MARCH 2019
The Healthy Nudge
Welcome to The Healthy Nudge . Each month, we'll get you up to speed on the latest developments in policy-relevant health behavioral economics research at CHIBE. Want more frequent updates? Follow us on Twitter @PennCHIBE and visit our website .
Higher P4P Bonus Associated with Improved Care
A recent JAMA Network Open study authored by CHIBE Associate Director Amol Navathe, MD, PhD and colleagues found that increasing bonus sizes in a physician pay-for-performance (P4P) program was associated with an improvement in quality of care for patients with chronic diseases. However, introducing the behavioral economic principles of loss aversion and social pressure did not lead to additional benefits for patients.
RFA Announced for CTSA Proposals
In partnership with the Institute for Translational Medicine and Therapeutics, CHIBE is inviting proposals for Clinical and Translational Science Award (CTSA) pilot projects from ITMAT Members and Associate Members addressing 1.) improvement of enrollment in clinical trials and 2.) improvement of population health outcomes or health behavior through the use of connected health interventions. Applications focusing on reducing the risks from opioid addiction or atherosclerotic cardiovascular disease (ASCVD) and applications investigating the use of behavioral phenotyping will receive special consideration. CHIBE strongly encourages proposals to use the Way to Health platform. Proposals are due by March 29, 2019 for a proposal start date of June 1, 2019.
Sharing Insights in Europe
During the early part of 2019, CHIBE faculty are traveling overseas to exchange knowledge with colleagues across Europe engaged in the field of behavioral economics and health policy. In February, CHIBE Associate Directors Alison Buttenheim, PhD, MBA and Christina Roberto, PhD attended the International Workshop on Choice Architecture, held by the Behaviour and Health Research Unit at University of Cambridge. The workshop reviewed current evidence and progress on implementation, while establishing an international network of researchers in choice architecture and health behavior. Additionally, Heather Schofield, PhD is spending March through mid-April presenting on the preliminary results of her study on the economic impacts of chronic sleep deprivation among low-income workers. Schofield's talks will take place at universities in the United Kingdom, Switzerland, Germany, France, Italy and Sweden.
Blog Spotlight
Payment, Lying and Research Eligibility
A recent blog post from LDI Health Policy$ense summarizes a J AMA Network Open study that considered whether payment impacts deception about study eligibility, and if so, whether more money leads to increased deception. The study was co-authored by CHIBE Associate Director Harsha Thirumurthy, PhD .
Work-in-Progress Seminar:
with Julia Raifman, ScD, SM
Assistant Professor of Health, Law and Management
Boston University
03/28/19 @ Noon
253 Biomedical Research Building
In The News
Do E-Cigarettes Do More Good Than Harm?

Health-Related Google Searches Increase Just Before ED Visit

Why People Give Into Bribery Decoded

Why Bribery Works and What Changes Its Effectiveness

To Get Smokers To Quit, Tap Into Their Biology

Effective Self-Control Strategies Involve Much More Than Willpower, Research Shows

When Research Participation Pays, Some People Lie, Penn Study Suggests

Bonus Pay For Doctors Can Boost Quality Of Care

Non-Profits May Be Waiting Too Long to ask for Donations, Study Says

Penn Prof. Angela Duckworth Publishes Research On Self-Control Methods

There's a Scientific Reason You Always Overcomitt to Future Plans
 CHIBE Profile
CHIBE External Advisory Board member Rebekah Gee, MD serves as Secretary of the Louisiana Department of Health. Her oversight responsibilities include public health and other direct service programs for citizens in need, such as behavioral health, developmental disabilities, aging and adult services, emergency preparedness, and the Medicaid program.
In the wake of Medicaid expansion in Louisiana, your office launched a dashboard to measure access to health care services. Could you describe how this dashboard influences health care in your state?
The Medicaid expansion dashboard was created to provide transparency and to demonstrate the outcome and success of expansion. It gives us a parish (county) level breakdown of enrollment data so we have a better understanding of where our members are and which healthcare services they are benefiting from such as preventive care and cancer screenings. The dashboard not only allows citizens, state officials, news reporters and others to get Louisiana Medicaid expansion data quickly, it is also being recognized by others. Officials from Ohio, California, Colorado and other states have contacted us about our site, seeking input and information to help them develop similar sites for their states.
Additionally, the Louisiana Department of Health has launched an interactive database to understand, analyze, and apply data to our opioid mitigation efforts. This dashboard incorporates a variety of key outcome measures such as opioid prescriptions, emergency department visits, hospitalizations, and deaths. This tool helps guide how we think about, and respond to, the opioid epidemic in Louisiana and it ensures that we maximize resources in the areas most in need.

A major accomplishment in your role thus far has been the negotiation of lower costs for Hepatitis C drug treatment through a subscription program. How has this program changed patient behavior, and what makes a subscription model unique?
Our main goal with the subscription model is to provide access to treatment for more people who need it – eventually eliminating Hepatitis C. In the United States, hepatitis C kills more people than all other infectious diseases combined. At least 39,000 people in Louisiana's Medicaid program and prison system suffer from hepatitis C infection. Because of the high cost of the drug, less than three percent of Medicaid patients who have hepatitis C were treated last year.
The subscription model for hepatitis C treatment will give us the opportunity to have unlimited access to highly effective direct-acting antiviral treatment(s) for five years, without spending more than what we already spend today on hepatitis C medications. Our goal is to treat over 10,000 Medicaid-enrolled and incarcerated individuals by the end of 2020 through the subscription model, with the ultimate goal of eliminating this disease. We have released a solicitation for offers (SFO) to identify a pharmaceutical partner to negotiate unrestricted access to curative treatment for hepatitis C for Medicaid and incarcerated patients in Louisiana. 

How have you incorporated behavioral factors into your strategies for tackling public health concerns in Louisiana?
It’s important to meet people where they are. When Louisiana expanded Medicaid, our goal was to reach out to working people who were accessing healthcare but truly could not afford it. We positioned workers in emergency departments, clinics and Medicaid enrollment centers across the state. We met people where they were and helped them to enroll.
New Publications

The Center for Health Incentives and Behavioral Economics (CHIBE) at the University of Pennsylvania conducts behavioral economics research aimed at reducing the disease burden from major U.S. public health problems. Originally founded within the Leonard Davis Institute of Health Economics , our mission is to inform health policy, improve healthcare delivery and increase healthy behavior.
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