Regional Learning Session August 25th
Thank you to our funders! Lead Supporter
Major Supporters
AHC Enterprises, LLC
Supporters
Additional Supporters • 100% of our Board of Directors & Staff • Individual & Corporate Donations
Today’s Agenda • Welcome • HCGC Update • The Basic Principles of Behavioral Economics
• Behavioral Economics and Health Care • Panel Discussion
HCGC Updates • Welcome to Caroline Carter and David Brackett! • CPC+ Practice Facilitation/Coaching • Patient Family Advisory Councils and Special Projects
Healthcare Collaborative of Greater Columbus Regional Learning Session August 25, 2017 Douglas E. Hough, Ph.D.
Mainstream
All participants are rational All participants know their preferences All participants have full information Preferences are pathindependent Deviations from rational choice are random
Behavioral Economics Participants are not always rational Participants learn their preferences through experience Asymmetric information abounds Preferences are pathdependent Deviations from rational choice can be systematic
A Caveat “Think how hard physics would be if particles could think.” - Murray Gell-Mann (Nobel Laureate, Physics, 1969)
Loss Aversion Endowment Effect Framing Power of the Default/Opt-In vs. Opt-Out Hyperbolic Discounting System 1 vs. System 2 thinking
Class
Initial
1
% w/mug
or
2
3
End
or
or JL Knetsch, The endowment effect and evidence of nonreversible indifference curves. Amer Econ Rev. 79:5 (1989): 1277-84.
Class
Initial
1
% w/mug
or
2
3
End
or
or
56%
JL Knetsch, The endowment effect and evidence of nonreversible indifference curves. Amer Econ Rev. 79:5 (1989): 1277-84.
Class
Initial
1
or
2
3
End
% w/mug 89%
or
or
56%
JL Knetsch, The endowment effect and evidence of nonreversible indifference curves. Amer Econ Rev. 79:5 (1989): 1277-84.
Class
Initial
1
or
2
3
End
or
or
% w/mug 89%
10%
56%
JL Knetsch, The endowment effect and evidence of nonreversible indifference curves. Amer Econ Rev. 79:5 (1989): 1277-84.
Presentation 1 • Surgery: “Of 100 people having surgery 90 live through the post-operative period, 68 are alive at the end of the 1st year and 34 are alive at the end of 5 years” • Radiation therapy: “Of 100 people having radiation therapy all live through the therapy period, 77 are alive at the end of the 1st year and 22 are alive at the end of 5 years”
Presentation 2 • Surgery: “Of 100 people having surgery 10 die during surgery or the post-operative period, 32 die by the end of the 1st year and 66 die by the end of 5 years” • Radiation therapy: “Of 100 people having radiation therapy none die during the therapy period, 23 die by the end of the 1st year and 78 die by the end of 5 years”
McNeil, B., Pauker, S., Sox, H., & Tversky, A. (1982). On the elicitation of preferences for alternative therapies. NEJM, 306(21), 1259-1262.
18% favored radiation therapy Presentation 1 (survival frame) • Surgery: “Of 100 people having surgery 90 live through the post-operative period, 68 are alive at the end of the 1st year and 34 are alive at the end of 5 years” • Radiation therapy: “Of 100 people having radiation therapy all live through the therapy period, 77 are alive at the end of the 1st year and 22 are alive at the end of 5 years”
44% favored radiation therapy Presentation 2 (mortality frame) • Surgery: “Of 100 people having surgery 10 die during surgery or the post-operative period, 32 die by the end of the 1st year and 66 die by the end of 5 years” • Radiation therapy: “Of 100 people having radiation therapy none die during the therapy period, 23 die by the end of the 1st year and 78 die by the end of 5 years”
Effective consent %
100 80 60
40 20 0
Johnson, E. J., & Goldstein, D. (2003). Do defaults save lives? Science, 302(5649), 1338-1339.
Effective consent %
100 80 60
40 20 0
Johnson, E. J., & Goldstein, D. (2003). Do defaults save lives? Science, 302(5649), 1338-1339.
Effective consent %
100 80 60
40 20 0
Johnson, E. J., & Goldstein, D. (2003). Do defaults save lives? Science, 302(5649), 1338-1339.
Effective consent %
100 80 60
40 20 0
Johnson, E. J., & Goldstein, D. (2003). Do defaults save lives? Science, 302(5649), 1338-1339.
System 1 System 2 • Automatic • Controlled • Effortless • Effortful • Rapid, parallel • Slow, serial • Process opaque • Self-aware • Skilled action • Rule application • Requires little energy • Uses lots of energy Kahneman, D. (2011) Thinking, Fast and Slow. New York, Farrar, Straus and Giroux
Heuristics and biases
The variety of cognitive biases Action bias
Confirmation bias
Endowment effect
Outcome bias Optimism bias Hindsight bias Impact bias
Overconfidence bias
Attribution bias Survivorship bias
SO WHAT????
http://www.choosingwisely.org/doctor-patient-lists/
USPSTF 2009 Recommendations on Screening Mammography
Education/persuasion Guidelines/checklists Penalties/rewards Commitment devices Defaults Mandates Coercion/compulsion
Saghai, Y. Salvaging the concept of nudge. (2013). J Medical Ethics (39): 487-493.
Behavioral economics is not a magic bullet
Behavioral economics is a systematic way of understanding & influencing behavior
Panel Discussion •
Erika Clark Jones, Executive Director, Celebrate One
•
Jimmie Davis, MPH, Deputy Health Commissioner, Pickaway County General Health District
•
Erica Drewry, MSW, Director of Strategic Initiatives, Central Ohio Area Agency on Aging
•
Anita Patel, Director of Care Management, Molina Healthcare of Ohio
•
Carly Skillington, MSW, LSW, Population Health Social Worker, Mount Carmel Health System