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Follow-up video and service tool prototypes completed in 2010: 1. Video concept prototype developed by Interaction Design grad students at Univ of Kansas: www.youtube.com/watch?v=pnyAllwb7SQ 2. Service tool concept: "Healthy Serving" www.youtube.com/watch?v=6xWs59b7_vw 3. Service tool concept: "Better Everyday" www.youtube.com/watch?v=83nu-xaR3iw 4. Service tool concept: "Custom Cook" www.youtube.com/watch?v=ccZVAak11kY Best, -Michael Intro: Simple fact is we know how to preserve health and mitigate the effects of disease. What's needed is a good model for persuading a large cross-section of high-risk Americans to alter their lifestyles in ways that maintain good health and reduce the need for the costliest forms of care. This requires fundamentally innovating the ways by which health care services enlist the willing compliance of people most likely to experience preventable chronic diseases.
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Except where otherwise noted, this work is licensed under a Creative Commons Attribution 3.0 License.
Service tools for innovating chronic disease management
Service Innovation Design & Development
by Michael Eckersley, PhDHumanCentered
UPDATE: “The Prescription Mobile App For Chronic Disease Management”, by Michael Eckersley, PhDhttp://www.slideshare.net/mindcentric/the-prescription-mobile-app
Thanks to all the dedicated people who contributed so generously to this
exploratory study. It’s a modest beginning toward the goal of making a
difference in the lives of those who struggle with chronic disease.
*Note: This document does not necessarily reflect the opinions or
policies of EHN, St Johns, or The Sisters of Mercy System
Graduate Design Management Students and Interaction Design Students fromThe University of Kansas, School of Architecture, Design & Planning
Jeffrey AlbrittonLu Bever
Randall Blair
Rachel MagarioCare MillerTom Petty
Hedi HeinzJennifer KnightKevin Lafferty
Mason PineAngel Stahl
Denise Staples
Employers Health Network*Medical Management Services
Springfield, Missouriwww.employershealthnetwork.com
St. John’s Health Plans* Medical Management
Springfield, Missouriwww.stjohns.com
Janet Pursley, RNAnn Cave, RN
and team members
Kezia Lilly, RN, BSN
Except where otherwise noted, this work is licensed under a Creative Commons Attribution 3.0 License.
“Where are the game-changers, the investments that we
make now that are going to reduce costs now? Even if
they don’t reduce them this year or next year, but ten
years from now or twenty years from now, we are going to
see substantially lower costs.”
“...(W)e are going to...invest more in prevention and wellness programs.
-President Barack Obama
“The greatest threat to America’s fiscal health is not Social
Security... It’s not the investments that we’ve made to
rescue our economy during this crisis. By a wide margin, the
biggest threat to our national’s balance sheet is the
skyrocketing cost of health care. It’s not even close.”
The Premise
The economics of health care are not ultimately about
payer systems, utilization levels, or supply, but about
the behaviors, lifestyles and cultural norms that lead to
massive health care demand. That demand can be
traced to a handful of well known and mostly avoidable
diseases. The simple fact is, we know how to prevent
most of them or, at least, mitigate their most tragic and
costly effects.
Any sustainable health care solution will have to stem
the demand for such services and not just pay the
costs of supplying them.
Solutions to explosive health care costs won’t come
from medical science, from government, from the
insurance industry or even from health care itself.
Our Study
Our Activities
– adapted from V. Kumar, ID-IIT & IDEO
MAKEUNDERSTAND
REALIZE
frame insightsform hypotheses
know context & users• health care industry modeling• bench research chronic disease• interviews (cdm professionals)• disposable camera study• ethnographic interviews (patients)
articulate intent
explore conceptsmake plans
represent & prototype offerings
research & discovery
1
2 3
4
Develop a Systems Understanding of The Problem
physical/biological
socio-cultural
psychological
spiritual
“street-level” issues & operations
global
macro economic
market/industrial
organizational
Deep Search:human factors
High Search:environmental
& market factors
Learning Cycle 0
LearningCycle 1(time)
0
1
2
3
4
4
3
2
1
High
Deep
Syste
ms S
cope
back stagewellness,
prevention and health
managementservices
front stageservices
econ
omics
customerexperience
technology
what’s viable?
what’s feasible?
what’s desirable?
“what is”
The economics, institutional, and market factors around chronic disease
global
macro economic
market/industrial
organizational
20,000 classifiable diseases
cardiovascular disease
Data Source: National Health Library, NIH Rendered with Many Eyes, IBM
diabetes
Data Source: National Health Library, NIH Rendered with Many Eyes, IBM
chronic obstructive pulmonary disease
Data Source: National Health Library, NIH Rendered with Many Eyes, IBM
cancer (neoplasms)
Data Source: National Health Library, NIH Rendered with Many Eyes, IBM
liver cirrhosis
Data Source: National Health Library, NIH Rendered with Many Eyes, IBM
asthma
Data Source: National Health Library, NIH Rendered with Many Eyes, IBM
These six diseases account for the vast majority
of deaths, disabilities & health care costs
asthma
liver cirrhosis
cancer
COPD
cardiovascular disease
diabetes
Chronic diseases are non-infectious, long term, mostly avoidable. Worst effects are preventable.
Determinants include poor diet, inactivity, obesity, smoking, psychosocial stresses, genetic predisposition.
Causes or compounding factors include lifestyle choices and behaviors, lack of regular health check-ups and preventive care.
Source: National Center for Health Statistics, 2006
30%34% 7.3% 6.7% 6.5% 3.9% 3.9% 3.0% 2.4% 1.8%
Stroke
Cancer
Heart
Disease
Blood
Poisoning
Kidney
Disease
Influenza &
Pneumonia
COPD
AccidentsD
iabetesA
lzheimer’s
✔
✔
✔✔
✔
Leading Causes of US Deaths, 2006
Total U.S. Health Spending 2007
Total spending =$2.2 trillion
75%Share spent treating patients with one or more chronic conditions
25%
= $1.7 trillion
Source: CMS
Chronic Disease Prevalence Among American Workers, 2007
None23%
One22%
Five or more19%
Four8%
Three12%
Two16%
Source: Newsweek Web Exclusive
Projected Rise in Cases of Seven of the Most Common Chronic Diseases, 2003-2023
Diabetes
53%
Mental Disorders
54%
Cancers
62%
Hypertension
39%
Stroke
29%
PulmonaryConditions
31%
Heart Disease
41%➜
➜
➜
➜
➜
➜➜
Source: The Miliken Institute
The best strategy against soaring health care costs?
Investment in prevention, health risk reduction and
disease management. Such programs are cheap
compared to the staggering costs of not implementing
them.
our objective: chronic disease reduction & mitigation
scope of health care services, facilities, personnel
Less than 1% of health care expenditures go toward prevention or managed care of chronic disease.
Source: Institute of Medicine, Health Affairs, JAMA
Rendered with Many Eyes, IBMData Source: National Health Library, NIH
preventive health services
Rendered with Many Eyes, IBMData Source: National Health Library, NIH
managed care programs
Rendered with Many Eyes, IBMData Source: National Health Library, NIH
...and having an effective process in place
to translate that mix into an effective system solution.
attention
knowledge
information
empathy
imagination
on the basis of having the right mix of
Health Care succeeds or fails
Treatment Expenditures and Lost Economic Output (in Billions) Per Chronic Condition*
Source: The Miliken Institute
$22
$105
$94
$105
$171
$280
$271
$27
$45
$65
$46
$33
$48
Treatment Expenditures
Lost Economic Output
Stroke
Diabetes
PulmonaryConditions
HeartDisease
MentalDisorders
Hypertension
Cancers
0 50 100 150 200 250 300
$
Health care expenditures in the US are highly concentrated,
with 5% of the patient population accounting for 49% of costs.
RelativelyHealthy
51%
Sickest 28%
Very Sick 21%
Health Care Costs
$
$
$
Patient Population
RelativelyHealthy
95%
Sickest 1%
Very Sick 4%
Reducing these numbers even slightly will result in
large system savings
The human costs of chronic disease are much higher
"Consumers of health care need choices. Individually they need to value the preciousness of their own health in order to conserve and prolong it, and to manage their own aging. The governing agent is behavior".
–Sam Keihl, MDColumbus, Ohio
Stemming the demand for avoidable health care services is the silver bullet in any serious, sustainable health care solution. For everyday Americans, whether covered by health insurance or not, that means modifying risky behaviors (i.e., smoking, excessive drinking, drug use, overweight and obesity) and altering personal lifestyle factors (i.e., exercise, diet), that compromise health, and ultimately require intervention.
– Michael Eckersley, “Solving The Economics of Health Care: How Employer-Provider Partnerships Are Producing Cost Savings and Healthier People”
There are solid benchmarks for assessing good medical judgment. The medical science is clear. What no program has yet mastered is the formula for persuading or motivating large numbers of Americans to get their lifestyles and behaviors in line with their health and economic self interests.
– Michael Eckersley, “Solving The Economics of Health Care: How Employer-Provider Partnerships Are Producing Cost Savings and Healthier People”
What’s Needed:
A Truly Patient-Centered Managed Care Model
dig here
physical/biological
socio-cultural
psychological
spiritual
“what is”
The human factors of chronic disease
qualitative, naturalistic data
“Anecdotes carefully collected and reported are the important data of cultural understanding. Anecdotes can reveal truths below the surface
that broader market statistics conceal” – Clarence Page
The real focus of an ethnography is not behavior per se, but the symbolic systems that guide human behaviors, inform beliefs, and shape the things in use.
– Rick Robinson & Jim Hackett
breaking the “human code”
“Asthma: another word for frustrating”
“Marcus”5 y/o maleSparta, MO
Conditions: Asthma, HeartMom & Dad: “Stacy & Ron”
“We have put our son in the hands of so many doctors and have been lucky. But doctors need to be more accessible to special needs kids.”
“The cardiologist came back into the room with the pediatrician and they both sat down. That’s when I knew there was something wrong... All I remember is “open heart surgery”.
“Eye. I have been told I have pretty eyes. I was diagnosed w/glaucoma last year. I am only 45. I am scared.”
“Beth”45 y/o female
Nixa, MOConditions: Type 1
diabetes, hypothyroidism, hypertension, asthma,
severe allergies, depression & anxiety
“Food outlets. It is everywhere. I am hungry all the time. I crave sweets, so bad for a diabetic. After eating a large amount of sugar or carbs I will usually awake in the middle of the night nauseated and having to vomit. Yet I wake up later craving carbs.”
“Pills, a weeks worth. A daily reminder that at 45 yrs old my body is not well.”
“Cat, her name is Millie, I call her Mimi. She follows me everywhere & loves me unconditionally, skinny or fat. Since I became diabetic I am 70lbs heavier.”
“For years, I think I was in denial... I did not want diabetes & thought it was an older person’s disease”
“Teresa”48 y/o female
Nixa, MOConditions: Diabetes, high
blood-pressure, high cholesterol
“I’m on medication to combat high-cholesterol... I don’t want to be on any more medication... In February 09 my A1C was over 8. I know I need to do something.”
“Even with physical problems, there were times over the last eight years when I did use my treadmill or take walks. I did lose some weight and feel better when I did.”
“Controlling sugar levels is a lifetime commitment. I am eating smaller amounts. I am almost a vegetarian”
“I used to work in construction, dirt work, and asphalt work. I think this has effected my breathing”.
“Sam”67 y/o male
Springfield, MO(CD Risk)
Conditions: High blood-pressure, asthma,
allergies, leg disabilities, overweight
“I have high blood pressure. I think I eat too much pizza and beer maybe. I have to cut down on these things. I seem to eat too much fast food and this has caused me to gain weight.”
“I go to my doctor at SGC (clinic) in Springfield. I have a handicap Parking pass since I can’t walk very far.”
“I use a lot of medicine now. This is for my blood pressure and breathing. Allergy medicine too.
“Mary”Chronic Disease Case Manager, RN
Springfield, MO
•“We've moved into a new level of nursing.•”Working with our chronic disease patients requires patience, empathy
and persuasion.” •“Our medical management database equips our team to see the whole
system picture down to the patient level.”
“what if?”
What kinds of service tools and motivational supports could help people with chronic disease, and people at risk, better manage and improve their health? How can we make it easier for them to succeed and harder to fail?
Tentative Recommendations
1. Focus upstream: target people across a wellness spectrum– from well, to at-risk, to sick. Offer a network of incentives and supports appropriate to their individual situation.
2.Develop a platform of effective psychological, socio-cultural, and spiritual affordances to enable positive behavior and lifestyle changes.
3.Augment existing medical management, prevention, and wellness programs with integrated service tools that empower people to monitor and self-manage their health.
Create a culture of wellness empowerment
Healthy, good diet, high activity level, no signs of a chronic disease. Healthy, good diet, moderate to high activity level. Age and lifestyle may start to create favorable variables of chronic disease. Moderately healthy, moderate diet, little to no activity level. May start to show signs of a chronic disease. Moderately healthy, moderate diet, little to no activity level. Starting to show definite signs of chronic disease, or diagnosed with a pre- condition. Health problems associated with a diagnosed chronic disease. Daily activity level is affected. Treatments plans advised. Severe health problems associated with a diagnosed chronic disease. Daily activity level is impaired. Hospitalization required.
1
2
3
4
5
6
Track the status across a wellness spectrum
1 2 3 4 5 6GOOD HEALTH AT RISK POOR HEALTH
1 2 3 4 5 6GOOD HEALTH AT RISK POOR HEALTH
Work with people where they’re at
John “Mr. Indestructible”
Age: 26Non-Profit Admin
MBASingle
Weight: 150 lbsHeight: 5’-8”
High cholesterolNon-smoker
Margo “Ms. Denial”
Age: 45High School StafferMarried, 2 Children
Weight: 175 lbsSedentary, Overweight
High cholesterolNon-smoker
➔➔
Stuart “Down but not out”
Age: 63Retired Salesman
Married, 2 ChildrenWeight: 165 lbs
High blood pressureDiabetes
Melanoma
➔
• “My Health Network”. Live health & wellness resources;
special health topics forums; peer mentoring and motivational coaching; real-time online “nurse/physician-
on-call”; health behavior is self-directed, personal, social
networking-type site, appropriate positive reinforcements.
• “My Health Portal”. Personal health dashboard for ages 14
& up); pertinent health and wellness content; health
tracker with real -time data feeds charted over time; lifestyle and simple diagnostic calculators; goal-setting
and achievement tools; future health scenario projections;
incentive programs and competitions for improving health
indicators, e.g., blood pressure, cholesterol, and tracking
them over time”.
Two Service Design Concepts
*
*
The Service Technology Platform
“My Health Network”
“My Health Portal”
WELLNESSCONCIERGE
MY HEALTH PORTAL
SOCIALIZATION MOTIVATION
EDUCATION
Sports Leagues
Clubs & Groups
Virtual Social Networks
Community Activities
Social “Meet Ups”
Travel Connections
Wellness Counselors
Peer Mentoring
Discount Programs
Customized Incentives
Spiritual Support
Support Groups
E-Health Record
Physician Database
Medical Treatment Information
Financial Strategies
Mental Health Strategies
Physical Activity Strategies
Classes and Training Live Health Chat
COACH
“My Health Network”
Margo uses the Wellness Concierge to help take her likes, dislikes and priorities to find a Health Network that works great for her.
She now attends a Cooking with Diabetes class where she learns of recipes to try out with her new friends in the Dinner Club she attends. She is also working on a weight loss goal of 20 pounds to win a free, year-long gym membership.
With this network, Margo is well on her way to lowering her chronic-disease risk, and enjoying a new, active life.
Margo•Likes to cook •Wants to lose weight•Wants to exercise•Concerned about diabetes
MARGO’S RISK
LEVEL
1 2 3 4 5 6
Socialization: Dinner Clubs
Motivation: Free Gym Membership
Education: Cooking Class
User Profile
“My Health Network”
Technology Mashup
© Cara Miller, Boxspring Design
My Health Web Portal UI
Copyright Ricarda Miller
© Cara Miller, Boxspring Design,
Concept SketchMy Health Web Portal UI (drill-down)
Copyright Ricarda Miller
Better Everyday
HealthyServing
CustomCook
GetInvolved
My Health Web Portal UI (mobile apps)
Copyright Ricarda Miller
http://www.youtube.com/watch?v=83nu-xaR3iw&list=PL93019A1526FC1BE6&ind
ex=32&feature=plpp_video
http://www.youtube.com/watch?v=6xWs59b7_vw&list=PL93019A1526FC1BE6&index=25&feature=plpp_video
http://www.youtube.com/watch?v=pnyAllwb7SQ&feature=related
http://www.youtube.com/watch?v=ccZVAak11kY&feature=related
My Health Network:
Service Video Prototype
My Health Portal: Smartphone App Video Prototypes
click links to
view
*This study evaluated the burden of seven of the most common chronic diseases/conditions (cancer, diabetes, heart disease, hypertension, mental disorders, pulmonary conditions, and stroke). Source: The Milken Institute
Lost economic output (indirect)
Treatment expenditures (direct)
2004 06 08 10 12 14 16
$1200
$1000
$800
$600
$400
$200
$0
18 20 22 2023
What Cost Savings Accrue from ImprovedChronic Disease Prevention and Management?
(in Billions)
Savings By Year of Lowered CD Risk Factors
➔
2009
$190
$180
$170
$160
$150
$140
2010 2011 2012 2013 2014 2015 2016 2017 2018
Lowered CD risk of 10% of the populationwould save $1.65 trillion over 10 years, and save over 1 million lives.
1 2 3 4 5 6GOOD HEALTH AT RISK POOR HEALTH
Want a sustainable health care solution?
Here’s it takes:
“Get a little healthier. Stay a little fitter. Eat a little less. Walk and exercise a little more. Oh, and get a check-up
more often. In other words, take responsibility for getting yourself and your family healthier, and in return
you and everybody else can have quality, affordable health care services over a longer life.”
title slide
Service Innovation Design & Development
by Michael Eckersley, PhDHumanCentered
Except where otherwise noted, this work is licensed under a Creative Commons Attribution 3.0 License.
Service tools for innovating chronic disease management