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Behavioral Economics, Dr Paul Terry
1.
Dec 14, 2010 Behavioral
Economics: Review concepts, supporting research, and modifying company policies for the better Presented by: Paul Terry, Ph.D. CEO, StayWell Health Management © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 1
2.
Behavioral Economics
Thaler, R.H., & Sunstein, C.R. (2009). Nudge: improving decisions about health, wealth, and happiness (2nd ed.). New York: Penguin Group. http://www.danpink.com/drive http://danariely.com/ http://www.alfiekohn.org/books/pbr.htm
3.
Overview and General
Concepts Choice Architect Responsibility for organizing the context in which people make decisions Libertarian Paternalism- “Free to Choose” Libertarian Free to make choices and opt out of undesirable arrangements should they want to do so Do not want to burden those to want to exercise their freedom Paternalism Influencing other people’s behavior in order to make their lives longer, healthier, and better Nudge Any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding any options or significantly changing their economic incentives Not mandates (i.e., putting healthier food at eye level rather than banning junk food) © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 3
4.
Overview and General
Concepts- cont. Econs Reject paternalism- claim that human beings do a terrific job of making choices Thinks and makes choices well – Think like Albert Einstein – Store as much memory as IBM’s Big Blue – Exercise the willpower of Mahatma Gandhi Respond primarily to incentives Humans Humans predictably error. Decision making is not great Research shows that people stick with a default option Humans respond to incentives, but also influenced by nudges © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 4
5.
Modifying Company Group Discussion
Policies for the Better
6.
Mock Company Policies: Nudges,
Pushes, or Kicks? The following exercise will allow you to analyze company policies using your new choice architecture perspective. Directions: Everyone will score each policy on a scale of 1 to 10: –A paternalistic nudge will score 1-3 –A well-meaning push will score 4-7 –A mean kick in the butt will score 8-10 Discuss and Share! Once we have scored each policy, we will evaluate each and work together to improve the policies that fall outside of the paternalistic nudge range. Note: The following policies are examples and used for discussion purposes only. © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 6
7.
Tobacco Cessation-Group Discussion Company
provides ongoing and generous resources for all smoking employees who are ready to quit smoking. In addition to providing a smoke free workplace to discourage smokers from smoking and to protect our staff from second hand smoke, we also have established smoke free grounds surrounding our building/campus. (Research shows that more restrictive policies result in higher quit rates and reduced heart disease.) Smokers are asked to smoke in offsite areas. How would you score this policy? A paternalistic nudge will score 1-3 A well-meaning push will score 4-7 A mean kick in the butt will score 8-10 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 7
8.
Smoking Cessation Research-
2009 Smoking is the leading preventable cause of premature death in the United States.
9.
Incentive Research, Smoking
Cessation Study 1: A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation Randomly assigned 878 employees to two groups – Group one received information about smoking- cessation programs – Group two received information about smoking- cessation programs plus financial incentives – $100 for completion of smoking-cessation program – $250 for cessation of smoking after six months – $400 for abstinence for an additional six months – Confirmed by biochemical test (saliva or urine cotinine test) Source: Volpp, K.G., Troxel, A.B., & Pauly, M.V. A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation. New England Journal of Medicine, 2009; 360(7):699-709. © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 9
10.
Results and Findings
Financial incentives can have major impact on smoking-cessation Smoking-cessation rates among employees who were given both information about cessation programs and financial incentives to quit smoking were significantly higher than those that were given program information but no financial incentives Incentive group participants had higher rates of enrollment in a smoking-cessation program – 15.4% vs. 5.4% Incentive group had higher rates of smoking-cessation program completion – 10.8% vs. 2.5% Incentive group had significantly higher rates of smoking cessation than did the information-only group. – 6 months (20.9% vs. 11.8%) – 9 or 12 months (14.7% vs. 5%) – 15 or 18 months (9.4% vs. 3.6%) Source: Volpp, K.G., Troxel, A.B., & Pauly, M.V. A Randomized, Controlled Trial of Financial Incentives for Smoking Cessation. New England Journal of Medicine, 2009; 360(7):699-709. © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 10
11.
Weight Loss Research-
2008 Obesity falls just behind smoking as a preventable cause of premature death.
12.
Exercise-Group Discussion Physical activity
is strongly encouraged for all company employees, regardless of department or pay type. Managers are required to provide their verbal approval of exercise during the work day at staff meetings, or via team email messages. For salaried employees, exercise time is at their own discretion, provided it does not interfere with their work function and/or priority commitments such as meetings and projects, not to exceed 1 hour per day. For hourly employees, the combination of two 15 minute breaks, and the gift of another 15 minutes, allows for a total of 45 minutes of physical activity in the workday without sacrificing paid time. How would you score this policy? A paternalistic nudge will score 1-3 A well-meaning push will score 4-7 A mean kick in the butt will score 8-10 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 12
13.
Incentive Research, Weight
Loss Study 2: Financial Incentive-Based Approaches for Weight Loss, a Randomized Trial 57 healthy participants aged 30-70 years with a BMI of 30-40 were randomized to 3 weight loss plans: – Group one- Monthly weigh-ins – Group two- A lottery incentive program – Group three- Deposit contract that allowed for participant matching, with a weight loss goal of 1 lb per week for 16 weeks. Outcome measurement- Weight loss after 16 weeks Source: Volpp, K.G., John, L.K., & Troxel, A.B. Financial Incentive Based Approaches for Weight Loss: A Randomized Trial. Journal of the American Medical Association, 2008; 300(22):2631-2637 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 13
14.
Results and Findings
The use of economic incentives produced significant weight loss during the 16 weeks of intervention. The longer-term use of incentives should be evaluated Incentive groups lost significantly more weight than the control group Compared with the control group – Lottery group lost an average of 13.1 pounds – Deposit contract lost an average of 14.0 pounds Half those in both incentive groups met the 16-lb target weight loss (47.4%), whereas 10.5% met the goal in the control group Net weight loss at the end of 7 months follow-up was larger in the incentive group (not statistically significant) – Control- 4.4 pounds – Lottery- 9.2 pounds – Deposit Contract- 6.2 pounds Incentive participants weighed significantly less at 7 months whereas the controls did not Source: Volpp, K.G., John, L.K., & Troxel, A.B. Financial Incentive Based Approaches for Weight Loss: A Randomized Trial. Journal of the American Medical Association, 2008; 300(22):2631-2637 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 14
15.
Nutrition-Group Discussion Soda, high
fat, and high sugar products with little to no Nutritional Value (NV), as determined by a panel of dietitians and nutrition experts, offered in the lunch room will be sold at twice the value that it currently retails for. However, food products offering unquestionable NV (e.g. water along with low fat, low sugar, high fiber, and protein) will be sold at a wholesale price. Additionally, high NV foods at company events will be offered for free, while low NV foods will need to be purchased at some value (TBD). How would you score this policy? A paternalistic nudge will score 1-3 A well-meaning push will score 4-7 A mean kick in the butt will score 8-10 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 15
16.
Impact on Population- Best
Practices Level Engagement & Risk Research Reduction
17.
StayWell Best Practices
Research Study Methods Study sample included 22 companies from the StayWell book of business – 767,640 eligible employees, spouses, and retirees 52% of companies were first year clients Rated on 9 best practice components identified by literature and industry experts using standard reports, internal documents and structured interviews with staff Calculated total weighted score and split companies into two groups: standard practice vs. best practice Compared engagement rates, prevalence of best practices and health risk impact Source: Terry PE, Seaverson EL, Grossmeier J, Anderson DR. J Occup Environ Med, 2008;50:633-641 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 17
18.
StayWell Best Practices
Research Best Practice Elements Comprehensive program design Integrated incentives Integrated, comprehensive communication plan Strong senior management support Dedicated onsite staff Multiple program modalities (telephone, mail, online) Population-based awareness building activities Biometric health screenings Vendor integration © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 18
19.
Best Practices Research
Engagement Rates 100% 85% 84% 85% 80% 68% 67% 60% 47% 48% 40% 34% 20% 0% Health Coaching Coaching Coaching Assessment Eligibility Participation Completion Participation Standard Practice Best Practice Source: Terry et al, 2008 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 19
20.
Best Practices Research
Use of Best Practices % Implementing Practice Source: Terry et al, 2008 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 20
21.
Best Practices Research
Population-Level Health Risk Change 3.50 3.46 3.45 Number of Health Risks -2.0% 3.43 3.39 3.40 3.35 -4.7% 3.30 3.25 3.27 1-year 3.20 Baseline Health Assessment Follow-up Health Assessment Standard Practice Best Practice Source: Terry et al, 2008 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 21
22.
Best Practices Research
Intervention-Level Health Risk Change 4.25 4.09 Number of Health Risks 4.00 -6.5% 3.83 3.75 3.63 -7.0% 3.50 3.37 1-year 3.25 Baseline Health Assessment Follow-up Health Assessment Standard Practice Best Practice Source: Terry et al, 2008 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 22
23.
401 K- Group
Discussion All eligible company employees are automatically enrolled in the company 401k program after 6 months of employment. Based on their age, and the risk profile they complete during benefit enrollment, their money is invested in the appropriate portfolio. Each employee must elect the percentage of their salary as part of the benefit enrollment forms; they cannot leave it blank. There is a calculation tool that allows employees to determine how much money they want to elect, and the company recommends that they elect the minimum required to receive the company match. Employees are also encouraged to sign up for a 15 minute appointment with the HR department/manager in order to help determine their contribution amount. How would you score this policy? A paternalistic nudge will score 1-3 A well-meaning push will score 4-7 A mean kick in the butt will score 8-10 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 23
24.
Engagement Research –
2006
25.
Engagement Research
Study 3: Impact of Financial Incentives on Health Assessment (HA) Participation Companies offering incentives for HA participation Examined employee HA participation only Excluded companies requiring spouses to participate in HA or requiring participation in multiple programs (e.g., HA and activity) to get incentive Final sample: 36 StayWell customers Source: Anderson DR, Grossmeier J, Seaverson ELD, Snyder, D. The Role of Financial Incentives in Driving Employee Engagement in Health Management. ACSM’s Health & Fitness Journal, 2008;12(4):18-22. © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 25
26.
Impact of Incentives
on HA Participation 100% 90% 80% HA Participation Rate 70% 60% 50% 40% 30% 20% 10% 0% $0 $100 $200 $300 $400 $500 $600 Estimated Incentive Value Source: Anderson et al, 2008 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 26
27.
Impact of Incentive
Type on HA Participation 100% 80% HA Participation Rate 60% 40% 20% 0% $0 $100 $200 $300 $400 $500 $600 Estimated Incentive Value Non-Financial Cash Benefits-Integrated Source: Anderson et al, 2008 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 27
28.
Engagement Research Study 4:
Impact of Communications & Culture on HA Participation Structured interviews with Account Managers Communications during program year – Delivery modalities – Types of communications – Perception of quality Worksite culture – Factors related to cultural support for employee health – Perception of cultural support © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 28
29.
Culture Score Definition Management
Support Executive & mid-level management support Infrastructural Support Demonstrated efforts around health policy, promotion of nutrition and/or physical activity, flexible schedule for wellness activities, company mission statement Wellness Team Member of management actively participates in team Integrated Program Data exchanged between vendors or warm-transfer of participants to additional services Onsite Staff Dedicated onsite staff, including all vendors © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 29
30.
HA Participation by
Communication & Culture 100% Weaker Strong 80% 69% HA Participation Rate 65% 60% 53% 51% 51% 44% 41% 41% 40% 37% 33% 33% 27% 20% 0% Comm. Culture Comm. Culture Comm. Culture Non-Cash Cash Benefits-Integrated Incentives Incentives Incentives (n=4) (n=16) (n=16) Source: Seaverson ELD, Grossmeier J, Miller, TM, Anderson DR. The role of incentive design, communication strategy and worksite culture on health assessment participation (in press). © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 30
31.
Conclusions Financial incentives
can have major impact on HA participation Healthy culture and effective communications are essential to realize potential value of incentives Integration of incentives into health plan design most effective Need more research on independent and combined impact of these and other best practices on program engagement and outcomes © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 31
32.
Volunteerism Policy- Group
Discussion Employees are expected to volunteer one week per year. Supervisors are evaluated on the level of volunteerism in their departments and are rated per their efforts in corporate citizenship. Supervisors will remind staff if they are short on their expected number of volunteer service hours. How would you score this policy? A paternalistic nudge will score 1-3 A well-meaning push will score 4-7 A mean kick in the butt will score 8-10 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 32
33.
Green Policies- Group
Discussion All company employees will receive a reusable dining set containing a plate, silverware, and water bottle for use at work. Interested employees can receive and sign an environmental contract/covenant stating: They agree to use these materials the majority of the time for their everyday work eating needs (not including company events) Will recycle appropriately And agree to rethink the need of single use products around the office The individuals that sign the covenant can then earn a credit from company to make a $20 donation at the end of the year to an environmental/nature group of their choice (default choice- TBD) How would you score this policy? A paternalistic nudge will score 1-3 A well-meaning push will score 4-7 A mean kick in the butt will score 8-10 © 2010. StayWell, NextSteps and StayWell Online are registered trademarks of The StayWell Company, LLC. All rights reserved. 33
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