Triple Aim Design Thinking - Stanford MedX 2014

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.

1. Designing connected care solutions at the intersection of medicine and finance James Dias – CEO Lucas Dailey – Senior UX Designer

2. Introductions Audience Survey About us - Who is Wellbe

3. Part 1: A Healthcare Framework for Design Part 2: A Case S tudy of Good Design Part 3: A Workgroup Exercise (30 mins ) Agenda

4. Patient-Centric design isn’t enough Fire starter

5. 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

6. Pop Quiz

7. Design Framework

8. The Triple Aim Improving the patient experience of care Improving the health of populations Reducing the per-capita cost of healthcare http:// www.ihi.org /Engage/Initiatives/ TripleAim /pages/ default.aspx

9. The Triple Aim Population Health Experience of Care Per Capita Cost

10. 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

11. A F oundational Concept Triple Aim ONC CMS CHT ACA The Triple Aim is a prevalent influencer in all major healthcare transformational initiatives

12. Office of National Coordinator The 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

13. Metrics

14. Metrics

15. Experience Metrics

16. Experience Metrics Health Care

17. Cost Metrics

18. Reducing Costs Lower the cost of therapies and treatments Improved efficiency in care delivery Improved choice-making Mitigating risks

19. Improving Experience Quality of the care Patient Satisfaction, HCAHPS Alignment of expectations

20. Improving Outcomes Measurable Functional Achievements Patient reported Outcomes Measures (PROM) Monitoring Activities of Daily Living Clinical Indicators, health status B y 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 .

21. Evaluating Technology

22. Primary Focus Evaluated 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

23. 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

24. 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!

25. Refilling Prescriptions in a Patient Portal Case Study

26. Case Study – MyChart EPIC’s patient portal Most used EMR and patient portal in US

27. Case Study – Screens Screen Shots

28. 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

29. Design Approaches Lean Design – good for process efficiency Design Thinking – good for product design Agile – good for software development

30. The 5 Basic Steps The Stanford d.school Design Thinking Process

31. The 5 Basic Steps 1. Empathize See the problem from the perspective of the user’s experience 2. Define Use the 5 Why’s to define the problem, then the success criteria 3. Ideate Brainstorming solutions to meet the goals 4. Prototype Build prototype(s) of the solution as fast as possible 5. Test Measure the impact of your solutions, then iterate The Stanford d.school Design Thinking Process

32. The 4 Basic Steps Empathy: Being able to see challenges and opportunities from others’ perspectives and understand what people truly need. Multi-Disciplinary Collaboration:  Leveraging the creativity and intelligence of diverse perspectives to see the bigger opportunity. Ideation & Prototyping: Exploring many possibilities to get to the breakthrough idea. Experimentation: Testing new solutions early and often to increase the chance of marketplace success The Rotman School’s “Business Design”

33. 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, 10 th Man.

34. 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

35. A New Framework

36. Forging A New Framework Triple Aim Design Thinking

37. Methodology of Design thinking Framework Of the Triple Aim Forging A New Framework

38. Two strategies Triple Aim Design Thinking

39. Use Three- s takeholder Lens Provider Patient Payer

40. Design for the Future

41. The Value of Triple Aim Design Thinking Better alignment with systemic challenges Creates clear and compelling value Unveils new avenues for transformation Opens commercial opportunities

42. Name one of the more popular apps or sites that people use for their healthcare. Pop Quiz iTriage WebMD YouTube

43. Healthcare Challenges

44. A Seeming Contradiction Improve quality and lower cost. Oftentimes , quality, profitability and sustainability operate at odds with each other.

45. No Two Patients Vast differences in demographics Changing Expectations No one wants to be there

46. Fragmentation Everywhere Siloed , disconnected processes and systems Diverse, un-coordinated care delivery Compartmentalized data and limited visibility Poor patient experiences across transitions

47. Healthcare Culture Necessarily, Risk averse Deference to authority Submissive patients

48. What is the largest segment of the healthcare consumer market? Pop Quiz

49. Pop Quiz

50. Showcase - Virtuwell

51. Screenshot Showcase 1 - Virtuwell

52. Screenshot Showcase 1 - Virtuwell

53. Screenshot Showcase 1 - Virtuwell

54. Screenshot Showcase 1 - Virtuwell

55. Screenshot Showcase 1 - Virtuwell

56. Screenshot Showcase 1 - Virtuwell

57. Positive Experience: High convenience Population health: Quick diagnosis and treatment; better health outcomes Cost: Savings with a new delivery model Virtuwell – Triple Aim

58. In 2014, what percentage of US Physicians communicate electronically with their patients? Pop Quiz 74% 39% 15% 7%

59. Triple Aim Design Thinking Exercise

60. Empathize Define Ideate Prototype Test Triple Aim Design Thinking Exercise

61. Case Study – Screens Screen Shots

62. Redesign the medications refill element of a patient portal. Triple Aim Design Thinking Exercise

63. 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

64. Exercise - 25 Minutes Why don’t patients take their medications (properly)? How could the medication refill part of a patient portal help, while reducing costs?

65. Nota bene : Ignore technical constraints!

66. Exercise - 25 Minutes Why don’t patients take their medications properly? How could the medication refill part of a patient portal help, while meeting the Triple Aim? Ignore technical constraints!

67. Exercise - 5 Minutes Share your tables’ ideas with the room

68. What did we learn? What insights did we uncover? Wrap-Up Discussion

69. Triple Aim Design Thinking Take away 2 Takeaway 3 Restate the Takeaways

70. James Dias – CEO [email protected] Lucas Dailey – Senior UX Designer lucas.dailey@ wellbe.me Deck on Slideshare – tweet # TripleaimDesignthinking