Bob Nease on eliminating the “intention/behavior gap”: Part 1 of an interview by Bob Morris


Nease (M)Bob Nease received his doctorate from Stanford University, where he studied methods to improve medical decisions made by doctors and patients. Before joining Express Scripts in 2001, he was an associate professor of internal medicine at Washington University in St. Louis and an assistant professor at the Dartmouth Medical School. He recently retired as the Chief Scientist at Express Scripts, a Fortune 25 healthcare company dedicated to making the use of prescription medications safer and more affordable. As a leader in the convergence of consumer behavior and healthcare, he was responsible for advancing the Express Scripts behavior-centric approach to the pharmacy benefit. He is the author of more than 70 peer-reviewed scientific articles, and inventor on six US patents.

Over the past several years, Bob has emerged as the nation’s expert on the application of behavioral sciences to health care. He has now turned his attention to equipping others to make practical use of those insights in applications beyond health care — at work, at home, and in the community. His book, The Power of Fifty Bits: The New Science of Turning Good Intentions into Positive Results, was published by HarperBusiness/An Imprint of HarperCollins (January 2016). He and his wife Gina split their time between Phoenix, Austin, and their farm in rural Italy.

Here is an excerpt from Part 1 of my interview of Bob.

* * *

Morris: Before discussing The Power of Fifty Bits a few general questions. First, who has had the greatest influence on your personal growth? How so?

Nease: My family, no question about it, and especially my wife, Gina. If you do personal relationships right, you won’t paper over areas that need improvement and change. I am very fortunate to be doing that work with a small number of people who are rooting for me, and for whom I am rooting.

Morris: The greatest impact on your professional development? How so?

Nease: It’s a three-way tie. My thesis advisor at Stanford taught me how to strip complicated problems – ethics, politics, business strategy – down to their very essence. That’s an incredibly powerful skill in any setting. My colleague and coach at Express Scripts, Larry Zarin, taught me the strategic power of storytelling, to never overshoot the target, and that success comes with performance over time. And Barrett Toan, the founder of Express Scripts, hired me when I’d lost interest in academics. He turned me loose on all sorts of interesting healthcare problems I might not have gotten to work on otherwise.

Morris: Years ago, was there a turning point (if not an epiphany) that set you on the career course you continue to follow? Please explain.

Nease: To understand this story, you need to know that my formal training is in decision analysis. You can think of that as applied classical economics. People are supposed to make decisions that are rational and advance their interests. I’d been applying this discipline at Express Scripts for a few years, trying to get patients to make better decisions via education and more aggressive incentives. And frankly, the results were modest at best.

Then my wife and I visited Atlanta, and went out to dinner with friends. It was clear that we were going to split the bill at the end of the evening, and everyone was being well behaved in terms of what they ordered for dinner… except for this one guy, named Jack. Jack drank faster than everyone else and ordered a really expensive dinner. I was infuriated; his selfish behavior was coming at a direct cost to every other well-behaved person at that meal. As I drove the rental car back to the hotel, I gripped the steering wheel until my knuckles turned white and the vein in my forehead throbbed.

And then it struck me: Jack was simply behaving according to the principles of classical economics. He ordered $50 more of stuff than the average. There were ten people at the dinner, so his cost was just $5. That’s a 10X ROI and a payback period of two and a half hours. Any CFO would applaud that kind of performance.

So here’s the epiphany: it was because of that dinner that I realized that despite having a doctoral degree in how people are supposed to make decisions, my gut overwhelmed my head. That’s when I realized that most people don’t run the numbers to make a decision. Instead, they behave according to some other set of rules. I wanted to know whether we could reshape the environment in which our patients lived to harness those forces and achieve more positive behaviors. That evening with Jack profoundly changed the course of my professional life.

Morris: To what extent has your formal education been invaluable to what you have accomplished in life thus far?

Nease My degrees came out of engineering schools. Engineering taught me a systematic way to take problems apart and come up with solutions. That’s been extremely useful.

Morris: What do you know now about the business world that you wish you knew when you went to work full-time for the first time? Why?

Nease: The org chart doesn’t capture the true importance of the players. You need to figure out the “influence chart.”

Morris: Of all the films that you have seen, which – in your opinion – best dramatizes important business principles? Please explain.

Nease: I love movies like Apollo 13 and more recently The Martian. For me the main message is that every problem has a solution, and the solutions are often elegant in a rag-tag sort of way. I also admire Chariots of Fire because it’s a reminder that there’s no replacement for raw passion. Do what you’re built to do, and do it with everything you’ve got.

Morris: From which non-business book have you learned the most valuable lessons about business? Please explain.

Nease: Do the assembly instructions from IKEA count? Work hard to make things as simple as possible while getting the job done.

*     *     *

Here is a direct link to all of Part 1.

Bob cordially invites you to check out the resources at these websites:

For more information about Fifty Bits design, please click here.

For more information about the book and where to buy it, please click here.

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