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Health Policy and the Affordable Care Act

Ezekiel Emanuel, MD, PhD

This course will explore the many problems of the American health care system and discuss the specific ways that the Affordable Care Act will impact access, quality, costs, as well as medical innovation.

The Center for Health Incentives and Behavioral Economics

The Center for Health Incentives and Behavioral Economics (CHIBE) provides an academic home for behavioral economic research that makes significant contributions to reducing the disease burden from major U.S. public health problems, such as tobacco dependence, obesity, and medication non-adherence.  

Founded in 2008 by University of Pennsylvania faculty in collaboration with faculty from the Center for Behavioral Decision Research at Carnegie Mellon University, the Center for Health Incentives and Behavioral Economics, or CHIBE, was one of the first dedicated to the implementation of behavioral economic research in health. We are one of two NIH-funded Centers in Behavioral Economics and Health in the United States.

Kevin Volpp, MD, PhD, is Director of CHIBE

 

Testing Behavioral Economic Interventions to Improve Statin Use and Reduce CVD Risk                 

Principal Investigators: Kevin Volpp, Iwan Barankay, Peter Reese

The application of conceptual approaches from behavioral economics offers considerable promise in advancing health and health care. In patients with suboptimal cholesterol control who are at high risk for CVD, this study will test the effectiveness and cost-effectiveness of different behavioral economic techniques to improve statin adherence following discontinuation of the intervention. Investigative team leaders Iwan Barankay, Kevin Volpp and Peter Reese will use a 4-arm randomized controlled trial to compare the effectiveness and cost effectiveness of alternative approaches to inducing habit formation among CVD patients with poorly controlled cholesterol who have been prescribed statins.

Funded by: NIH/National Institute on Aging

A Randomized Trial of Financial Incentives for Maintenance of Weight Loss

Principal Investigators: Kevin Volpp, Will Yancy

Identifying effective strategies for treating obesity is both a clinical challenge and a public health priority. While a variety of approaches are successful in achieving initial weight loss, techniques for maintenance of initial weight loss have largely been unsuccessful. This randomized controlled trial will compare the relative effectiveness and cost-effectiveness of lottery-based incentives, traditional direct payments, and daily feedback without incentives among patients who successfully lost at least 5 kg over 6 months during participation in Weight Watchers (Pre Phase). Incentives will be provided to some study participants for the following 6 months (Phase I), and subjects will be followed for 6 more months to examine effects following cessation of incentives (Phase II).

Funder: National Institute on Aging

Process Versus Outcomes Incentives for Lipid Management

Principal Investigators: Peter Reese, Kevin Volpp

Financial incentives have been shown to be effective at improving patient health behaviors including medication adherence in a wide variety of contexts. The delivery of such incentives has been enhanced by the recent development of new wireless technologies that facilitate the measurement of daily medication adherence and the provision of incentives in an automated fashion. However, the relative effectiveness of incentives based on process (e.g. statin adherence) versus outcome (e.g. improvements in LDL cholesterol) is unknown.This is a randomized controlled trial to evaluate the relative effectiveness and cost-effectiveness of improving cholesterol levels among participants who are at high risk of CVD and who have elevated LDL cholesterol levels by testing process versus outcomes financial incentives.

Funder: National Heart, Lung and Blood Institute
 

CDC Prevention Research Center

Directors: Karen Glanz, PhD, MPH; Kevin Volpp, MD, PhD
A five-year, $4,350,000 grant from the Centers for Disease Control and Prevention has established a Prevention Research Center (PRC) at the University of Pennsylvania. The PRC, one of 26 in the nation, will conduct innovative public health and disease management research aimed at preventing chronic disease and reducing health disparities in Southeastern Pennsylvania. This will be the first PRC in Philadelphia.
Among other initiatives, the PRC will conduct a workplace weight loss study to evaluate environmental change strategies and incentives for decreasing obesity and preventing cardiovascular disease in employees of the City of Philadelphia, Independence Blue Cross, and the Southeastern Pennsylvania Transportation Authority (SEPTA).
Funded by: Centers for Disease Control and Prevention

Evaluating Methods to Use Health Benefits Design to Encourage Employee Weight Loss

Principal Investigators: Kevin Volpp, Mitesh Patel
Employers are increasing looking for opportunities to encourage weight loss among employees. While studies have shown that financial incentives can effectively encourage weight loss, little is known about their use in health benefits design. The goal of this study is to determine whether a financial incentive program for obese University of Pennsylvania Health System employees can effectively encourage weight loss when compared to changes in health benefit design.
Funder: University of Pennsylvania Health System

A Rapid Cycle Approach to Improving Medication Adherence through Incentives and Remote Monitoring for Coronary Artery Disease Patients

Principal Investigators: Kevin Volpp, David Asch
The goal of this project is to improve medication adherence and health outcomes in post-discharge patients who are recovering from acute myocardial infarctions.  Such patients typically have high rates of poor medication adherence and hospital readmissions and are costly to monitor through intensive case management.  The intervention will increase medication adherence through use of wireless pill bottles, financial incentives, and social incentives. We are conducting this study in 38 states with 5 major insurer partners. The anticipated result will be improved health outcomes and lower cost.
Funder: Center for Medicare and Medicaid Innovation