The Healthy Nudge
August 2019
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 .
Learning from Patient Behavior to Improve Outcomes
David Asch, MD, MBA, CHIBE Internal Advisory Board Member and Executive Director of the Penn Medicine Center for Health Care Innovation, was recently interviewed on patient behavior. In this video , he explains: “Patient behavior is central to so much of health care … Often we find that patients aren’t adherent to their medications. They’re not adherent to their diet. They don’t exercise. So, changing patient behavior - and also actually provider behavior - is critically important to advancing individual and population health.”
Adherence monitoring for hypertension control
Can adherence monitoring with electronic pill bottles or bidirectional text messaging improve hypertension control? A new study in Journal of General Internal Medicine finds that despite good measured adherence, neither form of feedback improved blood pressure control. The study authors, including Shivan Mehta, MD, MBA, concluded that: “Future efforts could provide feedback to providers to escalate prescribing of antihypertensive medications, incorporate remote monitoring of blood pressure readings with ongoing feedback to patients, or leverage additional insight from behavioral science to encourage greater engagement and iterative improvement.”
Assessing Medicaid Beneficiaries in Kentucky
States are pursuing Section 1115 Medicaid demonstration waiver authority to apply community engagement (CE) requirements (eg, participation in work, volunteer activities, or training) to beneficiaries deemed able-bodied as a condition of coverage. These findings from Kentucky in JAMA Network Open suggest that most beneficiaries who would be included in CE programs either already meet activity requirements, which they will be required to proactively report, or may qualify for a medical frailty exemption. Consequently, the outcomes of CE programs will depend on states’ processes for addressing health-related, socioeconomic, and administrative barriers to participating in and reporting CE activities and identifying medical frailty. CHIBE-affiliated faculty member Atheendar Venkataramani, MD, PhD, and several other CHIBE members authored this piece. Read coverage of the study in the Northern Kentucky Tribune and 89.3 WFPL .
CHIBE Profile: Ellen Moscoe, ScD, MA
Ellen Moscoe, PhD, MA, is a post-doctoral researcher whose research lies at the intersection of global health and behavioral economics. She focuses on poor populations in sub-Saharan Africa as well as marginalized groups in the United States.
 
What global health issue would you like more attention/research on?

This is a hard question because I have plenty of answers. I attended a health economics conference in July and was surprised and excited to see many sessions focused on mental health. There is increasing attention to this as an important health issue, but I think it's still not given the weight it deserves in low-income country contexts. The evidence linking poverty to stress has really big implications if we believe that constant stress, especially in early life, can both impact decision-making and put people at risk for chronic illnesses. I'd love to see, and be involved in, more work in this area! If I get to pick a second thing, I would say we need a better way of tracking the results of randomized trials in the social sciences so that we know what did not work. Asking journals to publish null results might be possible, but it could be more efficient to require publication of a short summary of findings linked to the trial registry and make those searchable, so that it would be easy to, for example, find all the trials of financial incentives for exercise and quickly assess what we know from them. If I were a billionaire looking to invest in a vanity philanthropy project, that's probably what I would spend my money on.

What do you find most rewarding about your work?

On a day-to-day basis, I find it really rewarding to work with very talented and smart colleagues. My favorite collaborations have been projects that I've worked on with colleagues who are first and foremost friends, because it makes it really enjoyable to learn from each other. Taking a step back, I think my main motivation in this job comes from the potential to make a measurable impact with my work. Of course most studies will make modest contributions, but the kind of work that CHIBE does is so closely tied to policy that once in a while something will really stand out and have a big effect on well-being. I hope that I have one of those over the course of my career. And work that doesn't translate directly into policy change can contribute to an evidence base that will chip away at a complex problem over time. And even studies that completely fail will still have taught us something about why they fell apart, so we can do better the next time.
CHIBE In the News
Blog Spotlight: 2019 Summer Intern Social Luncheon
The CHIBE/Health Policy Summer Intern Social Luncheon was co-hosted by Norma Coe, PhD , and Harsha Thirumurthy, PhD, and was attended by interns, faculty, and staff.  Learn more about our talented interns on our blog.
Blog Spotlight: NIH Highlights Work By CHIBE Members
The National Institute of Health’s Research Spotlights section for July featured work by CHIBE members: Mitesh Patel, MD, MBA, MS; Justin Bekelman, MD; and Dylan Small, PhD. Their research tested a default order in the electronic medical record on unnecessary daily imaging during palliative radiotherapy for adults with cancer. Read the study published in JAMA Oncology here.
What's New?

Tell us about a behavioral economics-related project or article that a colleague is working on that you find fascinating and deserves more attention. Email chibe@pennmedicine.upenn.edu.
New Publications
Connor A. Moseley, Madhulika Vulimiri, Robert S. Saunders, William K. Bleser, Eliana M. Perrin, Sarah C. Armstrong, Gary X. Wang, Peter A. Ubel, Mark McClellan, Charlene A. Wong. Medicaid and CHIP Child Health Beneficiary Incentives: Program Landscape and Stakeholder Insights . Pediatrics .
Genevieve P. Kanter, George Loewenstein. Evaluating Open Payments . JAMA Network Open.
Katelin Hoskins, Connie M. Ulrich, Julianna Shinnicka, Alison M. Buttenheim. Acceptability of Financial Incentives for Health-Related Behavior Change: An Updated Systematic Review . Preventive Medicine.
Emily M. Becker-Haimes, Nathaniel J. Williams, Kelsie H. Okamura, Rinad S. Beidas. Interactions Between Clinician and Organizational Characteristics to Predict Cognitive-Behavioral and Psychodynamic Therapy Use . Administration and Policy in Mental Health and Mental Health Services Research.
Ricardo Castillo-Neyra, Amparo M. Toledo, Claudia Arevalo-Nieto, Hannelore MacDonald, Micaela De la Puente-León, Cesar Naquira-Velarde, Valerie A. Paz-Soldan,  Alison M. Buttenheim, Michael Z. Levy . Socio-spatial Heterogeneity in Participation in Mass Dog Rabies Vaccination Campaigns, Arequipa, Peru . PLOS Neglected Tropical Diseases.
Pengxiang Li, Abhishek Kavati, Justin T.Puckett,Jordan Jahnke, Paula Busse, Nicola A. Hanania, Benjamin Ortiz, Jalpa A.Doshi. Omalizumab Treatment Patterns Among Patients with Asthma in the US Medicare Population. The Journal of Allergy and Clinical Immunology: In Practice.
Deepshikha C. Ashana, Scott D. Halpern, Craig A. Umscheid, Meeta P. Kerlin, Michael O. Harhay. Use of Advance Care Planning Billing Codes in a Retrospective Cohort of Privately Insured Patients . Journal of General Internal Medicine.
Michael Seward, Roberta Goldman, Stephanie Linakis, Paul Werth, Christina Roberto, Jason Block . Showers, Culture, and Conflict Resolution: A Qualitative Study of Employees’ Perceptions of Workplace Wellness Opportunities . Journal of Occupational and Environmental Medicine.
Jane M. Zhu, Amol Navathe, Yihao Yuan, Sarah Dykstra, Rachel M. Werner. Medicare’s Bundled Payment Model Did Not Change Skilled Nursing Facility Discharge Patterns . The American Journal of Managed Care.
Emily F. Gregory, Jeffrey M. Miller, Richard C. Wasserman, Roopa Seshadri, David M. Rubin, Alexander G. Fiks . Routine Cholesterol Tests and Subsequent Change in BMI Among Overweight and Obese Children . Academic Pediatrics.
Timothy W. Levengood, Yinan Peng, Ka Zang Xiong, Ziwei Song, Randy Elder, Mohammed K. Ali, Marshall H. Chin, Pamela Allweiss, Christine M. Hunter, Alberta Becenti. Team-Based Care to Improve Diabetes Management: A Community Guide Meta-Analysis . American Journal of Preventive Medicine.
Maria E. Fernandez, Gill A. ten Hoor, Sanne van Lieshout, Serena A. Rodriguez, Rinad S. Beidas, Guy Parcel, Robert A. C. Ruiter, Christine M. Markham, Gerjo Kok. Implementation Mapping: Using Intervention Mapping to Develop Implementation Strategies . Frontiers in Public Health. 
Katherine R. Courtright, Corey Chivers, Michael Becker, Susan H. Regli, Linnea C. Pepper, Michael E. Draugelis, Nina R. O’Connor. Electronic Health Record Mortality Prediction Model for Targeted Palliative Care Among Hospitalized Medical Patients: a Pilot Quasi-experimental Study . Journal of General Internal Medicine.
Annaka Scheeres, Regina Xhezo, Rose Julius, Ryan Coffman, Jarma Frisby, Luise Weber, Jessica Streeter, Frank Leone, Cheryl Bettigole, Hannah Lawman. Changes in Voluntary Admission and Restraint Use After a Comprehensive Tobacco-Free Policy in Inpatient Psychiatric Health Facilities. Substance Abuse.
Tamara D. Clark, Dalsone Kwarisiima, James Ayieko, Jane Kabami, Norton Sang, Teri Liegler, Gabriel Chamie, Carol S. Camlin, Vivek Jain, Kevin Kadede, Mucunguzi Atukunda, Theodore Ruel, Starley B. Shade, Emmanuel Ssemmondo, Dathan M. Byonanebye, Florence Mwangwa, Asiphas Owaraganise, Winter Olilo, Douglas Black, Katherine Snyman, Rachel Burger, Monica Getahun, Jackson Achando, Benard Awuonda, Hellen Nakato, Joel Kironde, Samuel Okiror,
Harsha Thirumurthy, et al. HIV Testing and Treatment with the Use of a Community Health Approach in Rural Africa . The New England Journal of Medicine .
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 health care delivery, and increase healthy behavior.