A program focused on changing the opinions of popular students could change the way others think about “norms” around bullying—which, in turn, could potentially lead to a change in students’ behavior.

Princeton professor Betsy Paluck provided this example during a recent presentation about her pioneering work using social network insights to affect culture and norms. Ever since, the concepts she explored have been influencing my thoughts about how to solve perplexing health and health care problems.

As I prepared for a recent visit from the RWJF Board of Trustees, I reviewed our portfolio of grants that apply behavioral economics to perplexing health and health care challenges and reflected on what is pioneering about this batch.

These projects are all well-designed studies that, when completed, can inform policy development and result in behavior change. In the near future, policymakers, leaders of health care institutions, program officers, and clinicians will benefit from these nuanced findings about the applications of behavioral economics to health and health care.

To help those who want to respond to our recent Call for Proposals, Applying Behavioral Economics to Perplexing Health and Health Care Challenges, I sat down with Drs. Kevin Volpp and David Asch, co-directors of the Foundation’s Behavioral Economics Initiative at the University of Pennsylvania, to talk about low-value health care, why we are doing this CFP and what we are seeking from applicants.

Why are we doing this CFP now?

Kevin: There’s enormous concern about the growth in health care spending—both in the public and private sector. We can’t afford to keep increasing spending the way we have. But health care spending shouldn’t be defined as too high simply because it’s high. The question should be “How much value are we getting?” There is a widespread belief that there is too much health care that doesn’t provide value that’s commensurate with the costs—to individuals or to the government.

What’s particularly exciting is that, while health policy experts have acknowledged the problem of low-value health care for a long time, influential physician groups are becoming vocal about their belief that society would be better off — from both a quality and patient safety standpoint — if less of this care was provided. And they’re creating lists of health care services and procedures that they consider to be of low value that are available to the public.

Reducing use of low-value care is what’s going to be able to allow us to continue to fund high-value care for large portions of the American population.

What is low-value health care?

We have announced our second Call for Proposals in the field of behavioral economics. We’re actively seeking ideas that will help us to better understand how to discourage the consumption of low-value health services — those that provide more harm than benefit or which provide only marginal health benefits. In addition to improving health outcomes, this knowledge could contribute to lowering health care costs for us all.

Behavioral economics is an area of study by which I’ve personally grown increasingly intrigued and in which the Foundation has recently begun to invest.  We all know, for example, that we need to exercise, eat right and be actively engaged in our own health care. But we don’t always do what we know we should do; knowing the “right” decision to make does not guarantee that we make that decision. The goal of behavioral economics is to uncover insights that could enable people to make better — more “rational” — choices for their health.

In December, we asked our readers to tell us about the health care problems they felt were most in need of innovation—the tough problems, the crucial ones, maybe even those they’d seen firsthand. The number of comments we received was encouraging. It has also challenged our thinking, and generated a great deal of discussion on our team.

One thing is certain: The conversation that ensued from that post confirmed that our team needs to do more listening—listening to patients, caregivers, health care professionals, innovators, thought leaders—the list goes on and on.

We saw some common themes in the problems you shared. A few of them are reflected in areas in which the Robert Wood Johnson Foundation is already working. Clearly there are problems that, despite the intensive efforts of many really smart people, resist conventional solutions. Other themes showed us how important it is to always be examining what we’re doing from perspectives other than our own. 

So where do we go from here?