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. 1. Introductions
2. Audience Survey
3. About us - Who is Wellbe

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

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

5. Pop Quiz
What is Meaningful Use Stage 2?
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
1. Improving the patient experience of care
2. Improving the health of populations
3. 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 Foundational Concept
The Triple Aim is a prevalent influencer in all major
healthcare transformational initiatives
ONC CMS CHT ACA
Triple Aim

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
1. Lower the cost of therapies and treatments
2. Improved efficiency in care delivery
3. Improved choice-making
4. Mitigating risks

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

20. Improving Outcomes
1. Measurable Functional Achievements
2. Patient reported Outcomes Measures (PROM)
3. Monitoring Activities of Daily Living
4. 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.

21. Evaluating Technology

22. Primary Focus
Evaluated technologies that serve
value-driven delivery and reimbursement models
Improve the
Patient Experience
Improve the
Health of Populations
Reduce Per
Capita Cost of Care
Evidence? Investment?

23. Findings
The vast majority of companies did not meet
the intent of the Tripe Aim
“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.”

24. More findings
Missing the mark!
“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. “

25. Case Study
Refilling Prescriptions in a
Patient Portal

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
The Stanford d.school Design Thinking Process
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

32. The 4 Basic Steps
The Rotman School’s “Business Design”
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

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, 10th 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. Forging A New Framework
Methodology of
Design thinking
Framework
Of the Triple Aim
Popula on Health
Experience of Care Per Capita Cost

38. Triple Aim Design Thinking
Two strategies

39. Use Three-stakeholder 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. Pop Quiz
Name one of the more popular apps
or sites that people use for their
healthcare.
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. Pop Quiz
What is the largest segment of the
healthcare consumer market?

49. Pop Quiz

50. Showcase - Virtuwell

51. Showcase 1 - Virtuwell
Screenshot

52. Showcase 1 - Virtuwell
Screenshot

53. Showcase 1 - Virtuwell
Screenshot

54. Showcase 1 - Virtuwell
Screenshot

55. Showcase 1 - Virtuwell
Screenshot

56. Showcase 1 - Virtuwell
Screenshot

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

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

60. Triple Aim Design Thinking
Exercise

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

62. Case Study – Screens
Screen Shots

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

64. 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

65. 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?

66. Nota bene:
Ignore technical constraints!

67. 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
meeting the Triple Aim?
Ignore technical constraints!

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

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

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

71. James Dias – CEO
dias@wellbe.me
Lucas Dailey – Senior UX Designer
lucas.dailey@wellbe.me
Deck on Slideshare – tweet #TripleaimDesignthinking