Six Ideas for Reducing the Use of Low-Value Health Care

Oct 17, 2013, 8:00 AM, Posted by Lori Melichar

Lori A. Melichar Lori Melichar, director

Two years ago, my colleagues and I knew very little about how to use behavioral economics to improve health care decisions. Today, we know more. We also know how much there is to learn and do in this field.

That’s why we’re excited to announce six new grantees who will continue to build on the work we’ve funded over the last two years to apply principles from behavioral economics to challenges in health care.

The new grantees are as follows:

  • Amber Barnato and Rebecca Sudore, University of Pittsburgh and University of California, San Francisco, Consumer-directed financial incentives to increase advance care planning among Medicaid beneficiaries
  • Jeremiah Schuur, Brigham and Women's Hospital, Inc., Decision Fatigue in the Emergency Department and the Use of Hospital Services
  • Jeffrey Kullgren, University of Michigan Medical School, Decreasing Overuse of Low-Value Health Care Services through Physician Precommitment
  • Mark Vogel and Scott Halpern, Genesys Health System and University of Pennsylvania, BEACON -  Behavioral Economics for Advanced Care OptioNs
  • Richard Frank and Abigail Friedman, Harvard Medical School, Behavioral Experiments in Improving Medicare Coverage Choice
  • Mark Schlesinger and Rachel Grob, Yale University and University of Wisconsin – Madison,  Precommitment, Provider Choice, and Forgoing Low-Value Health Care

If you’re curious about why we’re funding these particular projects at this specific moment in time, read on.

Our Progress So Far

In 2011, we partnered with the Donaghue Foundation to put out our first Call for Proposals. We were looking for ideas inspired by behavioral economics that could dramatically improve consumer behavior around health challenges, like obesity and medication adherence.

We received hundreds of applicants and ultimately chose eight exciting projects. At least one of those eight teams will publish their findings this fall—and others will follow in 2014 and 2015. We’re excited about the potential these simple interventions have to produce breakthroughs on seemingly intractable health challenges.

For our second and final Call for Proposals, which we released this March, we focused on the choices that patients and health professionals make in the clinic. Actually, not just any choices—but the choices that lead to the costly and sometimes harmful use of “low-value” health care services.

There is no lack of data showing which low-value services are being used or how much they cost the system. In 2012, the Robert Wood Johnson Foundation chose to fund the ABIM Foundation’s Choosing Wisely campaign to elevate the importance of avoiding unnecessary medical tests and procedures.

The campaign continues to build momentum. It enjoys the support of more than 50 specialty societies and a host of large consumer groups.

Where We Are Heading

Despite the progress achieved through Choosing Wisely, we still found ourselves in the dark about how and why doctors and patients make low-value health care decisions, especially if those decisions could harm the patient. Is there a lack of information? Moral Hazard? Conflicting incentives? Outside pressures from family or employers? Before we can ever change behavior, we need to understand the forces that are driving it.

That was our motive for this second CFP and that’s what we’re excited to learn from the six new grantees we’ve just selected. Each project has the potential to reveal or change something significant about how health care decision-makers choose which services to use.

We look forward to continuing our work with the Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute of the University of Pennsylvania to track and share what we learn from these new grants, and from our first CFP. This November, the Center will host all of our grantees in behavioral economics for a special summit to improve how the field uses behavioral economics to solve big health care problems. I can’t wait to join them.

This commentary originally appeared on the RWJF Pioneering Ideas blog.