Behavioral Economics in the ‘Last Mile of Healthcare’ with Karen Horgan


Creating a New Healthcare – Episode #60 – Behavioral Economics in the ‘Last Mile of Healthcare’ with Karen Horgan

The topic we’re going to cover in this podcast episode may be one of the most disruptive changes in hospital care to come along in over a century.  It’s the movement of ‘hospital at home’ – literally shifting hospital-based care to people’s homes. It might sound a bit futuristic, but it’s already an established practice in other countries; and it’s rapidly gaining traction here in the US.

Our guest today is a leading medical director and researcher in this area.  David Levine, MD MPH MA, is a practicing general internist and clinician-investigator at Brigham Health and Harvard Medical School.  His research is focused on digital health technology, measuring the quality & experience of outpatient care, and optimizing healthcare at home.  As assistant medical director of “alternative care pathways” for the Brigham and Women’s Physician Organization, Dr. Levine works to bring acute, hospital-level care to patients’ homes as a substitute to traditional hospitalization.

Episode Recap

Dear Friends & Colleagues,

The phrase, “Last Mile of Healthcare,” is used to describe a number of situations in healthcare.  First, it’s been used to describe the value-laden interface between a provider and a patient.  Second, it describes patients in the context of their life – as individuals making healthful as well as unhealthful decisions.  It is in these so-called ‘last mile of healthcare’ moments that the issue of behavior is paramount – provider behavior and patient behavior.  The metaphor has significant ramifications in population health as well as in public health.  For example, chronic disease management, which now accounts for the majority of healthcare encounters, as well as costs, is all about behavior change.  It’s not so much the advice or treatment as much as the follow-up that really makes the difference.  Despite all of our advances, sustained behavior change remains a holy grail of healthcare delivery.

This week’s guest has made it her career ambition to tackle this issue head on.  She and her colleagues are consumed by the issue of engagement and behavior change.  Their tool box is called ‘behavioral economics’.  Karen Horgan is the CEO and a co-founder at VAL Health, which she started with her colleagues Kevin Volpp MD and David Asch.  I’ve been a long-time fan of Dr. Volpp’s work and had the wonderful opportunity to interview him on this podcast a while back .

Behavioral Economics provides an evidence-based array of methods to create healthful behavior change. There have been a plethora of recent studies demonstrating how Behavioral Economics can greatly advance how we communicate and engage with patients, as well as with providers.  As Karen points out in this interview, these market-tested techniques are used in many other industries, as well as in public health campaigns.

In this interview Karen will share:

  • The basic underlying principles of Behavioral Economics.
  • Illustrations of the most powerful Behavioral Economics techniques used to influence healthy patient behaviors as well as value-based provider behaviors.
  • A number of impressive examples of how Karen and her colleagues at VAL Health are deploying Behavioral Economic initiatives with provider and payer clients.
  • Why Behavioral Economics isn’t more well known in healthcare; where she’s seeing greater adoption; and how long she believes it’ll take for general adoption to hit that exponential inflection point.

Up until now, in our Fee-For-Service dominated market, patient behavior and follow-up has not really mattered.  For the most part, healthcare systems, provider groups and individual clinicians do not get paid, bonused or dis-incented based on outcomes.  But, as the market shifts to value-based payment, both provider behavior – in terms of appropriate utilization and quality care – as well as patient behavior, will actually make a huge impact on revenue.

From my perspective, it’s exciting and encouraging.  Here we have a scientifically proven approach to influence positive behavior, an approach that does not manipulate behavior or force compliance, but instead makes it easier for people to do the right things to enhance health outcomes.  The vision that Karen Horgan paints is a world in which the way we communicate and engage with patients will include Behavioral Economic techniques as a matter of course. It will just be the way we deliver healthcare. I, for one, would like to see us nudge this along a bit faster.  But in the meantime, I’ll be closely following the work that these folks are doing to further validate and advance one of the toughest nuts to crack in healthcare – our own behavior!

Until next time, be well!

Zeev Neuwirth, MD

About the Creating a New Healthcare Podcast

The Creating a New Healthcare Podcast is produced and hosted by Dr. Zeev Neuwirth. The podcast is for healthcare professionals who are passionate about comprehending and advancing the patient-centered, consumer-oriented, value-based transformation of healthcare. In these interviews, listeners hear from highly accomplished leaders with fresh perspectives, new ideas and bold solutions – courageous individuals who are successfully creating a new healthcare! New episodes are available bi-weekly and can now be listened to right here on DocWire News.

DR. Zeev Neuwirth is a physician executive and a nationally recognized thought leader in healthcare consumerism, patient-centered care redesign and value-based population health. He speaks regularly at national conferences and at board retreats with hospital systems, healthcare industry consortium, and national medical societies. He is an industry adviser to successful healthcare startups as well as nationally recognized healthcare brands. He is also the producer and host of a healthcare podcast, Creating a New Healthcare.