine, The Dartmouth Institute for Health Policy & Clinical Practice and Geisel Medical School at Dartmouth University
01/13/16 - 12:00 pm
Location TBD
Co-Hosted with the Leonard Davis Institute of Health Economics

Physician, Internal Medicine, Brigham And Women's Hospital; Instructor of Medicine, Harvard University
01/26/16 - 12:00 pm
1311 Blockley Hall

Assistant Professor of Psychology, School of Arts and Sciences, University of Pennsylvania
02/09/16 - 12:00 pm
1311 Blockley Hall