To help those who want to respond to our recent Call for Proposals, Applying Behavioral Economics to Perplexing Health and Health Care Challenges, I sat down with Drs. Kevin Volpp and David Asch, co-directors of the Foundation’s Behavioral Economics Initiative at the University of Pennsylvania, to talk about low-value health care, why we are doing this CFP and what we are seeking from applicants.

Why are we doing this CFP now?

Kevin: There’s enormous concern about the growth in health care spending—both in the public and private sector. We can’t afford to keep increasing spending the way we have. But health care spending shouldn’t be defined as too high simply because it’s high. The question should be “How much value are we getting?” There is a widespread belief that there is too much health care that doesn’t provide value that’s commensurate with the costs—to individuals or to the government.

What’s particularly exciting is that, while health policy experts have acknowledged the problem of low-value health care for a long time, influential physician groups are becoming vocal about their belief that society would be better off — from both a quality and patient safety standpoint — if less of this care was provided. And they’re creating lists of health care services and procedures that they consider to be of low value that are available to the public.

Reducing use of low-value care is what’s going to be able to allow us to continue to fund high-value care for large portions of the American population.

What is low-value health care?

We have announced our second Call for Proposals in the field of behavioral economics. We’re actively seeking ideas that will help us to better understand how to discourage the consumption of low-value health services — those that provide more harm than benefit or which provide only marginal health benefits. In addition to improving health outcomes, this knowledge could contribute to lowering health care costs for us all.

Behavioral economics is an area of study by which I’ve personally grown increasingly intrigued and in which the Foundation has recently begun to invest.  We all know, for example, that we need to exercise, eat right and be actively engaged in our own health care. But we don’t always do what we know we should do; knowing the “right” decision to make does not guarantee that we make that decision. The goal of behavioral economics is to uncover insights that could enable people to make better — more “rational” — choices for their health.

In December, we asked our readers to tell us about the health care problems they felt were most in need of innovation—the tough problems, the crucial ones, maybe even those they’d seen firsthand. The number of comments we received was encouraging. It has also challenged our thinking, and generated a great deal of discussion on our team.

One thing is certain: The conversation that ensued from that post confirmed that our team needs to do more listening—listening to patients, caregivers, health care professionals, innovators, thought leaders—the list goes on and on.

We saw some common themes in the problems you shared. A few of them are reflected in areas in which the Robert Wood Johnson Foundation is already working. Clearly there are problems that, despite the intensive efforts of many really smart people, resist conventional solutions. Other themes showed us how important it is to always be examining what we’re doing from perspectives other than our own. 

So where do we go from here?  

A little more than 13 years ago, the Institute of Medicine (IOM) released its seminal report on patient safety, To Err is Human.  You can say that again. We humans sure do err.  It seems to be in our very nature.  We err individually and in groups—with or without technology.  We also do some incredible things together.  Like flying jets across continents and building vast networks of communication and learning—and like devising and delivering nothing- short-of-miraculous health care that can embrace the ill and fragile among us, cure them, and send them back to their loved ones.  Those same amazing, complex accomplishments, though, are at their core, human endeavors.  As such, they are inherently vulnerable to our errors and mistakes.  As we know, in high-stakes fields, like aviation and health care, those mistakes can compound into catastrophically horrible results.  The IOM report highlighted how the human error known in health care adds up to some mindboggling numbers of injured and dead patients—obviously a monstrous result that nobody intends.

The IOM safety report also didn’t just sound the alarm; it recommended a number of sensible things the nation should do to help manage human error. It included things like urging leaders to foster a national focus on patient safety, develop a public mandatory reporting system for medical errors, encourage complementary voluntary reporting systems, raise performance expectations and standards, and, importantly, promote a culture of safety in the health care workforce. 

Amanda E. Staiano, PhD, MPP, Research Fellow, Pennington Biomedical Research Center

Can video games help kids move more and even lose weight?  Long blamed for promoting an unhealthy, sedentary lifestyle, video games are gaining a new reputation—by offering opportunities for enhanced physical activity.

Exergames, which are video games that require physical exertion, are popular among children and adults alike. The Children’s Digital Media Center at Georgetown University received a grant from Health Games Research, a national program of the Robert Wood Johnson Foundation, to investigate the game design principles that might make exergames effective physical activity and weight loss tools. Professor Sandra Calvert of the Department of Psychology at Georgetown University served as the principal investigator and was joined by myself and Dr. Anisha Abraham of Georgetown University Medical Center as co-investigators.  The exciting results were recently published online in the journal Obesity.