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RED HOT Contributors


Episode 53 – Dr. Karen DeSalvo – Public Health Powerhouse


Today we have a powerhouse in healthcare. The former head of the ONC – appointed by President Obama, she’s a provider, health tech leader, sits on the board of Humana…and is making a hard charge toward jer vision for public health 3.0.

It’s Dr. Karen DeSalvo…and she’s taking on the tough issues and the tough questions…right here on Red Hot Healthcare..let’s go!

In this episode, Dr. Steve and former Asst. Secretary Dr. DeSalvo discuss the following:

  • Her unique history in dual leadership roles at CMS
  • The effects of her tenure with the Meaningful Use Act of HIPAA
  • A much needed lift for public health
  • Loss aversion vs rewards in patient motivation
  • Lessons she learned as Health Commissioner of New Orleans during Hurricane Katrina

Here’s a small snippet of transcription from the show interview — 

DR. STEVE: “One of the things I tend to focus on [in my advising and consulting]is consumer behavior – and especially in crafting marketing toward loss aversion. The STICK rather than the carrot, that is…the fear of loss, often is greater for individuals than gaining a reward for the positive.

Just speaking about social determinants of health and the responsibilities of both individuals and communities, where do you think THEIR responsibility lies in helping to get our health system back on track?

In other words, SHOULD THERE BE some type of loss aversion toward motivating the right type of healthcare behavior and responsibility?

DR. DeSALVO: “This is such an age-old question that we’re trying to understand. The science of behavioral economics recently recognized this type of motivation, in the form of the recent Nobel prize.

It is beginning to teach us more, especially as technology can better track our behavior and then leverage A.I. to support us in decision making. We see this in retail, where they encourage decision-making at the point of opportunity, which is in its earliest stage in health care.

In a new world, there can be better integration for patients – through their credit card transactions and their online retail activity. One example would be if a patient shared their healthcare information, for instance if they had Diabetes, with a company like Amazon.

Amazon helps them shop, and uses techniques such as discount pricing or perhaps suggested grocery bags to help them make the health choice and the easier pathway.

This doesn’t mean that just because Kale could be offered cheaper than Cheetos, that people will always choose Kale. It may be that there HAS to be some sticks, in terms of motivation.

Some people think this – and it may be the case. We may need to look at more understanding of differential pricing for premiums and co-pays if people have unhealthy behavior.

But this is where I have some concerns. When you think about punishing people for bad behavior, especially if they are low-income already, you get into self-medication under stress happens in the form of food, tobacco, alcohol, or opioids. And populations that are low-income, more rural and marginalized tend to be more stress and self-medicate.

So I think we have to be thoughtful to help – but recognize that punishment must also be carefully applied in a thoughtful way.


 I have had the privilege and pleasure of working with Steve Ambrose on a podcast that covered a range of topics in healthcare information technology. The podcast logistics – communications, interview questions, scheduling and production – were every well managed.
A great experience that I would do again in an instance.

Dr. John Glaser
SVP, Population Health at CERNER

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