Architecture Before Experience - EuroIA Amsterdam 2016
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This document provides an overview of key topics in healthcare, including population health, healthcare spending, outcomes, quality of life, patient experience, and digital health trends. Some key points: - US healthcare spending reached $3 trillion in 2014, or $9,523 per person, with 47% from public sources. However, 30% of Medicare payments cover the last year of life and 40% the last month. - Life expectancy has increased but quality of life is also important. By 2050, 10% of people in OECD countries will be over 80, up from 4% today. Many older adults have multiple chronic conditions. - The Triple Aim framework aims to improve patient experience of care, improve population
Architecture Before Experience - EuroIA Amsterdam 2016
- 3. 1,863 B Corporations 50 Countries
- 4. $38 bln $3.6 bln $79 bln $4.8 bln $7 bln $4.2 bln $2.2 bln $2.6 bln
- 5. Why should I spend my time listening to you? Because you cannot build a better world on your own.
- 6. 1. Population Health 2. Healthcare Strategy 3. Patient Experience
- 7. I am not going to talk about which healthcare system (US/EU) is better.
- 8. Healthcare Healthcare Players Health Outcomes Health Factors Policies and Programs Healthcare Delivery Healthcare Strategy Patient Experience Hospital-based Health SystemsPopulation Health Infrastructure Education Economic Development
- 10. In 2014 U.S. national health spending reached $3 trillion, or $9,523 per person. Sources: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group.
- 11. Sources: IMF, WB, UN, CIA
- 12. World Bank Data http://data.worldbank.org
- 13. World Bank Data http://data.worldbank.org
- 14. World Bank Data http://data.worldbank.org
- 15. World Bank Data http://data.worldbank.org
- 16. Health expenditure, total (% GDP) World Bank Data http://data.worldbank.org
- 18. As a sector, healthcare makes more profits when you are sick.
- 19. In 2014, 47% of the U.S. national health spending was public. Sources: Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group.
- 20. More important than who’s paying and how much, is what do we do with the money?
- 21. Population Health The health outcomes of a group of individuals, including the distribution of such outcomes within the group.
- 22. Outcomes You stay healthy as long as possible. You die.
- 23. Life expectancy at birth, total (years) World Bank Data http://data.worldbank.org
- 24. USA vs OECD
- 25. Life expectancy at birth in US by ethnicity Source: http://kff.org/other/state-indicator/life-expectancy-by-re/
- 29. People are living longer, but are they healthier? HLE – Healthy Life Expectancy (United States) 72.7% of total life (all sexes, all races) HLY – Healthy Life Years (European Union) 79 % (women) and 74 % (men) of total life
- 30. Source: Eurostat
- 31. Source: CDC
- 32. By 2050, 10% of the people in the OECD countries will be aged over 80, compared to 4% today. 60% of the people aged between 65 and 74 suffer from at least one chronic condition, and, from the age of 75, many have three or more. Source: IDC Health Insights
- 33. Medicare is a national social insurance program for Americans aged 65 and older, and younger people with some disabilities. In 2015, Medicare provided health insurance for over 55 million—46 million people age 65 and older and 9 million younger people. (1966) Medicaid is a government insurance program for persons of all ages whose income and resources are insufficient to pay for health care. (1965) 30% of Medicare payments cover the cost of care for people in the last year of life. 40% of Medicare dollars cover care for people in the last month. 10% of Medicare beneficiaries account for 70% of program spending.
- 34. The less money spent in this time period, the better the death experience is for the patient. It seems that no matter how much money you use during that last year/month, if the person is sick enough, the effort makes things worse. A lot of the money being spent is not only not helping, it is making that patient endure more bad experiences on a daily basis. The patient’s quality of life is being sacrificed by increasing the cost of death. - Michael Bell, Forbes (2013)
- 35. Financial Security Medical expenses represent 62% of all personal bankruptcies. 78% of people filing for bankruptcy had some form of health insurance. Source: Harvard University
- 36. As a sector, healthcare will no longer make profits off a sick, poor, and aging population.
- 37. The healthcare business model is disrupted by the transition from volume to value.
- 38. Of all the forms of inequality, injustice in health care is the most shocking and inhumane.” Dr. Martin Luther King, Jr. “
- 39. Per Capita Cost Population Health Experience of Care Institute for Healthcare Improvement (2008) Triple Aim
- 40. Health Outcomes Health Factors Policies and Programs Length of Life 50% Quality of Life 50% Clinical Care 20% Social & Economic 40% Health Behaviors 30% Physical 10% Source: University of Wisconsin Population Health Institute © 2014 Population Health Tobacco Use Diet & Exercise Alcohol & Drug Use Sexual Activity Air & Water Quality Housing & Transit Education Employment Income Family & Social Support Community Safety Access to Care Quality of Care
- 41. Health Outcomes Health Factors Policies and Programs Clinical Care 20% Social & Economic 40% The Patient Protection and Affordable Care Act (2010) Financial Security Access to care Quality of care Obamacare Patient Satisfaction 30% Patient Outcomes 70%
- 44. Customer Satisfaction Is Expected Source: ACSI American Customer Satisfaction Index © 2015
- 46. Do we measure what matters? (HCAHPS)
- 47. Do we measure the same things?
- 51. 19% The experiences and interactions from a patient's single visit 17% Any experiences the patient has within our facility over multiple visits 33% All experiences the patient has with our system of care over multiple visits 31% All things related to a patients health 19% 100%36% 69%CUMULATIVE The place of the journey Source: GE Healthcare – Patient Experience Survey
- 52. The frequency of the journey Source: GE Healthcare – Patient Experience Survey 5% 10% 5% 39% 16%6% 9% 4% 9% 8% 3% 10% 5% 9% 7% 3% 9% 11% 7% 21% 11% 15% 15% 6% 10% 14% 37% 31% 28% 17% 26% 17% 11% 16% 49% 26% 53% 40% 43% 70% 22% 35% Not once Once Twice Three Times Four times 5+ Times Obtained health insurance Proactively managed health Found a healthcare facility/doctor Visited a doctor (existing condition) Visited a doctor for tests Received emergency health services Filled prescriptions Handled payment for services PRE-VISIT POST-VISIT
- 53. Journeys within the journey
- 54. The length of the journey Worried well Pre treatment Active treatment Post treatment Prospective patient Inpatient Outpatient Discharged patient Former patient access, website, patient portal, call center, CRM, social media, scheduling, admissions, 2nd opinion, referrals, registration, authorization non-clinical experiences; patients, family, friends, parking, food service HCAHPS Experiences billing, collections, payment plans, claims, scheduling, therapy, appointments, discharge, disputes
- 56. An average life Years Cost 75% of the cost in the last 25% years of life
- 57. Health Systems 3rd party tools Startups Individuals High skills High costs Transfer knowledge, decrease costs
- 58. Trends affect disease states and procedures differently, creating distinct market dynamics
- 59. Industry changes will create opportunities to redefine business models and enter new markets
- 60. Consumer solution companies Payers Life Sciences Patients Providers New devices and solutions will enable new health plan offerings. Clinical solution companies Device and service around therapeutics will facilitate the transition toward value based care. Better ability to manage own health, with more wearable devices that will speed up the self-care model. Opportunities to new sources of data to improve delivery timing, quality, and outcomes. Entering regulated healthcare markets Adopting consumer centric design principles A new era of digital health solutions
- 61. Digital maturity in healthcare
- 62. Healthcare startup funding Source: Startup Health © 2016
- 63. Healthcare startup map Source: Kelvin Chan © 2016
- 64. mHealth Source: IMS Institute for Healthcare Informatics © 2015 165,000 healthcare consumer apps 36 apps account for ~50% of all downloads 40% of apps have fewer than 5,000 downloads.
- 65. From ineffective electronic health records, to an explosion of direct-to-consumer digital health products, to apps of mixed quality ... This is the digital snake oil of the early 21st century.” James L. Madara, MD Executive Vice President and CEO American Medical Association June 11, 2016 “
- 67. Healthcare Business Objectives PATIENT ENGAGEMENT CUSTOMER SATISFACTION BRAND DATA QUALITY MARKET SHARE CULTURE ACCESS GROWTH OUTCOMES Emerging: Architected Customer Experiences Minimum Viable Product Lean Startup
- 68. Map the patient journey
- 69. Understand people, and help them understand CURRENT Meaningful Use EMERGENT STARTUPS CRM Brand Awareness Brand Preferences Clinical Data Referrals EHR Patient Portals Claims ProcessingReduce Leakage Revenue Cycle Management Dashboards Predictive Modeling Grow Employed Physician Base EMR Care Management Alternative Financing Patient Engagement Consumer Education Wellness & Lifestyle Wearables Consumer Diagnostics TelehealthGenetics Therapy Quality Metrics Reporting
- 70. Architect your strategy along the way CURRENT Meaningful Use EMERGENT STARTUPS CRM Brand Awareness Brand Preferences Clinical Data Referrals EHR Patient Portals Claims ProcessingReduce Leakage Revenue Cycle Management Dashboards Predictive Modeling Grow Employed Physician Base EMR Care Management Alternative Financing Patient Engagement Consumer Education Wellness & Lifestyle Wearables Consumer Diagnostics TelehealthGenetics Therapy Quality Metrics Reporting Awareness Research Primary Care Selection Hospital ER Specialist 1 Lab/Tests Specialist 2 Pharmacy My Account Pay My Bill Care Plan
- 71. Healthcare spending is inefficient and unsustainable. Treat people when they are sick, but shift resources and knowledge to help them stay healthy. A healthier population provides higher returns than any short-term financial gains. Bring your skills to healthcare business disruptors to assist people on their health journey.
- 72. Source: Peter Jones, OCAD University • Communication • Promotion and advertising • Branding and identity • Patient literature • User experience design • Service design • Product design • Informatics and decision support • Product team collaboration • Organizational processes • Business system design • Participatory leadership • Cross-functional teams • Business, process, and practice innovation • Social impact • Population health • Social innovation • Participatory research
- 73. Adapted from Milan Guenther’s Enterprise Design Model
Editor's Notes
- #2: Hello! Welcome to my talk. How’s everyone doing? I’m really glad to be back in Amsterdam. I was here in 2008 for EuroIA and 2012 for The Web and Beyond conference. You have an amazing city that always gives me energy and hope.
- #3: This is a picture I took two months before the US elections. This time I was looking for some Bernie Sanders stickers. No luck!
- #4: So I come from Richmond Virginia, where I work for a benefit corporation called Impact Makers. There are not a lot of benefit corporations in the world, but you might already recognize a few brands on this screen. As a new legal entity we are known for donating our profits to community and charity partners. Although the legal statutory requirements are 10%, my company donates 100% of its profits.
- #5: We also like tackling big problems, such as healthcare, and we work with a few companies in this space. Both payers and providers. Those are yearly revenue numbers. So why am I here?
- #6: Actual quote from the movie. And it’s true. You can’t. Especially in healthcare.
- #7: I am here to talk about the issue of population health, healthcare strategy, and patient experience, mostly in a hospital-care environment. And because the theme of the conference is connected things among us, I want to show you how these three things connect, and where you can help as UX designers. I really want to see more UX people working in healthcare.
- #8: [slide] The issues that we are going to talk about today affect every healthcare system in the world.
- #9: So although I work in UX, I’m a development economist by training, and I still have an attachment for sectors that contribute to the economic development of any country: infrastructure, education, health. So, today, we’ll be following this horizontal continuum.
- #10: Every time you interact with healthcare, you interact with one of these players.
- #11: In United States all those players (combined) eat $3 trillion dollars a year. That’s pretty big in itself, but …
- #12: … to give you a sense of scale, let’s remember that there are only 4 countries in the world with a GDP higher than 3 trillion dollars.
- #13: I’m going to skip pretty fast over the slides that show you the breakdown of spending. Total …
- #14: Public …
- #15: private
- #16: And out-of-pocket. Which a sub-category of private spending.
- #17: So there are at least two big areas of concern: Health expenditures are eating too much of every country’s GDP.
- #18: And 2. Healthcare spending goes up at a faster rate than the rate of the GDP growth. So I don’t think these are the trends that we should encourage or sustain.
- #19: This might sound like common sense, but it’s not that simple. Please stay with me on this one for a while. Because this is about to change.
- #20: Also, the argument between 100% public or 100% private healthcare is not the argument that needs to be won here. United States is 53% away from the single-payer model that most of you experience. The conversations around risk pools are more important.
- #21: And [slide] What are the health outcomes?
- #22: When we talk about health outcomes at large scale, we talk about population health. And there two important outcomes: One you desire. And you can’t avoid. Yet.
- #23: People tend to favor the first one. Really, this is what everyone is trying to do. Remember what I said about risk pools? To the healthcare systems, we, all of us, are a risk. Healthcare systems were setup to treat sick people. They are not setup to keep you healthy. They don’t know how to do that yet. There are not enough mechanisms in the system to help you avoid sickness.
- #24: One of the measures of health outcomes is the length of life. And that’s been going up consistently.
- #25: Yes, United States is not seeing great returns compared to OECD countries. But these are averages. By country, internal factors matter a lot.
- #26: 12 years difference between African-Americans and Asian-Americans. It’s not the ethnicity that makes the difference here. It’s the factors and conditions that affect each ethnicity. Going back to health factors, and economics.
- #27: Rich women live longer than poor women, regardless of the race.
- #28: Rich men live longer that poor men. Healthcare is a social justice issue, too. Make no mistakes about it.
- #29: But income alone doesn’t seem to matter, when other factors come in place. Costa Rica and Cuba achieve pretty much the same outcome as Norway and United States, with 4 or 5 times less money.
- #30: In US we measure this in Healthy Life Expectancy, And Healthy Life Years in the European Union. 25% of your life is not healthy. And that’s if you are a happy average.
- #31: On average in EU you live 60 healthy years. But there are 20 years difference between Latvia and Malta. Sorry Latvia!
- #32: In US, if you are lucky, 72% of your life is healthy. But you also have almost 20 years difference between Mississippi and Vermont.
- #33: When you are old and sick, the chances are that you have between 1 and 3 chronic health conditions. In US chronic condition care eats 86% of the healthcare spending.
- #34: Also, most of the spending happens in the last year, or the last month of your life.
- #35: With tragic results. You spend everything waiting to die. Are you looking for an area to contribute as an UXer? Palliative care can be a big one.
- #36: I don’t think I have to comment anything on this one.
- #37: These were a few reasons why things are going to turn. But [slides] Remember risk pools? Healthcare systems don’t have a financial incentive to have you sick. It costs too much to treat you. It kills their profits. They would rather have you healthy. And that’s exactly what you want.
- #38: But they don’t have yet a business model to do that. They are trying to figure this out. And this is the perfect time for you, as UX designers, to step in. There are two reasons to fix this: Access to care should be a right everywhere. These trends are not sustainable.
- #39: I’m going to let you read this. Keep this in mind: we are not doing this to help healthcare get their profits back. We need to keep them in business for their knowledge and skills. We can’t do this alone. But we are doing this because it’s human.
- #40: Efforts are made. The Institute for Healthcare Improvement established that improving a health system requires improving: the health of populations the experience of care, and reducing per capita costs of health care. It’s called Triple Aim.
- #41: We talked about health outcomes: length of life, and quality of life. Let’s look at the Health Factors for a second. Clinical Care and Social and Economic Factors are two areas of interest here.
- #42: Social and Economic factors through Financial Security. And Clinical Care through Access to Care, and the Quality of Care. This is what Obamacare, as a Law, is changing. And as UXers, the Quality of care is where you can contribute most. So we have Patient Outcomes, and Patient Satisfaction.
- #43: When you get discharged from a hospital, you are not going home healthy. You are going home clinically OK. The chances are you are going to come back. And readmission rates affect a lot of things. Like reimbursement rates, and how money change hands, Between your Insurance, your Provider and the Government.
- #44: Your satisfaction is measured differently, depending on who are interacting with.
- #45: And Customer Satisfaction is expected in every industry. We can do better, if we provide the right outcomes.
- #46: Customer Satisfaction Pays Off. Pretty much every type of hospital records higher net margins that are directly correlated with excellent levels of satisfaction.
- #47: Sometimes we measure what matters to people, but sometimes we don’t. In grey are elements that patients care for, but are not recorded in the standard hospital surveys.
- #48: In fact, depending on the type of feedback, we are collecting different factors impacting the satisfaction of healthcare consumers.
- #49: But we start to understand how often, and how much touchpoints matter.
- #50: We start to understand how hard or easy is to change certain things.
- #51: But maybe we are focusing too hard on the touchpoints, when the journeys matter most.
- #52: At the moment, only 31% of providers designed their patient experience around all things related with their patient’s health. So think about this in terms of system design. How many organizations understand the need?
- #53: Now we understand the frequency of the journeys.
- #54: And the journeys within the journey.
- #55: We get some visibility in the length of the journeys. And the things that matter there.
- #56: Now, based on these averages, do you think health providers pay enough attention to you? It’s less than an hour a year. You spend way more time in the waiting room. It’s frustrating.
- #57: This could turn out to be your life, And you realize that you haven’t received all the help, advise, and direction, that you needed to be or stay healthy.
- #58: People are trying to stay healthy by themselves now. Start-ups build solutions that Healthcare Systems can’t offer yet.
- #59: And you’ll notice how the market dynamics will be changing over time based on this knowledge transfer to the patients, and their own engagement. But we still need physicians and their knowledge.
- #60: It’s just a change in balance. More focus on outcomes, personal care, wellness, nutrition, genomics.
- #61: Clinical and consumer principles are coming together to create a new era of digital health solutions.
- #62: In digital, healthcare is not a very mature sector. But we’ve all seen the benefits, and the value that got created (especially in retain and banking) for the consumers.
- #63: And that’s why startups are finding so many opportunities. Because they have the ability to change a stagnant sector.
- #64: And these are the areas that startups are targeting. The exact same areas where the healthcare sector is weak. The South-West side of this is the most important. People looking for help, and looking to stay healthy at a lower cost.
- #65: A lot of the funding goes toward mHealth, or mobile Health. Yes, this is an overload of apps. With so many options, and without guidance from their healthcare provider, patients may either choose: the most popular apps or try several to determine what’s best for their particular situation. I’m not saying all of this is good. I’m just showing you some of the market dynamics. The results might vary.
- #66: In fact, some applications create a lot of problems. I understand his point of view.
- #67: This is serious stuff. There are real consequences to poorly working software, and poorly designed systems.
- #68: This is how hospital-based health systems are responding. It’s a pretty large strategy landscape. It you want to solve problems, if you want to change the system from the inside … You need to be familiar with it. Growth is a big one here.
- #69: The good news is … you have the toolbox to affect change. You know how to discover what people need, you know how to prototype, how to test, how to iterate, how to arrive at solutions.
- #70: You need to understand the ecosystem, and how the parts interact.
- #71: And even with the most simple journey you have the opportunity to architect a better experience. I could talk about every single step here, and show you how things interact.
- #72: To recap …
- #73: The healthcare is changing … Some are still in phase one, some are moving from phase 3 to 4. I’ve met a few visionaries. But even for them is hard to fight alone. They need you.
- #74: Here’s the biggest systemic opportunity you have. You have the power to inject so much human understanding in these big, clunky systems, that will force them to adapt. And after they adapt, their only way to stay alive, will be to care for people even more.
- #75: So be the change. If you can. Fight from the inside, fight from the outside, but bring care to health. We all need it.
- #76: I dedicate this to my father, who died 5 years ago, from a brain tumor, that developed from a misdiagnosed condition. It was one day after I returned from EuroIA in Prague.
- #77: Please ask me questions, I want to talk to you more.