Shutterstock.com

After Federal Officials Sent Letters to Over-Prescribing Docs, Prescriptions Fell and Patient Safety Rose

A small office at GSA is helping agencies apply behavioral science to reap big improvements in program effectiveness.

The Centers for Medicare and Medicaid Services recently analyzed data for antipsychotic drugs prescribed to elderly patients and found that some doctors were over prescribing these potent and costly drugs. So CMS sent letters to the high-volume prescribers, informing them of how their prescription rates compared with those of other doctors in their state. That single action—sending the comparison letters—reduced prescriptions by 11%, thereby saving money and improving patient safety, CMS found. 

CMS undertook this initiative with the help of a small office in the General Services Administration that specializes in the use of data analytics and behavioral science techniques, such as the use of comparison letters. 

As I’ve noted in previous blog posts, behavioral science is a growing field that is still somewhat diffuse in nature. It is international and multidisciplinary, and its use has rapidly evolved over the past several years in the public sector. This growth is in tandem with the growth of evidence-based government, data and analytics, rapid cycle testing, and pressures to improve customer experience with government services.

In the U.S. federal government, these different threads intersect in GSA’s  Office of Evaluation Sciences. This small office was created in 2015 to provide a cadre of talent to help agencies use these new techniques to get better results from their programs.

Interestingly, this office preceded the adoption of the Evidence Act earlier this year, which will create an even greater demand for its specialized talents as agencies are pressed to develop their own evidence and evaluation strategies, which also include the use of behavioral science techniques. For example, the Labor Department has already developed a guide for its operational bureaus on how to use behavioral interventions to improve their programs. 

The Team 

The Office of Evaluation Sciences is a multidisciplinary team that blends a range of professional disciplines comprising the field of behavioral science. These include psychology, economics, political science, ethnography, statistics, and program evaluation. Under the leadership of Kelly Bidwell, the office conducts work that spans behavioral science, evidence, and evaluation. It supports agencies, for example, in carrying out the Office of Management and Budget’s implementation guidance for the recently-passed 2018 Foundations for Evidence-Based Policymaking Act.

The office is located in GSA’s Office of Governmentwide Policy and has a staff of about 15-20 specialists who are a mix of career civil servants and rotational staff from academia or nonprofits serving one- to four-year terms. Staff members typically oversee two to four projects at a time.  Office director Bidwell says the use of rotational staff keeps the career staff connected to cutting edge intervention design techniques such as appropriate sample size, evaluation design and analytic techniques. And since staff are federal employees, they have greater access to federal administrative data sets for analyses than would academics or other non-federal researchers.

The OES team’s approach is to undertake rapid-cycle projects, using low-cost solutions (e.g., redesigning a notification letter). Their core deliverables are actionable results to drive better programs and policies. All projects are posted and summarized on the office’s website.

What They Do  

Agencies approach OES for help conduct projects that require expertise that they may not have on their own staff. OES typically works on 20-30 projects at a time with a wide range of agencies to help clarify identified problems (e.g., define the gap between a program’s goal and reality in order to identify the key trip points), test interventions (often using randomized control trials and large existing data sets) and, where successful, help agencies determine how to scale the pilot to a larger population.

According to Bidwell, many of the OES team’s solutions are inexpensive and can be implemented relatively quickly, based on six- to 12-month trials. Their proposed interventions typically don’t require legislation, regulatory changes, or significant funding. Where possible, they like to conduct large-scale testing using federal administrative data, develop rigorous findings and results, and use evaluation techniques. Their approach is experimental—typically iterative, and trial-and-error. Oftentimes, their solutions involve changing the way a program is described, the timing, or the sequence of choices being offered.

Bidwell says her team likes to work in partnership with agencies with the goal of transitioning ownership of the project to the agency partner. Over the long run, Bidwell says, the staff hopes to create an appetite for using behavioral and analytic techniques.  

Actions taken by OES’s agency clients might vary from scaling up a successfully-tested intervention to advice on reorganizing administrative data so it can be used to answer questions or retest a successful intervention on a different population. So far, the staff has found agencies are more reluctant to change a program’s design (such as changing default settings on application forms) than they are to make small changes (such as fine-tuning the presentation of information). However, they hope to generate evidence on the effects of more substantial changes in the near future. 

A Range of Projects 

What kind of projects does OES undertake with different federal agencies? Team members work across the government to provide end-to-end support in the design of an evidence-based programmatic change and test the change to measure its impact. Bidwell says that sustaining such change is more effective when the OES team collaborates with internal agency champions who drive the process; participate in the design and implementation of an evaluation; assist in the analysis and interpretation of results; and make decisions about scale and program implications.

Recent projects OES has undertaken span a number of policy areas, such as:

Bidwell says that lessons learned in one program are sometimes transferable to programs in other agencies. 

Potential Next Steps 

OES staff have created informal networks of peers across agencies. They currently leverage existing and new networks, such as agency performance improvement officers, chief data officers, and chief evaluation officers. As the use of behavioral insights matures across government, there may be a collective effort to create a more formal network of peers. This has happened in other fields, such as among risk managers, evaluation experts, and strategic foresight practitioners.

Another potential future step might be the creation of a “playbook” of behavioral insights for use by agencies. Bidwell, however, says that the work done by OES and other federal agencies may not have created a sufficient critical mass of evidence to warrant a playbook, especially given the breadth of different behavioral techniques. In the interim, the office has begun to develop a series of more technical “method guides.” In addition, it holds an annual event with federal agency collaborators each fall to share what they have learned and the results from every project completed the previous year. Finally, as it completes more projects and inventories efforts from other agencies, it has begun to identify those techniques on which to focus future attention, and how to effectively implement them in a federal context. For example, OES has identified some of the clearance barriers for modifying agency forms as it has helped agencies improve their design and wording.

X
This website uses cookies to enhance user experience and to analyze performance and traffic on our website. We also share information about your use of our site with our social media, advertising and analytics partners. Learn More / Do Not Sell My Personal Information
Accept Cookies
X
Cookie Preferences Cookie List

Do Not Sell My Personal Information

When you visit our website, we store cookies on your browser to collect information. The information collected might relate to you, your preferences or your device, and is mostly used to make the site work as you expect it to and to provide a more personalized web experience. However, you can choose not to allow certain types of cookies, which may impact your experience of the site and the services we are able to offer. Click on the different category headings to find out more and change our default settings according to your preference. You cannot opt-out of our First Party Strictly Necessary Cookies as they are deployed in order to ensure the proper functioning of our website (such as prompting the cookie banner and remembering your settings, to log into your account, to redirect you when you log out, etc.). For more information about the First and Third Party Cookies used please follow this link.

Allow All Cookies

Manage Consent Preferences

Strictly Necessary Cookies - Always Active

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data, Targeting & Social Media Cookies

Under the California Consumer Privacy Act, you have the right to opt-out of the sale of your personal information to third parties. These cookies collect information for analytics and to personalize your experience with targeted ads. You may exercise your right to opt out of the sale of personal information by using this toggle switch. If you opt out we will not be able to offer you personalised ads and will not hand over your personal information to any third parties. Additionally, you may contact our legal department for further clarification about your rights as a California consumer by using this Exercise My Rights link

If you have enabled privacy controls on your browser (such as a plugin), we have to take that as a valid request to opt-out. Therefore we would not be able to track your activity through the web. This may affect our ability to personalize ads according to your preferences.

Targeting cookies may be set through our site by our advertising partners. They may be used by those companies to build a profile of your interests and show you relevant adverts on other sites. They do not store directly personal information, but are based on uniquely identifying your browser and internet device. If you do not allow these cookies, you will experience less targeted advertising.

Social media cookies are set by a range of social media services that we have added to the site to enable you to share our content with your friends and networks. They are capable of tracking your browser across other sites and building up a profile of your interests. This may impact the content and messages you see on other websites you visit. If you do not allow these cookies you may not be able to use or see these sharing tools.

If you want to opt out of all of our lead reports and lists, please submit a privacy request at our Do Not Sell page.

Save Settings
Cookie Preferences Cookie List

Cookie List

A cookie is a small piece of data (text file) that a website – when visited by a user – asks your browser to store on your device in order to remember information about you, such as your language preference or login information. Those cookies are set by us and called first-party cookies. We also use third-party cookies – which are cookies from a domain different than the domain of the website you are visiting – for our advertising and marketing efforts. More specifically, we use cookies and other tracking technologies for the following purposes:

Strictly Necessary Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Functional Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Performance Cookies

We do not allow you to opt-out of our certain cookies, as they are necessary to ensure the proper functioning of our website (such as prompting our cookie banner and remembering your privacy choices) and/or to monitor site performance. These cookies are not used in a way that constitutes a “sale” of your data under the CCPA. You can set your browser to block or alert you about these cookies, but some parts of the site will not work as intended if you do so. You can usually find these settings in the Options or Preferences menu of your browser. Visit www.allaboutcookies.org to learn more.

Sale of Personal Data

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Social Media Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.

Targeting Cookies

We also use cookies to personalize your experience on our websites, including by determining the most relevant content and advertisements to show you, and to monitor site traffic and performance, so that we may improve our websites and your experience. You may opt out of our use of such cookies (and the associated “sale” of your Personal Information) by using this toggle switch. You will still see some advertising, regardless of your selection. Because we do not track you across different devices, browsers and GEMG properties, your selection will take effect only on this browser, this device and this website.