Triple Aim Design Thinking - Stanford MedX 2014

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

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

Showcase - Virtuwell

Screenshot

Showcase 1 - Virtuwell

Screenshot

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

Case Study – Screens

Screen Shots

Redesign the medications refill element of a patient portal.

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

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 – CEOdias@wellbe.me

Lucas Dailey – Senior UX Designerlucas.dailey@wellbe.me

Deck on Slideshare – tweet #TripleaimDesignthinking

Triple Aim Design Thinking - Stanford MedX 2014

Health & Medicine