Expanding Patient Engagement
The quest to improve American healthcare has traditionally focused on finding new drugs, producing more powerful diagnostic tools, and building medical centers with ever-expanding footprints. Despite these investments, costing 5 percent of GDP in 1960 and over 18 percent of GDP in 2018, the U.S. healthcare system is fundamentally broken, if not unsustainable.
By Bill Hartman, Head of Innovation Strategy/Essential Design, part of PA Consulting
On a per-capita basis, the U.S. spends more on healthcare than any other nation, but health outcomes rank only 11th among peer countries. Life expectancy in the U.S. is about five years lower than it is in Japan, Italy, Switzerland, or Spain, and maternal health, on average, lags even further behind many more countries.
These sobering statistics point to the fact that the U.S. desperately needs a more patient-centered healthcare system, one that encourages people to maintain wellness, avoid risk factors, and better manage chronic conditions/comorbidities. We believe in improving the healthcare system by redesigning it to work smarter for patients. While the pandemic quickly led to creative workarounds and new solutions in a range of industries, this is an opportune time to also experiment with the entire system of healthcare in this country, pushing new solutions further and faster.
Pillars of Patient Engagement
To work smarter for patients, U.S. healthcare needs to move away from its break-fix mentality, with healthcare feeling like a series of disjointed transactions. Instead, we need to design a simpler, more proactive, continuous- care environment in which people are partners with their care team, rather than consumers in need of services. To achieve this, we envision six pillars, working interdependently, of a Patient Engagement Strategy:
- Transform Points of Care
- Leverage Technology
- Apply Behavioral Economics
- Turn Data into Wisdom
- Shape the End-to-End Experience
- Find the Value and Transform It
If broadly conceived and implemented, design offers high-potential impact to improve health and longevity, while reducing the cost of care. In our long-running national healthcare debate, many solutions have been proposed (Medicare for All, expansion or abolition of the ACA, single payer), yet none can succeed unless people are put at the heart of the program.
Victory to Policy Design
During the past decade, healthcare providers and payers (insurers) have explored a shift toward Value-Based Care and Accountable Care, where providers are compensated for the outcomes—keeping patients healthy— rather than the usual fee-for-service or volume of transactions, treating illness more than maintaining wellness. Fee-for-service also brings far too much administrative overhead and expensive infrastructure, with too little patient engagement and empowerment, forcing patients to focus more on their health plans, not their actual health.
More people were getting routine checkups, having their health conditions diagnosed sooner, and visiting primary care clinics rather than hospital emergency departments. From 2013 to 2018 alone, avoidable Emergency Department visits have decreased 14 percent.
Aside from the national comparisons above, there is already validation in the belief that expanding access reduces costs. After Massachusetts enacted healthcare reforms in 2006 (the model for The Affordable Care Act) which incentivized annual checkups, the total cost of healthcare in the state declined and health outcomes improved. More people were getting routine checkups, having their health conditions diagnosed sooner, and visiting primary care clinics rather than hospital emergency departments. From 2013 to 2018 alone, avoidable Emergency Department visits have decreased 14 percent.
But a vastly smarter healthcare system is possible, owing to the data science revolution that is transforming every industry. Increasingly affordable and available technology can further enable patients to collaborate with their care teams, focusing on prevention and early detection rather than diagnosis and treatment or acute care. This brings us to the first pillar: Transform Points of Care.
Boosted by Product Design
What if, instead of once a year, patients could also be monitored passively for signs of ill health? Imagine all the serious disease and comorbidities that could be prevented or addressed sooner, plus the costs that could be averted.
COVID-19 has already brought telemedicine to the forefront, but other technologies that have been maturing for a while can help to focus doctor-patient-payer relationships on prevention rather than intervention. Wearable devices and health apps provide persistent monitoring to detect problems early, while also encouraging mindfulness and behavior change. Smart watches already able to track heart rates and blood pressure now offer blood oxygen monitoring. Blood sugar monitoring has become far more convenient, too. Even hydration, which affects strength, endurance, and cognition, can easily become part of this personal health panoply. And so, the second pillar is Leverage Technology.
Shifting the provider-to-patient service dynamic toward one of shared value and effort benefits both parties, because accountable patients not only experience better outcomes, but also incur less cost. This would be the logical argument for a more collaborative relationship with one’s healthcare team. But to gain widespread buy-in and lasting behavior change, healthy choices can be presented to patients in ways that make them more attractive or less burdensome. Meet the third pillar: Apply Behavioral Economics.
Behavioral Economics, the intersection of psychology and economic theory which studies the economic decision making of real people as opposed to economic theorists alone, is easier said than done. Anticipated results are anything but, and unintended consequences become the only results people pay attention to. But, patterns can be identified, cause-and effect more clearly understood, and the system becomes that much more efficient—if we can capture, interpret, and iterate the system. Pillar 4: Turn Data into Wisdom.
So, with healthcare considerations being delivered more ubiquitously, and with algorithms mediating the pursuit of those goals, what makes people actually want to use products, systems, and touch points? Here is where design’s role becomes a lot more familiar: packaging the data to create a tool which supports constructive, caring dialogue.
Experience Design Makes it Solid
History and science show that people behave according to how they are challenged or rewarded, meaning that they will require the right challenges and incentives to embrace a more proactive approach to care, drawing their own conclusions rather than being told what to do. Incentives such as discounted health insurance premiums and subsidized fitness or nutrition plans can help motivate patients to embrace technology, sharing health data with providers to unlock these perks. Devices and apps must be simple and friendly, with new users needing the right onboarding: education, motivation, and technical support.
There is proof that continuous, well designed connection between engaged patients and their providers can fundamentally improve U.S. healthcare.
These types of solutions can also appeal to the individual in motivational terms, helping them embrace digital health and wellness services, monitor vital health or risk factor data, or enable them to confidently manage their own therapies. For example, many biologics are already moving to self-administered platforms: patients manage their own therapy at home, dosing according to recent biomarkers, and avoiding repeated trips to infusion centers. It’s a textbook example of prospect theory: the convenience and lifestyle benefits of self-managed therapy outweigh its perceived risks or complexity, and the idea of losing the privilege of self-management further heightens the value, creating an added mechanism for medication adherence. Everyone wins. In pillar 5, we can: Shape the End-to-End Experience.
A teamwork approach between patient and provider, technology-mediated where applicable, means more than telemedicine visits. Dashboards, progress reports, and immersive yet personal data visualizations that make the abstract more concrete can dramatically improve engagement, outcomes, and control over the cost of care. Which brings us to pillar 6: Find the Value and Transform It.
The hurdles to redesigning our system remain formidable. But there is proof that continuous, well designed connection between engaged patients and their providers can fundamentally improve U.S. healthcare. By redesigning it to be a more collaborative process that empowers patients, we will be able to vastly improve health outcomes while also reducing financial burden.
This is where a better-designed system can take us all.
From Design Museum Magazine Issue 017
THE PILLARS OF PATIENT ENGAGEMENT
1. Transform Points of Care
Orchestrate the value across various care settings
We can expand the purview of home health, enabling patients to provide more of their own monitoring and care through managed telehealth services that include diagnosis, therapy, wellness, and even clinical trials. We can think outside of traditional care settings like clinics to embrace and enable “health anywhere.”
FOOD FOR THOUGHT
Where and how might patients and providers be more collaborative? How might healthcare be supported in places where people spend their time and attention?
2. Leverage Technology
Finding the right role for the right technology
Technology has accelerated the sensing, transmission, and interpretation of data at an exponential pace. Technology, applied appropriately, can offer new opportunities to personalize medications and devices, establishing best practices continually for patients and providers.
FOOD FOR THOUGHT
How might platforms be better integrated, making them accessible and relevant to patients?
3. Apply Behavioral Economics
Personalized medicine informed by behaviors, attitudes, and public health objectives
Using principles from cognitive science, we can propel people beyond their own aspirations or defined goals by using choice architecture, coaching, and feedback loops. People can more willingly choose to effect change, rather than being pushed onto healthier pathways.
FOOD FOR THOUGHT
What existing behaviors should be steered in new directions? What are the determinants or decision points underneath those behaviors? What actions should be turned into irresistible alternatives?
4. Turn Data into Wisdom
Moving beyond data by turning insight into action
Like other commercial endeavors, healthcare can leverage unstructured information, using natural language processing, machine learning, and artificial intelligence, to yield greater insight. The progression from data, to information, to knowledge, and ultimately to wisdom is now itself becoming automated.
FOOD FOR THOUGHT
In your own work, does data currently add noise or bring clarity to developing personalized strategies? What hidden gems are still buried? If your product’s or system’s data could talk back to you, what would you ask it?
5. Shape the End-to-End Experience
Goal-directed customer experience design
Address gaps in knowledge, skill, and attitude using customer experience as a digital microbiome interfacing people with needed services, resources, and interventions by meeting people where they are.
FOOD FOR THOUGHT
How do today’s customer journeys compare with potential or ideal ones? Where are the breakdowns and implied opportunities? How can we transcend remits, reimbursements, and restrictions to instead rethink and rewire the healthcare experience?
6. Find the Value and Transform It
An innovative solution can only succeed with sustainable funding
New solutions to systemic problems are offered faster now than ever. But to be successful, they must also prove a way to capture the value. Identifying the prosumer, the professional consumer, as opposed to the consumer helps innovators better understand the value drivers and formulate a sustainable growth and business model. Recognizing the well-grooved financial flows and finding creative ways to address new opportunity spaces is part of transforming health ecosystems.