Locking in Our Good Intentions

Nov 7, 2013
Similar to the recent budget sequester, precommitment incents people to pursue a preferred behavior in the future. In healthcare, this tactic works.

As a polarized Congress continues to draw out resolution of its budget issues, “sequestration” has moved from an arcane fiscal concept to a heated buzzword associated with government paralysis.

Before the political battles, however, sequestration was a good illustration of a concept known to behavioral science as precommitment. In precommitment, we recognize our human pitfalls and put up barriers to prevent our succumbing to them. It’s a tool we at Express Scripts employ to lock in the good intentions of people to make smart decisions involving their healthcare.

Putting Precommitment to Use

Many individuals are aware of their tendency to procrastinate, and they often use strategies to make tempting behaviors difficult or expensive.

  • Late sleepers may put their alarm clock across the room to prevent themselves from repeatedly hitting the snooze button.
  • When trying to diet or quit smoking, people may remove all junk food or cigarettes from the house.
  • Several years ago, celebrity Kim Kardashian was reported to have told a radio host that to prevent overeating, she sprayed window cleaner on her food after taking a couple of bites.
  • There’s even a website, Stickk.com, that allows people to put their own money at risk if they fail to achieve self-designated outcomes, such as losing weight or writing a book.

In all of these examples, people clearly have a long-term preference for a certain behavior. And they use precommitment to help avoid straying temporarily from these underlying intentions.

Precommitment in Healthcare

At Express Scripts, we have applied precommitment in our product called Call4Generics. We offer members the opportunity to precommit to using generics when possible. About 50% decided in advance to permit us to move them to a lower-cost option if their doctor approves.

As another example, we found that offering our employees the opportunity to precommit nearly tripled actual participation in a company exercise program. If they agreed in advance to let us block the time on their calendar, they ultimately overcame the day-of excuses, showed up, and got some good exercise.

Precommitment locked in their good intentions.

Incentive to Compromise

For Congress and the administration, the idea of sequestration was to make inaction on the budget so unpleasant for all parties that they would be forced – or strongly incented – to come up with a compromise.

Of course, we all know now that it failed to produce said compromise, probably because Congress agreed to numerous exemptions – for example, it protected the number of air traffic controllers – rather than facing the full pain of the indiscriminate budget cuts.


Fortunately for us in the healthcare industry, locking in a healthier behavior for a single person appears to be simpler than achieving compromise in Washington.


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