August 2017 Regional Learning Session Slides

Page 1

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


Turn static files into dynamic content formats.

Create a flipbook
Issuu converts static files into: digital portfolios, online yearbooks, online catalogs, digital photo albums and more. Sign up and create your flipbook.