Episode #37 – Making it easier for patients & providers to do the right things – an interview with Kevin Volpp MD, Founding Director of CHIBE

Human behavior is, by far, the single biggest lever we have to impact our health outcomes. Yet, despite the profound impact our behaviors have on health outcomes, as well as on our national & global economic health; we continue to see adherence rates to appropriate treatment and medication taking hover between 40 to 50%!  These incredibly low adherence rates exist in chronic issues such as diabetes treatment and blood pressure control; and they also occur even after life-threatening events such as heart attacks. This is, without question, a major health care challenge for patients, providers, payers & employers.  In fact, it’s one of the most significant challenges for just about every stakeholder in healthcare, including pharmaceutical companies and pharmacies.

Clearly, behavior change is a tough nut to crack.  We all want to do the right things – but behavior change is challenging to initiate, and even more challenging to sustain.  Gratefully, there is a discipline called ‘behavioral economics’ – a combination of microeconomics, psychology & neuroscience – that is demonstrating marked success in making it easier for patients, as well as doctors, to repeatedly and more easily perform & sustain desired healthful behaviors.

In this interview, Dr. Kevin Volpp, one of the most highly published and productive physician-scientists in this discipline, shares numerous applications & techniques of behavioral economics – as applied directly to patients’ & providers’ behaviors.

What you’ll hear in this interview includes:

• How a large employer-based incentive program tripled the rate of sustained smoking cessation – from 5% to 15%.  And,in a smaller subset of employees (~14%) the intervention achieved rates of 50% long term smoking cessation!
• How a default electronic medical record intervention increased physicians’ prescribing of generic medications from less than 60% to 99% – leading to savings of approximately $32M in a couple of years time.
• How behavioral economics is being deployed to create a new primary care payment system in the Hawaii Medical Services Agency – incenting doctors to deliver high value care.

Toward the end of our dialogue, Dr. Volpp sketches an enlightened picture of the future of healthcare – a tremendous emancipation of value that could occur, if we can begin combining virtual digital technologies with the powerful techniques of behavioral economics

Clayton Christensen, the preeminent Harvard Business School Professor & one of the leading management scholars of our time, wrote in The Innovator’s Prescription: A Disruptive Solution for Health Care, “There are more than 9,000 billing codes for individual procedures and units of care.  But there is not a single billing code for patient adherence or improvement, or for helping patients stay well.”  In my opinion, Dr. Kevin Volpp’s groundbreaking work in Behavioral Economics addresses Dr. Christensen’s keen observation by focusing on creating the procedures & interventions for helping patients stay well, as well as helping physicians and other providers help patients stay well.  

I came away from this interview with one lingering question: Given the clear potential for behavioral economics to achieve sustained healthful behaviors, improve our health and the health of our nation, and lower the crippling costs of healthcare – how come we’re not doing more of it?  My hope – and intention – is that this interview advances the greater awareness of one of the most significant opportunities we have available to us to improve healthcare.

As always, I do hope you get as much out of this interview as I have!

Zeev Neuwirth, MD