Is It Fair to Reward Medicaid Patients for Receiving Flu Shots?


My son was underperforming at school, and I was gently encouraging him to try harder (if gesticulating like an over caffeinated Italian qualifies as gentle encouragement). He could not understand why I was upset: “Dad, most of my friends are doing drugs and engaging in unprotected sex. You should be rewarding me for being such a good kid.”
“Reward you for not being bad?!?,” I replied incredulously. That made no sense to me. “When you go above and beyond – when you exert exceptional effort to achieve important goals – then we can talk about what reward you have earned.”
The folks running South Carolina’s Medicaid program don’t appear to agree with my parenting philosophy. A couple years ago, they contracted with a private insurer, the Centene Corporation, to manage its Medicaid population. Part of the company’s approach involved rewarding Medicaid enrollees for receiving recommended preventive care.
This rewards program flips medical payment on its head. Normally, when people go to the family medicine doctor for an annual checkup, they are charged a modest copay for the visit. But through its CentAccount program, the folks at Centene pay patients for receiving such care. You got that right – they aren’t charged for the visit; they are rewarded for it!
When a Medicaid enrollee brings her infant in for a Well Child visit, she receives $10. If she makes all six visits for the year, she will get $25 in that final appointment, adding up to a $75 reward from taxpayers for bringing her child to appointments that the rest of us brought our kids to at our own expense.
In fact, here’s a list of some of the healthcare services CentAccount rewards its customers for receiving:

  • Annual Adult Well Care Visit
  • Well Child Visit
  • Infant Well Child Visits
  • Childhood Immunizations
  • Health Risk Screening
  • Annual Cervical Cancer
  • Annual Breast Cancer Screening
  • Annual Diabetes Screening – HbA1c Tests, Eye Exams, Kidney Screening, and LDL-cholesterol Screening
  • Flu Shot
  • Prenatal Visits
  • Postpartum Visit

At first glance, it might seem obvious that such rewards are unfair. For the same reason it seems wrong to reward my teenager for not doing drugs, why should we reward a parent for vaccinating a child – for doing what any good parent ought to do?
On the other hand, it is also not fair that many Medicaid enrollees are poor enough to qualify for the program despite working full time. It is also not fair that many lose out on their hourly earnings when they take time from work to bring their children to pediatricians.
(To read the rest of this article, please visit Forbes.)

Do You Overeat? Blame Childhood Stress



Lots of us eat when we are stressed. But did you know that even when we are not currently under stress, the amount of food we eat might be influenced by the stress we experienced as children? That’s the conclusion Sarah Hill, a psychologist at TCU, wants us to draw from several studies she ran with colleagues from the Universities of Arizona and Minnesota. In the research, Hill brought college students into her lab and left them in front of snack food while they were taking a break between two parts of a research study. She then looked at how much food people ate during this break, as a function of whether they experienced significant financial stress as a child – e.g. whether they reported “having enough money for things growing up.” Hill also asked people how long it had been since they ate and whether they were hungry. She found that among people with more privileged backgrounds, the amount of food they ate depended largely on how hungry they were. On the other hand, for those from less lofty socioeconomic backgrounds, they ate the same amount of food regardless of their hunger, a.k.a. their “energy needs:”
Do You Overeat Blame Childhood Stress 1
In an even more convincing part of her research, she brought people to the lab after all of them had fasted.
To read the rest of this article, please visit Forbes.

How to Stop Over-Eating — Lessons from Brain Science


Put our brains into the modern food environment, and you have a recipe for disaster. Our brains are hardwired to crave calorie-dense foods, this craving no doubt arising from our evolutionary time spent on the Tundra where calories were often scarce. But our modern food environment surrounds us with calorie-dense foods, forcing us to deplete limited willpower trying to keep our cravings from turning into over-consumption. Fortunately, brain science hints at several ways to reduce this pattern of craving and consumption.
Let’s start with a part of the brain called the left dorsal lateral prefrontal cortex, a region important for helping restrain ourselves from engaging in unwanted behaviors. Do something to disable the dlPFC (as the cool kids call it), and you will lose self-control or willpower. For example, psychologists often measure self-control using something called the Stroop effect, in which people are asked to quickly state, say, the color of a series of fonts. This seems like it should be pretty simple.
How to Stop Overeating 1
In the Stroop task, however, every once in a while people get something like the following:
How to Stop Overeating 2
When people see this word they are supposed to say “red” because the word is in a red font. But many people blurt out “green” instead, unable to inhibit the impulse. As it turns out, when researchers use a clinical stimulator to zap the dlPFC, people’s performance on the Stroop task declines. Here, in case you are interested, is a picture of one of these stimulators – don’t let a stranger persuade you to place one on your head!
To read the rest of this article, please visit Forbes.

What Behavioral Economics Get Wrong About Improving Healthcare


It is notoriously difficult to change physician behavior. When it’s discovered that primary care physicians are, say, prescribing too few cholesterol pills or too many antibiotics, it will not be easy to change those behaviors. Physicians are strong-willed people, with lots of things competing for their attention and with many well ingrained habits.
That’s why I should be excited about several recent studies establishing successful ways of changing physician behavior. One trial, which I wrote about earlier, showed that physicians were less likely to inappropriately prescribe antibiotics after receiving feedback on how their prescribing habits compared to their peers. Another trial, published in the New England Journal of Medicine showed that an intervention combining professional education, informatics and financial incentives reduced how often physicians inappropriately prescribed high-risk medications like pain pills that can cause GI ulcers. Here is a picture of those results, showing a reduction in high-risk prescriptions after the intervention, a reduction that lasted even after the intervention was no longer being implemented:
What Behavioral Economic Interventions Get Wrong About Improving Healthcare 1
And a third study published in JAMA showed that financial incentives informed by insights from behavioral economics increased the likelihood of getting patients’ cholesterol under control.
To read the rest of this article, please visit Forbes.

Peer Comparison Can Reduce Antibiotic Prescribing

Very interesting article in the Lancet recently, from the nudge unit in the United Kingdom. They give physicians feedback on how much they prescribed antibiotics compared to their peers, and found that such feedback reduced antibiotic prescriptions.
Peer Comparison Can Reduce Antibiotic Prescribing
I hope to see more of this work!
 
 

Financial Disparities and Abdominal Girth  

I recognize that correlation does not prove causation. But here is a picture illustrating the correlation between income inequality and the percent of a country’s population that is obese. The findings are provocative, to say the least.

https://t.co/fuCYbxoxqH
https://t.co/fuCYbxoxqH

Making the relationship somewhat plausible is all the evidence we have now of the toll that income inequality takes upon people’s lives. It is one thing to be poor. It is something much worse to be poor when surrounded by wealth. Income inequality increases stress. It is plausible that this stress contributes to behaviors that lead to obesity, and to physiologic changes that predispose people to gaining weight.
Thanks to Pierre Chandon for tweeting this image out.
 
 
 

Coolest Nudge Ever!

I love behavioral science. I love public policy. And I am obsessed with music. So you can see why I think the nudge pictured below may be the coolest thing on the planet! It encourages drivers to drive at an appropriate speed, so they can hear music created by their passage over the road:
Coolest Nudge Ever Musical Road Japan
I have no idea if this works. And of course I’m not sure I’d hear the road over the typical blare of my stereo when I drive. But who cares? This is absolutely brilliant.

PeterUbel