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 .
Interim Director Named at 2018 Roybal Retreat
At this year’s annual Roybal Retreat, Director Kevin Volpp PhD, MD announced that Alison Buttenheim, PhD, MBA will serve as interim director while he is on sabbatical from January to August 2019. About the annual retreat, Buttenheim said "[it] could be seen as an encapsulation of CHIBE's strategic goals. You can see our goal of advancing science in the presentations...our goal of developing new leaders in our field is obvious at the poster session where some of the amazing work of our trainees was vetted. Our goal of expanding CHIBE's reach and impact is there in the reports about the collaborations and partnerships that are taking our work to scale while enabling us to learn more about the scaling process itself."
RFA Announced for CTSA Pilot Program
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 December 17, 2018 for a proposal start date of February 1, 2019.
CHIBE Teams Up with Progressive to Test Distracted Driving Nudges
A research team led by Kit Delgado, MD, MS recently received $1.84 million from the Federal Highway Administration to leverage the power of nudges to help curb distracted driving. The team will investigate strategies — such as redesigning insurance discounts — for reducing cell phone use while driving. Through the project, Dr. Delgado will collaborate with Progressive Insurance, the first and one of the largest providers of usage-based insurance in the United States.
Blog Spotlight
Just as Medicare launched its new voluntary bundled payment program, CHIBE Associate Director Amol Navathe, MD, PhD joined Ezekiel Emanuel, MD, PhD, to host a forum at the National Press Club to discuss current evidence and best practices around payment transformation. The forum brought policymakers, policy advocates, researchers, health insurers, and health system leaders together to learn from each other’s experiences in implementing new payment models.
In The News

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 CHIBE Profile
CHIBE Faculty Affiliate Peter Reese, MD, MSCE focuses his research on the development of effective strategies to increase access to solid organ transplantation and to reduce complications after transplantation.
Your study on the use of Hepatitis-C infected kidneys for transplant has received a great deal of media attention . Are there any behavioral insights from this work that you found particularly interesting or surprising?
This work is a shining example of team science at Penn with a large team of collaborators including Dr. David Goldberg of Hepatology. Right now, organs infected with hepatitis C virus are commonly discarded because of concerns about infection risk. The most important insight that I want to emphasize concerns patients' and physicians' default decision-making process around kidney transplants. 
Many physicians and their patients think about this decision as a choice between getting a kidney without risk of infection or a kidney with hepatitis C. Instead, we believe that a better default decision would be to consider a choice between waiting many years to get an uninfected kidney while on dialysis, with the possibility of health deterioration, or accepting a kidney with hepatitis C in the near-term, avoiding dialysis and enduring the risks of viral complications.
Due to the current default thinking around this decision, many patients remain on the transplant waitlist knowing they have three or more years of dialysis ahead of them, because the risks of the status quo are known, and easier to grasp. Patients choose not to receive a transplant in just weeks to months in order to avoid the less familiar risk of getting infected with hepatitis C. 
Your work employs behavioral economics to promote renal health. How might behaviorally-informed interventions prevent the recurrence of urinary stone disease?
Kidney stones are terribly uncomfortable and may require costly surgical interventions to remove them. It’s an unforgettably unpleasant experience! Prevention of recurrent stones usually requires patients to drink more fluid every day. This remedy sounds simple, yet students of behavioral economics will not be surprised to learn that many patients are unable to maintain that consistent daily fluid intake. They get busy, or they forget, or perhaps the demands of work, travel, childrearing or a small bladder prevent them from drinking enough.
In the PUSH trial - generously funded by the NIH - we are testing financial incentives and customized coaching to help patients drink more fluids in order to prevent kidney stone recurrence. All patients receive a wireless-enabled fluid bottle to better track intake. The incentives are intended to overcome present bias and the coaching should help patients find pragmatic solutions to their personal barriers.
This work also provides an excellent example of collaboration - in this case between teams at Penn and CHOP, led by Dr. Greg Tasian of urology - as well as 4 other academic centers that form the Urinary Stone Disease Research Network.

What are some major takeaways from your work thus far using behavioral economics to promote medication adherence?
Solving this problem could bring tremendous benefits to almost every area of medicine. My takeaways are that we have the technology to measure adherence but we are still refining the tools needed to improve it. I see promise in interventions that involve the treating physician. A major challenge is choosing the ideal populations to test interventions, such that we maximize potential benefit and minimize potential risk.
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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