Master of Health Care Innovation faculty member Kevin Volpp, MD, PhD brings enormous expertise in health behavior change to his course, Behavioral Economics and Decision Making. There, he guides students through the potential of defaults, incentives, and social pressure to spark better decisions about healthy eating, exercise, and weight-loss. His teaching, in turn, is born of a career of research and leadership in the real-world applications of behavioral economics—most recently in partnership with the American Heart Association.

An American Heart Association distinguished scientist, Dr. Volpp serves as scientific lead for the organization’s Health Care by Food initiative. The goal of the initiative is to bring attention to—and build evidence for—a food is medicine (FIM) approach to improving people’s health.

In collaboration with a group of notable colleagues, Dr. Volpp has outlined an ambitious research agenda to advance FIM. And in the process, he has brought the field of behavioral economics to bear on the project of enhancing FIM’s uptake and implementation.

In an October 2023 Presidential Advisory from the American Heart Association, Dr. Volpp and colleagues write that FIM has the potential to be a “cost-effective approach to improve health among patients at risk for diet-related medical conditions.” And it may be complementary to efforts to achieve environmental sustainability and social justice. However, for FIM to succeed, researchers and practitioners must address several critical questions, including:

• Effectiveness
  Can FIM interventions improve health outcomes among different clinical populations, facing different types of health challenges? 

• Comparative effectiveness
  What are the optimal FIM strategies for different types of health conditions? What is the optimal duration for interventions? And what is the best approach for transitioning patients back to a nonprescription diet?

• Differences among demographics
  Are there specific genetic predispositions that might be more or less responsive to an FIM approach?

• Cost effectiveness
  How could FIM be made a sustainable intervention from an insurer’s perspective?

• Implementation
  How might designers use innovation techniques like human-centered design to create programs that can scale?

As Dr. Volpp and colleagues enumerate these issues, they sketch a role for behavioral economics, positing that nudges, enhanced incentives, and intentionally designed choice architecture can all improve participation and patient outcomes in FIM programs.

Additionally, in a separate JAMA Health Forum Viewpoint, Dr. Volpp outlines a more specific strategy to leverage behavioral economics in service of FIM.  Behavioral economics merges insights from economics and psychology to understand and influence behavior. Its value, as he explains, is that it “recognizes limits on people’s ability to make rational decisions, particularly when under chronic scarcity.” If FIM patients frequently suffer from food insecurity and acute financial stress, behavioral economics might be particularly well suited to guide them toward health behaviors that they know are beneficial but may have difficulty adopting.

To that end, Dr. Volpp suggests that FIM programs might be enhanced through:

• Automatic referral
  Eligible patients are automatically opted into FIM programs, lowering barriers to entry both for themselves and for their care teams. Patients still have the ability to opt out if they choose.

• Increasing salience and visibility
  Using behavioral strategies to enhance incentives by making rewards for participation in FIM programs immediate and apparent.

• Leveraging regret and loss aversion
  Structuring incentives so that patients feel like they are losing out when they choose not to participate, or when they fail to meet their goals.

• Engaging in deliberate choice architecture
  Designing an environment that encourages adherence to FIM by making the healthiest foods the easiest to access, and by bundling healthy choices with desirable rewards like small treats.

Finally, Dr. Volpp suggests that the lessons of behavioral economics as a field can help build evidence for FIM. Behavioral economists have experience conducting randomized trials in challenging, real-world environments, and the types of rigorous assessment they conduct may be a good model for FIM going forward.

Dr. Volpp’s work with the American Heart Association is deeply personal. In addition to a career focused on improving behaviors that are directly relevant to heart health, he himself is a cardiac arrest survivor. Since that event, he has refocused his expertise on increasing access to automatic defibrillators and CPR trainings. His work with FIM is an extension of this, building on his accumulated knowledge to advance a cause that is highly consequential to improving health at large.

Learn more about how behavioral science can drive innovation in Dr. Volpp’s Behavioral Economics and Decision Making course, and see how the Master of Health Care Innovation helps professionals throughout health care leverage its power to improve their work.