Service Tools For Innovating Chronic Disease Management

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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

http://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


http://www.employershealthnetwork.com




“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


chronic obstructive pulmonary disease


cancer (neoplasms)


liver cirrhosis


asthma


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


managed care programs


...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


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


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


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)


Better Everyday

HealthyServing

CustomCook

GetInvolved

My Health Web Portal UI (mobile apps)


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

http://www.youtube.com/watch?v=83nu-xaR3iw&list=PL93019A1526FC1BE6&index=32&feature=plpp_video

















































































*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.


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.”

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Service Innovation Design & Development

by Michael Eckersley, PhDHumanCentered


Service tools for innovating chronic disease management

Service Tools For Innovating Chronic Disease Management

Health & Medicine

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producing

national health

daily activity

high activity

diagnosed

activity level

high blood