triple aim design thinking - stanford medx 2014
DESCRIPTION
James Dias, CEO, and Lucas Dailey, Senior User Experience Designer, will present a workshop, “Designing connected care solutions at the intersection of medicine and finance” on Saturday, September 6th from 2:20-3:50 PM PDT. The workshop will explore how the business of performance-based healthcare requires a balance between giving patients the best possible quality outcomes and doing it in a cost effective manner. This emphasis on value-driven medicine is producing the opportunity for new technology solutions that address both care and costs. Designing effective solutions for “Connected Care” requires an interdisciplinary approach that brings together the disparate fields of healthcare economics, patient engagement, and digital technology.TRANSCRIPT
Designing connected care solutionsat the intersection of medicine and finance
James Dias – CEO
Lucas Dailey – Senior UX Designer
1. Introductions2. Audience Survey3. About us - Who is Wellbe
Part 1: A Healthcare Framework for Design
Part 2: A Case Study of Good Design
Part 3: A Workgroup Exercise (30 mins)
Agenda
Patient-Centric design isn’t enough
Fire starter
What is Meaningful Use Stage 2?
Pop Quiz
The final rule for meaningful use Stage 2* intends to increase health information exchange between providers and promote patient engagement by giving patients secure online access to their health information.
HealthIT.Gov
Pop Quiz
Design Framework
The Triple Aim
1. Improving the patient experience of care2. Improving the health of populations3. Reducing the per-capita cost of healthcare
http://www.ihi.org/Engage/Initiatives/TripleAim/pages/default.aspx
The Triple AimPopulation Health
Experience of Care Per Capita Cost
Background - The Triple Aim
• Framework developed by the Institute for Healthcare Improvement
• An approach to optimizing health system performance• Conjoin models about healthcare and financing• Create stakeholder accountability for all three dimensions,
simultaneously
A Foundational Concept
Triple Aim
ONC CMS CHT ACA
The Triple Aim is a prevalent influencer in all major healthcare transformational initiatives
Office of National CoordinatorThe mission of ONC is to optimize the paths to reach these five health IT goals along with interoperability
to support the Triple Aim.
• Achieve adoption and information exchange through meaningful use of health IT
• Improve care, improve population health, and reduce healthcare costs through the use of health IT
• Inspire confidence and trust in health IT• Empower individuals with health IT to improve their health and the health
care system• Achieve rapid learning and technological advancement
Metrics
Metrics
Experience Metrics
Experience Metrics
Health Care
Cost Metrics
Reducing Costs
1. Lower the cost of therapies and treatments2. Improved efficiency in care delivery3. Improved choice-making4. Mitigating risks
Improving Experience
1. Quality of the care2. Patient Satisfaction, HCAHPS3. Alignment of expectations
Improving Outcomes
1. Measurable Functional Achievements2. Patient reported Outcomes Measures (PROM)3. Monitoring Activities of Daily Living4. Clinical Indicators, health status
By 2015, health care providers participating in accountable care organizations will have to provide evidence that the care they've delivered produced value for the patient—as reported by the patient.
Evaluating Technology
Primary FocusEvaluated technologies that serve
value-driven delivery and reimbursement models
Improve the Patient Experience
Evidence? Investment?
Improve the Health of Populations
Reduce Per Capita Cost of Care
Findings
“The most striking finding of the DHSF is that the vast majority of digital health companies do not simultaneously emphasize achievement of all three Triple Aim Components. This limited emphasis on the Triple Aim may reflect a lack of awareness or perceived value of the entire Triple Aim for health technology entrepreneurs. This finding may also indicate a market in transition from technology products that currently serve dominant fee-for-service, volume-driven health care organizations toward technologies that serve value-driven delivery and reimbursement models in the future.”
The vast majority of companies did not meet the intent of the Tripe Aim
More findings
“Most technologies targeted toward Patients focus on trying to improve individual health outcomes. Very few focus on Decreasing the Costs of Care, which may be an opportunity for technology developers to create innovative applications to make consumers more fiscally informed about their health care decisions. Technologies focused on Payers and Providers are more oriented toward costs and outcomes, but suffer from a major lack of emphasis on Improving Patient Experience. “
Missing the mark!
Refilling Prescriptions in a Patient Portal
Case Study
Case Study – MyChart
• EPIC’s patient portal• Most used EMR and patient portal in US
Case Study – Screens
Screen Shots
Case Study – Key Points
• Doesn’t fulfill Triple Aim– Patient Experience: Helpful, Convenient– Population Health: marginal effect– Cost: marginal effect
• Single Use• Replaces an existing process with an online process –
incremental
Design Approaches
• Lean Design – good for process efficiency• Design Thinking – good for product design• Agile – good for software development
The 5 Basic StepsThe Stanford d.school Design Thinking Process
The 5 Basic Steps
1. EmpathizeSee the problem from the perspective of the user’s experience
2. DefineUse the 5 Why’s to define the problem, then the success criteria
3. IdeateBrainstorming solutions to meet the goals
4. PrototypeBuild prototype(s) of the solution as fast as possible
5. TestMeasure the impact of your solutions, then iterate
The Stanford d.school Design Thinking Process
The 4 Basic Steps
1. Empathy: Being able to see challenges and opportunities from others’ perspectives and understand what people truly need.
2. Multi-Disciplinary Collaboration: Leveraging the creativity and intelligence of diverse perspectives to see the bigger opportunity.
3. Ideation & Prototyping: Exploring many possibilities to get to the breakthrough idea.
4. Experimentation: Testing new solutions early and often to increase the chance of marketplace success
The Rotman School’s “Business Design”
Keys to Success DT
• Integrative Thinking – hold two opposing thoughts in mind – simultaneously
• Encourages divergent thinking to create new choices that haven’t existed before
• Challenging prevailing assumptions - Devils Advocate, Black Hats, 10th Man.
Successful Design Thinking
How DT Turned Around AirBnB • Growth flat lined in 2009 and they went broke• Founder Joe Gebbia went to RISD• DT analysis helped identify the problem: Photos sucked• DT helped them find and test a solution: Photograph spaces
themselves• Test worked: revenue jumped
A New Framework
Forging A New Framework
Triple Aim Design Thinking
Methodology ofDesign thinking
FrameworkOf the Triple Aim
Forging A New Framework
Two strategiesTriple Aim Design Thinking
Use Three-stakeholder Lens
Provider Patient Payer
Design for the Future
The Value ofTriple Aim Design Thinking
• Better alignment with systemic challenges• Creates clear and compelling value• Unveils new avenues for transformation• Opens commercial opportunities
Name one of the more popular apps or sites that people use for their healthcare.
Pop Quiz
iTriage WebMD YouTube
Healthcare Challenges
A Seeming Contradiction
Improve quality and lower cost. Oftentimes, quality, profitability and sustainability operate at odds with each other.
No Two Patients
• Vast differences in demographics• Changing Expectations• No one wants to be there
Fragmentation Everywhere
• Siloed, disconnected processes and systems• Diverse, un-coordinated care delivery• Compartmentalized data and limited visibility• Poor patient experiences across transitions
Healthcare Culture
• Necessarily, Risk averse• Deference to authority• Submissive patients
What is the largest segment of the healthcare consumer market?
Pop Quiz
Pop Quiz
Showcase - Virtuwell
Screenshot
Showcase 1 - Virtuwell
Screenshot
Showcase 1 - Virtuwell
Screenshot
Showcase 1 - Virtuwell
Screenshot
Showcase 1 - Virtuwell
Screenshot
Showcase 1 - Virtuwell
Screenshot
Showcase 1 - Virtuwell
Positive Experience: High convenience
Population health: Quick diagnosis and treatment; better health outcomes
Cost: Savings with a new delivery model
Virtuwell – Triple Aim
In 2014, what percentage of US Physicians communicate electronically with their patients?
Pop Quiz
a) 74%b) 39%c) 15%d) 7%
Triple Aim Design Thinking Exercise
Empathize
Define
Ideate
Prototype
Test
Triple Aim Design Thinking Exercise
Case Study – Screens
Screen Shots
Redesign the medications refill element of a patient portal.
Triple Aim Design Thinking Exercise
Focus on Cost:
An 2013 NEHI study found medication reconciliation cost the industry $26 billion
An Institute of Medicine found medication reconciliation to be the most common medical error
Triple Aim Design Thinking Exercise
Exercise - 25 Minutes
1. Why don’t patients take their medications (properly)?
2. How could the medication refill part of a patient portal help, while reducing costs?
Nota bene:
Ignore technical constraints!
Exercise - 25 Minutes1. Why don’t patients take their
medications properly?
2. How could the medication refill part of a patient portal help, while meeting the Triple Aim?
Ignore technical constraints!
Exercise - 5 Minutes
1. Share your tables’ ideas with the room
What did we learn?
What insights did we uncover?
Wrap-Up Discussion
Triple Aim Design Thinking
Take away 2
Takeaway 3
Restate the Takeaways
James Dias – [email protected]
Lucas Dailey – Senior UX [email protected]
Deck on Slideshare – tweet #TripleaimDesignthinking