Behavioral Science as Infrastructure: Rethinking Adherence, Engagement, and Managed Care Decision-Making
First Report Managed Care Editorial Advisory Board Member Chandra Osborn, PhD, MPH, explains why managed care decisions hinge on confidence over speed—and how embedding behavioral science across the care continuum can close adherence gaps, activate patients, and drive measurable performance in an evolving STAR landscape.
Chandra Osborn, PhD, MPH: My name is Chandra Osborn, and I am the Chief Experience Officer at AdhereHealth. I’m a behavioral scientist focused on how cognitive, emotional, and environmental factors shape health decisions, as well as initiate and sustain behavior change. My work spans research and real-world application in engagement, medication adherence, preventive care, and chronic disease management.
At AdhereHealth, I lead the integration of behavioral science across the end-to-end user experience—aligning the clinical, product, and analytics teams to drive measurable improvements in adherence, quality performance and outcomes, particularly in Medicare Advantage.
Managed care decisions are often described as slow but better understood as deliberate. From a behavioral science perspective, what drives that deliberation, and how should stakeholders adjust their expectations and engagement strategies accordingly?
Dr Osborn: Managed care decisions are high stakes by design. Behavioral science shows that when faced with uncertainty, risk, and accountability, organizations default to deliberative (System 2) thinking—prioritizing defensibility over speed. Loss aversion, competing incentives, and cross-functional alignment all reinforce this.
The implication? Don’t try to accelerate decisions. Instead, de-risk them. The most effective engagement strategies reduce cognitive and operational burden: they clearly quantify outcomes, align to existing priorities like STAR measures, and make implementation feel simple and low lift. Confidence, not urgency, moves decisions forward.
How do behavioral science principles help explain the persistent gaps between treatment availability and real-world adherence?
Dr Osborn: Availability is necessary, but not sufficient to resolve gaps. The Information–Motivation–Behavioral Skills (IMB) model makes this clear. Medication adherence and other health-enhancing behaviors depend on people having the required information, motivation and behavioral skills—while behavioral economics explains why even motivated individuals fall short due to factors like present bias, friction, and competing demands.
Adherence gaps persist because health care often over-indexes on information or educating patients, and under-designs for how patients actually behave. Behavioral science (distinct from behavioral health) addresses the full decision context, which includes simplifying actions, strengthening motivation, and building skills within the environments where people actually live and make decisions.
With the recent Centers for Medicare and Medicaid Services (CMS) final rule incorporating depression screening into the STAR Ratings framework, how do you see this shaping plan behavior, provider priorities, and patient engagement in the near term?
Dr Osborn: This is a meaningful shift. It formalizes mental health, specifically detection, as a quality and performance priority.
Plans may invest in screening and reporting, but the real impact will come from what happens next. Depression directly affects motivation, energy and follow-through, which are core drivers of medication adherence. That makes this both a behavioral health issue and a behavioral science challenge.
Plans that outperform must move beyond depression screening to activation—pairing identification with behaviorally informed follow-up that reduces friction, accounts for low motivation and decision fatigue, and supports the next best action.
Barriers like cost, complexity, and trust frequently influence decision-making in managed care. Which behavioral levers have you found most effective in helping patients and populations overcome these challenges?
Dr Osborn: A few levers consistently drive impact:
- Simplification: Make the next step obvious and easy
- Timeliness: Intervene at the moment decisions are made
- Social proof: Normalize positive, healthy behaviors
- Salience of risk: Use loss framing thoughtfully
- Empathy and tone: Build trust, especially in high-friction or sensitive moments
The key is orchestration. These levers are most effective when combined and tailored to context, not deployed in isolation.
How can managed care organizations apply behavioral science insights more systematically to improve outcomes across therapeutic areas?
Dr Osborn: The shift is from interventions to infrastructure. Leading organizations embed behavioral science across the experience:
- Identify behavioral risk, not just clinical risk
- Design for IMB—ensure people can, want to, and know how to act
- Leverage behavioral economics to reduce friction and bias
- Coordinate omnichannel engagement to reinforce action
- Continuously test and optimize based on behavior change, not just engagement (or connecting with a patient)
As STAR measures evolve, including depression screening, performance will increasingly depend on how well organizations operationalize behavior change—not just measure it.
