This is one of my favorite slides because it highlights how behavioral interventions can have very different effects in different portions of the population. MI FREEE was a randomized controlled trial in which Aetna waived copayments for all patients hospitalized with heart attacks. The trial showed that overall adherence to evidence-based therapy in the year following a heart attack is poor: 39% in the control group, 45% in the “free medication” group. Among African-Americans and Hispanics, however, the effects of the trial are striking — rates of major vascular events or revascularization dropped by 35% and total health care spending declined by 70%. These outcomes suggest that we need to think more about how innovations in benefit design may have different effects in different populations. Over time, this should lead to recognition that the typical approach to benefit design — one size fits all — may not be optimal.
This slide originally appeared in NEJM Catalyst on March 11, 2016.