After conducting a call for proposals earlier this year, the Nudge Unit has selected two projects to partner on that use behavior change principles to improve health care delivery. The Nudge Unit will support the winning teams with designing, implementing, evaluating, and scaling their solutions.

Getting an early start on prior authorizations for medications

Clinical team
Sarah Firda, PharmD 
Brittany Conahan, PharmD 
Tiffany Huang, MSN, CRNP, AGACNP-BC

This project takes aim at hospital discharge delays and other negative downstream effects that occur when medication prior authorization (PA) requests take a long time. Often, medication orders for discharge aren’t sent to the pharmacy with enough time to address insurance coverage issues. The team’s proposed solution is an electronic health record (EHR) nudge that helps initiate the PA process at the beginning of the hospital stay to decrease potential delays and enable the clinical team to choose alternatives that are covered by the patient's insurance. The prompt is triggered when an inpatient medication order is placed – much earlier in the process than with the current practice – which should shift up the PA timeline and help get patients their discharge medication sooner. This may also reduce the amount of “bridge” medications the health system supplies while the PA is pending, leading to cost savings.

Automating tobacco cessation in primary care

Clinical team
Cheryl Bettigole, MD, MPH, MA 
Jennifer Lee, MD 
Mario DeMarco, MD, MPH 
Matthew Kearney, PhD, MPH 
Frank Leone, MD, MS 
Brian Jenssen, MD, MSHP
Robert Schnoll, PhD

To simplify tobacco screening and treatment for patients and clinicians, this team will adapt and optimize an EHR-based intervention for use with Penn Medicine’s primary care patients. Based on a tool used successfully at Children’s Hospital of Philadelphia, this solution will systematically screen patients for tobacco use, offer several opt-out treatment choices – nicotine patches and gum, telephone coaching, and interactive text messaging – and automatically send prescriptions to the patient’s preferred pharmacy. This nudge aims to increase the treatment rate while reducing clinician burden.