Six Useful Ideas (Maybe!) On Health Decision Making. Mikes Plenary Presentation At Healthcare Unbound 2011

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  • 1. Six Useful Ideas (Maybe!) on Health Decision-MakingHealthcare Unbound 2011July 11, 2011 Michael J. Barrett Managing Partner Critical Mass Consulting www.CriticalMassConsulting.com © Critical Mass Consulting 2011
  • 2. Your basic shameless grab for credit11/1/2011 © Critical Mass Consulting 2011 2
  • 3. Six ideas11/1/2011 © Critical Mass Consulting 2011 3
  • 4. Six useful ideas11/1/2011 © Critical Mass Consulting 2011 4
  • 5. Six useful ideas (maybe – let’s keep watching)• From the social, behavioral and economic (SBE) sciences …• … useful in health technology strategy and design.11/1/2011 © Critical Mass Consulting 2011 5
  • 6. Six useful ideasBehavior• Decision-making 1. Choice architectures and nudges 2. Negative incentives 3. Ubiquitous computing and passive selves 4-6. Social networks and decision-making 4. How networks operate (i): loose vs. tight 5. How networks operate (ii) peer support / peer pressure 6. How networks operate (iii): norms11/1/2011 © Critical Mass Consulting 2011 6
  • 7. Behind the matter of usefulness, a question looms in the background As good outcomes begin to determine provider incomes, as cost containment pressures intensify for all of us, and as technology enables us to assign accountability, what do we ask of the patient/consumer?11/1/2011 © Critical Mass Consulting 2011 7
  • 8. Looming in the background … “What’s the future of patient responsibility?11/1/2011 © Critical Mass Consulting 2011 8
  • 9. Two ideas that didn’t make the cut• Do Malcolm Gladwell-style connectors route our communications with one another?  Contra: See Duncan Watts, Everything is Obvious, Once You Know the Answer (2011)• Do Facebook-style social networks affect our views of choices and preferences?  Contra: See Nicholas Christakis and James Fowler, Connected: The Surprising Power of our Social Networks and How They Shape Our Lives (2009)11/1/2011 © Critical Mass Consulting 2011 9
  • 10. Possibly useful idea #1: ID choice architecture, insert nudge11/1/2011 © Critical Mass Consulting 2011 10
  • 11. Choice architecture• “A choice architect has the responsibility for organizing the context in which people make decisions.” 1. “If you are a doctor and must describe the alternative treatments available to a patient, you are a choice architect. “ 2. “If you design the form new employees fill out to enroll in the company health care plan, you are a choice architect.”• “ … seeming small features of social situations can have massive effects on people’s behavior…”• “It is legitimate for choice architects to try to influence people’s behavior in order to make their lives longer, healthier and better.”• “There is no such thing as neutral design.” Source: Richard Thaler and Cass Sunstein, Nudge 11/1/2011 (updated paperback edition, 2009) at 3 and 5. 11
  • 12. “There is no such thing as neutral design”11/1/2011 © Critical Mass Consulting 2011 12
  • 13. Nudges “… any aspect of the choice architecture that alters people’s behavior in a predictable way without forbidding any options or significant changing their economic incentives.” Source: Richard Thaler and Cass Sunstein, Nudge (Updated Penguin paperback edition, 2009) at 6.11/1/2011 © Critical Mass Consulting 2011 13
  • 14. Nudges in the break room• Experiment: In the break room at Manhattan Mortgage Company, Good Morning America elevates the fruit plate closer to eye level• Result: Fruit gets eaten in less than a third of the time it normally takes.• Experiment: GMA moves donuts away from the center, off to the side.• Result: Donut consumption drops by 10%. Source: http://abcnews.go.com/GMA/story?id=7127723&page=111/1/2011 14
  • 15. Anxiety about neo-nudges in the 1950s11/1/2011 © Critical Mass Consulting 2011 15
  • 16. Anxiety about neo-nudges in the 2000s11/1/2011 © Critical Mass Consulting 2011 16
  • 17. Anxiety about neo-nudges intensifies © Critical Mass Consulting 2011 17
  • 18. Anxiety about real nudges fuels politics11/1/2011 © Critical Mass Consulting 2011 18
  • 19. Possibly useful idea #2: Let’s have a big hand for penalties?11/1/2011 © Critical Mass Consulting 2011 19
  • 20. At first it’s all about rewards11/1/2011 © Critical Mass Consulting 2011 20
  • 21. But feelings about personal responsibility are complicated …Who gets hurt when I over-eat? Good question. We’re not sure.• “the causes are too complex”• vs. “no one can save you if you don’t save yourself”• “obesity is a disease”• vs. “so get a grip on the disease”• “I’m only hurting myself”• vs. “well, actually, you’re costing us, too”11/1/2011 © Critical Mass Consulting 2011 21
  • 22. … and frustrated doctors are talking about negative incentives …11/1/2011 © Critical Mass Consulting 2011 22
  • 23. Possibly useful idea #3: Post-mobile, it’s all about ubiquitous … As computing becomes more ubiquitous, doesn’t the quantified self become more passive?11/1/2011 © Critical Mass Consulting 2011 23
  • 24. If it can stick, it’ll sense June 7, 2011: “Proteus’ personal monitoring technology [measures] heart rate, physical activity and sleep patterns. “ “Avery Dennison Medical Solutions is providing adhesive and material technologies and developing the manufacturing platform to mass produce the wearable sensors for the companies’ respective customers.”11/1/2011 © Critical Mass Consulting 2011 Source: Joint press release, June 7, 2011
  • 25. As computing becomes ubiquitous,won’t the quantified self become passive?11/1/2011 © Critical Mass Consulting 2011 25
  • 26. Possibly useful idea #4: Networks -- (i) sort out loose from tight11/1/2011 © Critical Mass Consulting 2011 26
  • 27. Possibly useful idea #4: Networks -- (i) sort out loose from tight11/1/2011 © Critical Mass Consulting 2011 27
  • 28. Possibly useful idea #5: Networks –(ii) in tight networks, harness peer effects11/1/2011 © Critical Mass Consulting 2011 28
  • 29. … and master the tipping pointsNew research:• Initiation: At the onset of a new interest or “market,” researchers find that variety-seeking prevails• Contagion: When a specific approach draws the support of 30% of the group, adoption takes off• Saturation: But when group adoption hits 80%-90%, individualism re-surfaces; the adoption curve flattens out• Takeaway: When something new gathers steam, people join in (at least until the new practice builds to stifling conformity) Source: Pascale Quester and Alexandre Steyer, “Revisiting Individual Choices in Group Settings: The Long and Winding (Less Traveled) Road?” Journal of Consumer Research, Vol. 36, No. 6 (April 2010)11/1/2011 29
  • 30. Obesity’s on the rise? So I’m not an outlier if I’m over-weight!11/1/2011 © Critical Mass Consulting 2011 30
  • 31. Harnessing peer effects: If the norm seems legit and I am an outlier …11/1/2011 © Critical Mass Consulting 2011 31
  • 32. Possibly useful idea #6: Networks -- (iii) segue from peer effects to norms11/1/2011 © Critical Mass Consulting 2011 32
  • 33. Mechanisms of transmission• When peer pressure operates, people externalize others’ behavior …• But when norms take hold, people internalize others’ values and beliefs.Behavioral economists performed the experiments: 1. Priming: Exposing people to small but well-timed cues can change behavior 2. Conformity effects: People look to others for such cues 3. Anchoring and adjustment (inertia): Once people have a point of reference, they don’t depart from it very muchNeuroscientists find preliminary indications of “hard wiring” for norms 1. Mirror neuron system: Watching lights up the same part of the brain as doing 2. Agreement alone lights up the ventral striatum, strongly associated with emotional and motivational aspects of behavior. Source: See, e.g., Campbell-Meiklejohn et al, “How the Opinion of Others Affects Our Valuation of Objects,” Current Biology 20, 1-6, July 13, 2010.
  • 34. Mechanisms of alteration? How do you change a norm? And how do you change it back?11/1/2011 © Critical Mass Consulting 2011 34
  • 35. Behind the issue of usefulness, a question looms in the background As good outcomes begin to determine provider incomes, as cost containment pressures intensify for all of us, and as technology enables us to assign accountability, what do we ask of the patient/consumer?11/1/2011 © Critical Mass Consulting 2011 35
  • 36. My standard disclaimer “I have opinions of my own, strong opinions, but I don’t always agree with them.”11/1/2011 © Critical Mass Consulting 2011 36
  • 37. Thank you! Michael J. Barrett Critical Mass Consulting 781-674-0097 mbarrett@criticalmassconsulting.com visit criticalmassconsulting.com11/1/2011 © Critical Mass Consulting 2011 37
  • 38. … targetting “outlaws” and free riders11/1/2011 © Critical Mass Consulting 2011 38