Practice and Behavioral Economics

In this recently awarded R61/R33 project, funded by the National Institute on Aging (NIA) and BE IMMUNE, we will pilot nudge interventions among older adults – including racial/ethnic minorities, low SES individuals, and other high-risk groups identified using novel analytic methods – and tailor nudges to overcome screening barriers facing these patient groups.

The REDUCE Trial is a Randomized Trial of Behavioral Economic Approaches to Reduce Unnecessary Opioid Prescribing. It is large-scale, pragmatic trial of approximately 50 emergency departments and urgent care centers at the Sutter Health System in Northern California. The goal of this quality improvement initiative is to optimize clinician opioid prescribing behaviors. The program uses two behavioral economic interventions: monthly individual audit feedback and/or monthly peer comparison feedback sent to clinicians with data on their opioid prescribing patterns. A cluster randomized, factorial design will be used to evaluate the effect of the intervention and qualitative surveys and interviews will provide context to understand the factors associated with performance.

Hawaii Medical Service Association (HMSA), an independent licensee of the Blue Cross Blue Shield Association, partnered with the Payment Insights Team (and subsequently the Parity Center) from 2017 through 2026 to apply behavioral economics to payment reform and clinical practice. Early in the partnership, the team conducted a cluster-randomized controlled trial examining whether peer-comparison feedback could improve quality among primary care providers transitioning from fee-for-service reimbursement to population-based payment, with findings published in Health Affairs in 2020. The study demonstrated the potential for scalable behavioral interventions to support changes in clinician practice.

Later work examined how clinicians and health care organization may respond to payment incentives, performance feedback, and gaps in diabetes care. The team also developed behavioral and implementation-focused approaches to inform strategies addressing clinical monitoring, care-management participation, medication initiation and adherence, and variation in treatment across patient populations. This portfolio combined pragmatic experimentation frameworks, claims-based evaluation, and qualitative and quantitative analyses to identify actionable opportunities for improving care delivery.

Over nearly a decade, the partnership produced an extensive body of applied research spanning payment reform, behavioral economics, diabetes care, medication use, and population-health management.

In this project, we’re using historical data and behavioral economics principles, and designing an incentive and benefit program that encourages healthcare providers to refer their patients to lower-cost labs/imaging centers/specialists, or performing some medical procedures at lower-cost facilities; thus, to reduce the healthcare spending of patients as well as the health systems without hurting quality-of-care.