Bob Nease, PhD — Chief Scientist; Express Scripts — is a leader in the convergence of behavioral economics and healthcare; at Express Scripts, he is responsible for advancing the understanding of consumer behavior. To this end, he closely follows emerging science around human behavior and decision making, then works to develop tools and communications that help plan sponsors enable better health and value.
Today’s Wall Street Journal reports on an Express Scripts study of GlowCaps, an integrated system for monitoring and improving medication adherence. Why are we excited about this study? A few important reasons:
Non-adherence to medications is a major problem. Conservative estimates peg the annual cost of non-adherence at over $100B… and that doesn’t include the pain and suffering that can result from failing to take medications as prescribed.
There’s no silver bullet solution. Darn! The causes of non-adherence are many, and no one intervention will solve the problem.
We’re often looking in the rear-view mirror. It takes months of prescription claims data to get a reliable measure of adherence. This means PBMs are constantly looking at an issue that took place months ago, and can’t intervene until after a bad habit has formed.
It’s hard to know what the problem is at the patient level. Claims data aren’t up to the task here, either; they just don’t have the resolution to tell us whether someone is having a problem with side effects, forgetfulness or procrastination on refills.
Approaches like the GlowCap system offer intriguing new ways to address each of these challenges. GlowCaps enables access to near real-time pill-taking behavior with extremely detailed resolution. We will, for example, be able to understand which patients do well taking their medications Monday through Friday, but struggle on the weekends. GlowCaps also offers a great platform for testing applied behavioral science approaches such as precommitment; patients will be able to sign up for phone reminders should they not take their medications on time, as well as adherence reports that can be shared with their physicians.
We’ll keep you posted as we learn more about innovative methods to gain better insights into the problem of therapy adherence… insights that we believe will lead to powerful solutions to drive to better health and value in the pharmacy benefit.
Bob Nease, PhD — Chief Scientist; Express Scripts — is a leader in the convergence of behavioral economics and healthcare; at Express Scripts, he is responsible for advancing the understanding of consumer behavior. To this end, he closely follows emerging science around human behavior and decision making, then works to develop tools and communications that help plan sponsors enable better health and value.
At my local convenience store* the other day, I waited impatiently in line behind an older lady who purchased a gaggle of lottery tickets and a carton of cigarettes. I thought about asking her if she thought the odds were better that she’d hit the jackpot or develop lung cancer, but I decided that I didn’t feel like getting beaten up by one of Betty White’s mahjong buddies.
As the day progressed, I kept coming back to this lady and her profoundly ill-advised purchase. How could she justify wasting money like that? My judgmental tendencies ran wild until I looked at the issue through the prism of hyperbolic discounting.
Sure, the rational move would be to quit smoking and maybe gamble on an investment rather than the Powerball. But let’s face it: Behaving rationally is kind of a pain in the rump. If she walked away from the counter empty-handed, she would only realize the benefits of her decision after the protracted wait for the investment to pay dividends and some serious nicotine withdrawal.
When I put myself in her shoes, her behavior made total sense – even though it really makes no sense at all.
* If there’s a better environment for questionable consumer decision making – especially when it comes to food-like substances – I haven’t found it.
Bob Nease, PhD — Chief Scientist; Express Scripts — is a leader in the convergence of behavioral economics and healthcare; at Express Scripts, he is responsible for advancing the understanding of consumer behavior. To this end, he closely follows emerging science around human behavior and decision making, then works to develop tools and communications that help plan sponsors enable better health and value.
I had the pleasure of speaking with Prof. Brian Wansink the other day. He’s the food genius who’s done all those funky experiments that remind me of something out of Willy Wonka (e.g., bottomless soup bowls). Three interlocking insights came to light as we spoke.
First, Wansink’s numero uno big idea is that we eat mindlessly. That is to say, a surprisingly large degree of our eating behaviors are driven by things of which we are flat out unaware. (This is exactly the sort of claim that is not ripe for assessment by self reflection, because it’s pretty hard to recall things of we are unaware.) He’s done the science, and the evidence is in his corner.
Second, Wansink has come to an interesting conclusion about our bellies when it comes to eating:
After conducting hundreds of food studies, I’m increasingly convinced that our stomach has only three settings: 1) We either feel like we’re starving, 2) we feel like we’re stuffed, or 3) we feel like we can eat more. Most of the time we’re in the middle, we’re neither hungry nor full, but if something’s put in front of us, we’ll eat it.
Stop with me for a second or two on this one. Prof. W is telling us that when it comes to eating, we naturally have three speeds, and none of them is neutral. Put another way, given the opportunity, we’ll eat to the point of regretting it.
The third idea relates to the first two: little things of which we’re unaware made us fat, and so little things of which we’re unaware can make us slim down as well. Move the bread and potatoes to the kitchen counter out of reach. Use smaller plates. Take that jar of candy off your desk and put it on your bookshelf. Put treats into a container that takes two hands to open.
There’s a more general design idea at work here: it’s the little foxes that spoil the grapes, but those little foxes take time to do their damage. And it’s those same little foxes - given time - that can make us healthier and happier. What are a few little things you can do to make the good behaviors easier and the bad ones just a bit more difficult?
Bob Nease, PhD — Chief Scientist; Express Scripts — is a leader in the convergence of behavioral economics and healthcare; at Express Scripts, he is responsible for advancing the understanding of consumer behavior. To this end, he closely follows emerging science around human behavior and decision making, then works to develop tools and communications that help plan sponsors enable better health and value.
I recently had the chance to speak briefly to our account management team, the hundreds of people who work daily to support the needs of our clients. They provide excellent consultation, solve problems, and are our heroes in the trenches who help the folks back at HQ understand the evolving, unspoken needs of the market.
Many of the faces were new to me (and only in part due to my spotty memory); gobs of talented people joined Express Scripts from NextRx over the past couple of months. Clambering onto the stage in my black slacks, blue shirt, sweater vest, and tweed jacket, I introduced myself: “I’m Bob Nease, Chief Scientist at Express Scripts. Based on what I’m wearing, I know that’s hard to believe; most people mistake me for a professional athlete or a secret agent.”
I was simultaneously pleased and hurt at the reaction: lots of laughter. (And I know what you’re thinking… when was the last time I heard the phrase “secret agent”?) Over the next couple of days, I got lots of ribbing: “Hey, don’t you play for the Cardinals?” or “Hey, Bob… James Bob!” Cute.
Which man would you trust more? (In case you’re confused, I’m the one on the right.)
A recent study suggests that it might be my narrow face rather than the tweed jacket that’s to blame. In a series of experiments, researchers at the University of St. Andrews found that men with broad faces were less trustworthy in economic exchanges, and that women tended to judge them as both less attractive and less trustworthy. They summarize their findings (so I don’t have to):
Experiment 1 showed that the ratio of facial (bizygomatic) width to height predicts male reciprocation behavior in trust games such that wider faced males are more likely to exploit trust than are slimmer faced males. In Experiment 2, participants were less likely to trust male counterparts with wide rather than slim faces (independent of their attractiveness). Moreover, in Experiment 3, manipulating face width with computer graphics controlled attributions of trustworthiness, particularly for subordinate female evaluators. These results clearly demonstrate that facial width-to-height ratio is used as a valid cue to trustworthiness.
In other words, nice guys may not always get the girl, but neither do the Neanderthals. And take that, Daniel Craig! (But don’t beat me up.)
Bob Nease, PhD — Chief Scientist; Express Scripts — is a leader in the convergence of behavioral economics and healthcare; at Express Scripts, he is responsible for advancing the understanding of consumer behavior. To this end, he closely follows emerging science around human behavior and decision making, then works to develop tools and communications that help plan sponsors enable better health and value.
It’s not surprising that more crimes are committed in the dark. At first blush (if you could see it), this seems obvious: darkness covers a multitde of sins… mostly by decreasing the chance of getting caught. But a series of new studies out of Canada suggest that’s not the only thing going on.
In a set of experiments, scientists at the University of Toronto created situations in which cheating was possible (e.g., subjects would solve a series of math puzzles, and then pay themselves for the number of puzzles they got correct without any one checking their work). Half of the subjects did this task in a brightly lit room; the other half in a more dimly lit room. The trick was that in both groups there was absolutely no way for anyone to be caught cheating. Despite the imposed anonymity, a greater fraction of subjects in the darker room cheated (61% vs. 24%), and a greater number of puzzles were falsely claimed to be solved in the darker room (4.2 vs. 0.8).
In a separate study, subjects played the Dictator Game anonymously via computer. Specifically, subjects were given $6 and told to make a proposed split with an unknown partner online. Subjects could offer any amount between $0 and $6. If their partner agreed to the split, the money would be split according to the division proposed by the subject; if not, neither play would receive anything. Subjects were told they would play the game once, and that that would not meet their partner. Half the subjects were told to wear tinted sunglasses, while the other half were given identical glasses with no tinting. Participants wearing sunglasses were far less likely to offer the fair (i.e., 50/50) split, and on average offered $0.90 less than those in the other group.
What’s odd is that in all cases, subjects were assured that their actions would remain anonymous. Even more strange is the idea that covering one’s one eyes increases self-interested behavior. This is quite reminiscent of small children who hide by covering their own eyes; because they cannot see, they assume that they cannot be seen.
The bottom line? The first blush reasoning - that people cheat more in the dark *because* they’re less likely to get caught - may not be the operative mechanism. Instead, people may be *wired* to cheat more in the dark because that’s generally what works. The rational part of it may simply the reason behind why the rule of thumb works, not the reason for the behavior itself.
Julie Adelsberger — Senior Manager; Express Scripts — As senior manager of knowledge management, Julie Adelsberger is responsible for translating scientific research into accessible communications for plan sponsors and other healthcare stakeholders.
The New York Times reports on a study that shows we change our investing behavior when our preferred political party is in power. Specifically, when the party we favor is in office, we are more likely to invest in risky stocks, move funds from foreign to domestic companies, and trade less frequently. When our non-preferred party takes office, the opposite behavior is more likely to occur.
The study found that investors with more education and experience were less likely to change their behavior based on political preferences.
The article quotes Dan Ariely, a professor of behavioral economics at Duke University and member of the Center for Cost-Effective Consumerism’s advisory board.
“Though you might think that having money on the line provides a strong-enough incentive to keep political biases from affecting one’s investment decisions, it shouldn’t come as a surprise that it doesn’t,” said Professor Ariely, who is also the author of Predictably Irrational. “In politics as in other arenas of life, our beliefs exert a powerful influence on the decisions we make.”
As an editor for the Corporate Database team, Eric Ferguson is responsible for writing and editing strategic language for Express Scripts' Sales & Marketing department.
In case you were too busy reading actual news to notice, the Oscar nominations came out this week. I’m embarrassed to admit that of the 10 Best Picture nominees, I’ve seen just one — and it was a cartoon.
Maybe I’ll have to check out some of the others. I certainly wouldn’t be the only person watching a movie based purely on Oscar’s seal of approval. Research by Randy Nelson, professor of economics and finance at Colby College, found that a best picture nomination can significantly boost a film’s ticket sales. As Nelson tells it:
[W]e compared box office data for every film nominated for Best Picture, Actor/Actress and Supporting Actor/ Actress from 1978 to 1987 with data for 131 “non-nominated” movies released in the same weeks as the lauded films. … Our results indicate that on average a nomination for Supporting Actor or Actress is worth $147,131; a nomination for Lead Actor or Actress, $476,617; and for Best Picture, $4,799,118.
If you ask me (and why wouldn’t you?), what we have here is a case of social norming — specifically, moviegoers responding to messages from the authority figures at the Academy of Motion Picture Arts and Sciences. After all, who knows movies better than the Hollywood elite?
There might also be a little “keeping up with the Joneses” thrown in. Would you rather say you’ve seen four or five of the Best Picture nominees or just one (or none)? Only a philistine would take pride in such cultural ignorance.
That’s why I’m slapping on some blue face paint and going to Avatar.
Julie Adelsberger — Senior Manager; Express Scripts — As senior manager of knowledge management, Julie Adelsberger is responsible for translating scientific research into accessible communications for plan sponsors and other healthcare stakeholders.
Sendhil Mullainathan, a Harvard professor of economics and 2002 receipient of a MacArthur genius grant, explains how applying the behavioral sciences can help us solve “the last mile” of social problems — that is, reaching the subgroup of people who aren’t responding to the available solutions.
As an editor for the Corporate Database team, Eric Ferguson is responsible for writing and editing strategic language for Express Scripts' Sales & Marketing department.
I’m just saying: The only reason I didn’t win a Grammy on Sunday is because there isn’t a category for “Laziest Non-Musician.”
Last week, I had to schedule my sweet ride (Honda Civics qualify as sweet rides, right?) for its 100,000-mile maintenance. That sounds easy enough. Here’s the problem: Doing so required a phone call. I hate talking on the phone. That’s not an exaggeration – I hate it with the fire of a thousand suns.
Compounding the problem, placing this phone call would require me to log on to the Internet, chase down the number for my friendly automotive price gouger, push a whole bunch of buttons, and then endure what was sure to be the most painful phone call of my life. Who has time for all of that? I’ve got blogs to write!
Then I had one of those flashes of genius that make things like Three Stooges movies and Skittles possible.
“What if I just had Jill call for me?”
This Consumerology thing has taught me a lot about procrastination and, in turn, a lot about myself. I wanted to take care of my car, but the hassles kept getting in the way. I knew I’d be more likely to take my car in if I could somehow circumvent those obstacles.
Being the kind and patient woman that she is, my wife set up the appointment for me.
Should I have been able to take care of this by myself like a grown-up? Sure … but there’s a large gap between what I should do and what I actually do.
Bob Nease, PhD — Chief Scientist; Express Scripts — is a leader in the convergence of behavioral economics and healthcare; at Express Scripts, he is responsible for advancing the understanding of consumer behavior. To this end, he closely follows emerging science around human behavior and decision making, then works to develop tools and communications that help plan sponsors enable better health and value.
Steve Jobs cranked up his technolust juggernaut yesterday by announcing what we Apple freaks have all been waiting for — the iPad tablet. (Even though I am not planning on buying one straight out of the gate, I am slightly — but only slightly — ashamed to admit that I knew with certainty the day of the big announcement and completely forgot that the State of the Union Address was the same evening.)
CNNMoney reported gyrations in Apple’s stock around the announcement:
In the 12 hours running up to the event, there were some pretty bold statements being made about how the announcement would be more about content creation than just cool hardware.
To wit, Wiredreported the following very early yesterday morning:
Apple’s goal is to offer a new platform for content creators to reinvent books, magazines and online content – in addition to offering a new avenue for content producers to make money. That platform will likely be far broader than just a tablet device, and will extend to every device or computer that iTunes touches.
So what’s the connection? I think there’s something to be learned about expectations and loss aversion here. Just a hunch (and looking at these things through the retrospectroscope can be wildly misleading), but here’s where I’m headed. Just before the party started, people probably expected two things: the announcement would transcend cool hardware and show off an entire mobile content ecosystem, and the device would cost about a thousand bucks (maybe less with a contract).
And here’s how the facts unfolded yesterday. First, it became clear that this was mostly about a device; a device that could immediately run apps for the iPhone, but certainly not the content creation ecosystem that Wired suggested hours earlier. Because we were expecting more, this looks like a loss. Stock price? Slump-o.
Then Jobs announced the pricing: less than $500 for the entry-level model, a relatively modest $1 a day plan for all-you-can-use 3G data, and the ability to cancel the data service at any time. These price points were uniformly more attractive than people were expecting; there’s an expected loss avoided. Stock price? Surge-o.
Expectations matter because they set the reference point for how we evaluate options and opportunities: If reality looks worse than we expected, it’s a loss. And setting expectations is critical for new products that people have no idea how to value. One wonders what would have happened had the expectation of that ecosystem not been set.
Approaches like the GlowCap system offer intriguing new ways to address each of these challenges. GlowCaps enables access to near real-time pill-taking behavior with extremely detailed resolution. We will, for example, be able to understand which patients do well taking their medications Monday through Friday, but struggle on the weekends. GlowCaps also offers a great platform for testing applied behavioral science approaches such as precommitment; patients will be able to sign up for phone reminders should they not take their medications on time, as well as adherence reports that can be shared with their physicians.
