The Perplexing Psychology of Saving for Health Care
NPR, February 15, 2017

Making Weight Loss Behavior Change Stick
Forbes, January 31, 2017

Mitesh Patels Weighs In On New 'Smart Belt'
Forbes, January 31, 2017

How Might Wearables Transform Health Care Delivery?
Philadelphia Inquirer, January 20, 2017

Financial Incentives and Opportunities to Donate to Charity Increase Physical Activity in Older Adults
Reuters, Penn Medicine News, Medical Xpress, January 13, 2017

Can Fitness Trackers Work Miracles?
USA Today, January 8, 2017

Kevin Volpp: How to Keep Your Fitness New Year's Resolution Without Breaking the Bank
New York Magazine , January 5, 2017

Medicare Bundled Payments for Joint Replacements Incentivize Care Coordination and Cut Costs
Kaiser Health News,, Science Daily, News Medical, Stat On Call, Healio, McKnight's, Nephrology News,   Managed Care Magazine, Benefits Pro, Becker's Hospital Review,   Fierce Healthcare, Managed Healthcare Executive, January 3, 2017

CHIBE Behavioral Economics Symposium Closes Seven-Year Research Program
LDI eMagazine, January 3, 2017

Heather Schofield Explains How Mental Bandwidth Impacts Poverty
Knowledge@Wharton, December 28, 2016

Kit Delgado Discusses Research on Smartphone Breathalyzers
Philadelphia Inquirer, December 22, 2016

CHIBE's Academic Home Launches Penn's First Online Master's Degree
Penn Medicine News, November 30, 2016

George Loewenstein Talks 'Information Avoidance' and Bad Decisions
Devex, November 23, 2016
Audrain-McGovern J, Strasser AA, Wileyto EP. Can repetitive mental simulation of smoking engender habituation? Exp Clin Psychopharmacol.
Cotton P, Newhouse JP, Volpp KG, et al. Medicare advantage: issues, insights, and implications for the future. Popul Health Manag. 2016;19(S3):S1-S8.

Dai H, Mao D, Riis J, et al. Effectiveness of medication adherence reminders tied to "fresh start" dates: a randomized clinical trial. JAMA Cardiol. 2017.

Doshi JA, Volpp KG. Medication adherence: the authors reply. Health Aff (Millwood). 2016;35(11):2151.

Doshi JA, Hu T, Li P, Pettit AR, Yu X, Blum M. Specialty tier-level cost sharing and biologic agent use in the Medicare Part D initial coverage period among beneficiaries with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2016;68(11):1624-1630.

Elshaug AG, Rosenthal MB, Lavis JN, et al. Levers for addressing medical underuse and overuse: achieving high-value health care. Lancet. 2017.

Li P, Schwartz JS, Doshi JA. Impact of cost sharing on therapeutic substitution: the story of statins in 2006. J Am Heart Assoc. 2016;5(11).

Navathe AS, Troxel AB, Liao JM, et al. Cost of joint replacement using bundled payment models. JAMA Intern Med. 2017;177(2):214-222.

Patzer RE, Serper M, Reese PP, et al. Medication understanding, non-adherence, and clinical outcomes among adult kidney transplant recipients. Clin Transplant.

Reese PP, Bloom RD, Trofe-clark J, et al. Automated reminders and physician notification to promote immunosuppression adherence among kidney transplant recipients: a randomized trial. Am J Kidney Dis. 2016 .

Simonsohn U. Each reader decides if a replication counts. Psychol Sci. 2016;27(10):1410-1412.


Tetlock PE, Mellers BA, Scoblic JP. Bringing probability judgments into policy debates via forecasting tournaments. Science. 2017;355(6324):481-483.

Thornton CM, Cain KL, Conway TL, et al. Relation of adolescents' physical activity to after-school recreation environment. J Phys Act Health. 2017;:1-21.

Woodhouse KD, Tremont K, Vachani A, et al. A review of shared decision-making and patient decision aids in radiation oncology. J Cancer Educ. 2017;
Peer Comparisons Among Physicians: A N ew Policy Tool?

Encouraging high-value practices among physicians has become an increasing point of emphasis in today's policy landscape. There are numerous programs that place a greater onus on physicians to take cost into consideration - either directly from insurance companies, such as through the new Medicare Access and CHIP Reauthorization Act, or from affiliated health systems trying to survive as accountable care organizations. Up to this point, however, standard practices that incentivize physicians to consider cost have not been consistently effective. For example, classic pay-for-performance (P4P) programs have been largely unsuccessful at changing physician practice.  
Amol S. Navathe, MD, Phd 
But what if we were to design incentive systems with behavioral economics in mind?
At CHIBE, we've recently begun studying how providing physicians with transparent feedback on their performance in comparison to peers could encourage high-value practices. There are a number of reasons why peer comparisons among physicians may be a good idea. First, they align with professional values - which are explicitly articulated for physicians in the Hippocratic Oath and charters from professional societies. Second, they can be a component of promoting a culture of transparency, which is a growing trend across medicine and healthcare. Third, peer comparisons provide physicians with informative feedback on how they practice relative to other physicians. 
Medicare recently started providing practice-level, transparent, comparative feedback under its new cancer payment model (the Oncology Care Model); the trend toward peer comparisons is already underway. However, before leaders start unrolling report cards and dashboards filled with comparative data, we must be mindful that studies outside of health care show that how a comparison is designed can greatly affect the type of behavior change it elicits. For example, providing employees with information on how much their colleagues were saving for retirement paradoxically decreased the amount that each employee saved. There are several dimensions to consider when making peer comparisons, including the framing of feedback and the focus of behavior change. These elements need further study before health care systems start deploying this practice as an intervention writ large.

With insights from behavioral economics, we can improve upon previous attempts to incentivize physicians to provide high-value care. Regardless of what happens to the future of health care payment, peer comparisons are one policy tool with the potential for impact.

-Amol S. Navathe, MD, PhD 
Online Competition - Not Support - Boosts Exercise 

In a recent study published in Preventive Medicine Reports, CHIBE faculty affiliate Damon Centola, PhD finds that social media support groups are not effective at increasing physical activity. Competition, on the other hand, provides a major boost. In a video from the Annenberg School, Centola explains the results of his study and what they can tell us about using social media to promote exercise.

Want To Exercise More? Get Yourself Some Competition.

FIELDS Program Sponsors Podcast on End-of-Life Decisions 

While issues surrounding end-of-life care have become increasingly visible in recent years, patients with serious illness continue to face troubling knowledge gaps about hospice and palliative services. With this in mind, CHIBE's Fostering Improvement in End-of-Life Decision Science (FIELDS) Program is sponsoring a podcast,  When I Die, Let Me Live. The podcast, narrated and produced by fifth year University of Pennsylvania medical student, Lauren Kelly, provides much needed support and ed ucation for patients with serious illness, their families and clinicians.

As a health communications intervention, 'When I Die, Let Me Live' introduces the topic of advance care planning through the accessible stories of patients, caregivers and health professionals. Among the show's interviewees are palliative care providers who offer insight on ways to approach patients and loved ones about the end-of-life. The podcast models open communication that can spark new dialogue or strengthen previously initiated conversations between patients and clinicians.

In the first episode, Kelly interviews the late Jay Fishman, a Wharton alumnus and former Penn Trustee, about his life with ALS. The episode also features contributions from Penn pulmonologist Dr. John Hansen-Flaschen who cared for Fishman near the end of his life. "The conversations are very personal," says Kelly. "We're talking about the things that make life worth living, which are different for each of us." Given the show's explorative tone, Kelly hopes that listeners can locate their own voices among the multitude of narratives, and, ultimately, engage in advance care planning with greater confidence and assurance.

Kelly obtained a degree in Narrative Medicine before attending the Perelman School of Medicine, an experience that has taught her to harness the power of storytelling to enrich health care perspectives. Her career interests center on the use of media and oral storytelling to improve patient engagement and advance the provision of end-of-life care. "Hearing the interviewees' voices in an intimate setting, clear and resonant in your ear buds, is the magic of podcasting," says Kelly. "I wanted to let those voices sing for others to hear and be moved by."

You can hear the podcast trailer online at and follow @WIDLML on Twitter for the latest updates. 
CHIBE's 2016 Behavioral Economics and Health Symposium: a Conversation with Amber Barnato, MD, MPH, MS
Amber Barnato, MD, MPH, MS  
On December 8th and 9th, CHIBE held its 2016 Behavioral Economics and Health Symposium, concluding a seven year research program funded by the Robert Wood Johnson Foundation and Donaghue Foundation. The two-day symposium featured research presentations and workshops applying behavioral economics to critical health and health care challenges. Amber Barnato, MD, MPH, MS, who traveled to the symposium from the University of Pittsburgh, describes her experience at this year's event.



What were your most valuable takeaways from this year's symposium? Which research findings had the greatest impact on you? 

The research I found most interesting was the work by Ayelet Fishbach and colleagues describing the effects of associating external rewards with intrinsic motivation in order to increase the durability of short-term external rewards. 
The lack of durability of external rewards (e.g., financial incentives) is a major problem with some of our behavioral economics work. Furthermore, there is reason to believe that external motivations can "crowd out" internal motivation. I really like the idea of "boosting" internal motivations with external rewards, so that internal motivations are potentially strengthened, not undermined, and persist in helping potentiate the behavior even after the external (financial) reward is taken away. It's the classic case of "internalizing" that we seek to support in the development of particular pro-health behavioral norms.

What is the focus of your current research, and what intersections did you see between your work and the content of the symposium?

I study end-of-life decision making and, in particular, decisions by patients, family members, and providers to discuss goals of treatment. Related to this is an interest in how such 'decisions' are influenced by organizational social norms. I have conducted trials of both framing effects and extrinsic financial incentives to influence decisions about advance care planning (ACP) in the event of an acute, life-threatening event. I was, therefore, interested in thinking about internal motivations for ACP conversations from both the patient and provider perspectives, and saw a link between this and Ayelet's work. 

The Robert Wood Johnson Foundation focuses on promoting a 'culture of health.' How do you think behavioral economics contributes to that mission?

I really like the idea of using interventions to change group behavior in ways that get reinforced by social sanctions or, better yet, internalized values. So far, most of the work in this area is limited to "team" incentives and social comparisons. Yet there is interesting work in sociology regarding changing social norms that behavioral economics could learn from.

At the conclusion of the symposium, Dr. George Loewenstein gave a keynote address on information avoidance in the context of health decisions.  What are some areas of health care research where you think it might be useful to further explore information avoidance? 

I believe that George is actually working with Rebecca Ferrer from NCI on the issue of information avoidance by people with life-threatening illness (e.g., cancer). Specifically, patients have a tendency to want to avoid information about prognosis that we as decision scientists and clinicians think that they 'ought' to know in order to make good medical decisions. I think that looking at information avoidance in this context merits further exploration.
CHIBE Work-In-Progress Speaker Series
Assistant Professor of Pediatrics, Perelman School of Medicine at the University of Pennsylvania 
03/09/17 - 12:00 pm
1104 Blockley Hall

Fellow, Pulmonary and Critical Care Medicine, Hospital of the University of Pennsylvania
03/23/17 - 12:00 pm
1104 Blockley

  Assistant Professor of Economics, Social and Decisions Sciences, Carnegie Mellon University
04/13/17 - 12:00 pm
1104 Blockley Hall

Professor of Psychology and Medicine; Director of the Decision Sciences Collaborative, Ohio State University
04/27/17 - 12:00 pm
1104 Blockley Hall