Abstract: Becker and Maiman wrote ""patient compliance has become the best documented, but least understood, health behavior."" Recent studies have found that about half of children and adults in the US receive recommended care, leaving much work to be done in improving the quality of care in our system. With a non-adherence rate of 20-30%, this represents over 180 million medical visits per year where patients are not following medical advice. While many interventions have tried to improve adherence rates, roughly half have failed. Traditional randomized control trials do not address the motivation issue so critical to adherence;they evenly distribute patients'motivation levels via the randomization process. For this project, we propose the creation of a choice architecture called the Healthy Ideas Exchange which will be implemented via the Web using Smartphones and tablets (e.g., iPad). In the Exchange, users will choose hooks, something they enjoy such as playing video games and link them to rewards when they accomplish a desired healthy behavior or adherence with a therapeutic regimen. We will draw lessons from the gaming world that are important to draw in users, provide enjoyment during play, and maintain customer or player loyalty, and then link them to desired health behaviors. Today, 82% of adults have a mobile device;38% of those with mobile devices use them to go online, and 34% of adults play games on their cell phones. These numbers are higher for minorities than Whites. From this increased mobility, hooks can be offered in any setting without having to wait for a sedentary lifestyle to develop. In the Exchange, users will also be exposed to nudges, which are aspects of the choice architecture that alter people's behavior in a predictable way without forbidding any options or significantly changing their economic incentives. We can nudge people looking to lose weight by providing better mapping between choice and welfare, e.g., ""Mr. Smith, your run on the treadmill burned a pack of carrots. With the spinning exercises, you will burn a total of 5 Oreo cookies."" The Exchange will be consistent with the IOM's belief that patient-centeredness should be central to our health care system, rather than a peripheral add-on. In the short-run, we will identify the hooks people use in the Exchange among different patient populations (e.g., by age, race, socio-economic status, resident location) to assess their preferences. We will also monitor how long individuals stay engaged in a hook that they choose and what aspects of the hook and nudges motivate them. Our health outcomes will include what percent of patients stay within their target weight and for how long, what proportion of engaged patients have fewer asthma symptoms, and how many elderly patients feel less depressed or have improved cognitive or physical functioning. For long-term outcomes, we will be looking at cost-savings to the healthcare system and the diffusion of this innovation. Public Health Relevance: "Patient compliance has become the best documented, but least understood, health behavior," and requires innovative thinking. For this project, we are proposing the creation of a choice architecture called the Healthy Ideas Exchange where users will choose the hooks (games with rewards) they enjoy and be presented with nudges to help motivate them for behavioral change. The Exchange, implemented via the Web using Smartphones and tablets (e.g., iPad), will be consistent with the IOM's belief that patient-centeredness should be central to our health care system, rather than a peripheral add-on.