Service Tools For Innovating Chronic Disease Management


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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:
2. Service tool concept: "Healthy Serving"
3. Service tool concept: "Better Everyday"
4. Service tool concept: "Custom Cook"

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.

Published in: Health & Medicine, Business
  • A 2013 update is posted here:
    'The Prescription Mobile App For Chronic Disease Management'
    Are you sure you want to  Yes  No
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  • Here’s some recent follow-up video service prototypes developed by Interaction Design grad students at Univ of Kansas:

    1. Margo & My Health Network

    2. Service tool concept: ’Healthy Serving’

    3. Service tool concept: ’Better Everyday’

    4. Service tool concept: ’Custom Cook’

    Best, -Michael
    Are you sure you want to  Yes  No
    Your message goes here
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Service Tools For Innovating Chronic Disease Management

  1. 1. title slide 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, PhD HumanCentered UPDATE: “The Prescription Mobile App For Chronic Disease Management”, by Michael Eckersley, PhD the-prescription-mobile-app
  2. 2. 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 from The University of Kansas, School of Architecture, Design & Planning Jeffrey Albritton Lu Bever Randall Blair Rachel Magario Care Miller Tom Petty Hedi Heinz Jennifer Knight Kevin Lafferty Mason Pine Angel Stahl Denise Staples Employers Health Network* Medical Management Services Springfield, Missouri St. John’s Health Plans* Medical Management Springfield, Missouri Janet Pursley, RN Ann 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.
  3. 3. “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.”
  4. 4. The Premise
  5. 5. 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.
  6. 6. Our Study
  7. 7. Our Activities – adapted from V. Kumar, ID-IIT & IDEO MAKE UNDERSTAND REALIZE frame insights form hypotheses know context & users • health care industry modeling • bench research chronic disease • interviews (cdm professionals) • disposable camera study • ethnographic interviews (patients) articulate intent explore concepts make plans represent & prototype offerings research & discovery 1 2 3 4
  8. 8. 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 Learning Cycle 1 (time) 0 1 2 3 4 4 3 2 1 High Deep SystemsScope
  9. 9. back stage wellness, prevention and health management services front stage services econom ics customer experience technology what’s viable? what’s feasible? what’s desirable?
  10. 10. “what is” The economics, institutional, and market factors around chronic disease global macro economic market/industrial organizational
  11. 11. 20,000 classifiable diseases
  12. 12. cardiovascular disease Data Source: National Health Library, NIH Rendered with Many Eyes, IBM
  13. 13. diabetes Data Source: National Health Library, NIH Rendered with Many Eyes, IBM
  14. 14. chronic obstructive pulmonary disease Data Source: National Health Library, NIH Rendered with Many Eyes, IBM
  15. 15. cancer (neoplasms) Data Source: National Health Library, NIH Rendered with Many Eyes, IBM
  16. 16. liver cirrhosis Data Source: National Health Library, NIH Rendered with Many Eyes, IBM
  17. 17. asthma Data Source: National Health Library, NIH Rendered with Many Eyes, IBM
  18. 18. These six diseases account for the vast majority of deaths, disabilities & health care costs asthma liver cirrhosis cancer COPD cardiovascular disease diabetes
  19. 19. 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.
  20. 20. 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 H eart D isease Blood Poisoning Kidney D isease Influenza & Pneum onia CO PD A ccidents D iabetes A lzheim er’s ✔ ✔ ✔ ✔ ✔ Leading Causes of US Deaths, 2006
  21. 21. 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
  22. 22. Chronic Disease Prevalence Among American Workers, 2007 None 23% One 22% Five or more 19% Four 8% Three 12% Two 16% Source: Newsweek Web Exclusive
  23. 23. 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% Pulmonary Conditions 31% Heart Disease 41% ➜ ➜ ➜ ➜ ➜ ➜➜ Source: The Miliken Institute
  24. 24. 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
  25. 25. scope of health care services, facilities, personnel
  26. 26. 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
  27. 27. preventive health services Rendered with Many Eyes, IBMData Source: National Health Library, NIH
  28. 28. managed care programs Rendered with Many Eyes, IBMData Source: National Health Library, NIH
  29. 29. ...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
  30. 30. 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 Pulmonary Conditions Heart Disease Mental Disorders Hypertension Cancers 0 50 100 150 200 250 300 $
  31. 31. Health care expenditures in the US are highly concentrated, with 5% of the patient population accounting for 49% of costs. Relatively Healthy 51% Sickest 28% Very Sick 21% Health Care Costs $ $ $ Patient Population Relatively Healthy 95% Sickest 1% Very Sick 4% Reducing these numbers even slightly will result in large system savings
  32. 32. The human costs of chronic disease are much higher
  33. 33. "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, MD Columbus, Ohio
  34. 34. 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”
  35. 35. 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”
  36. 36. What’s Needed: A Truly Patient-Centered Managed Care Model
  37. 37. dig here physical/biological socio-cultural psychological spiritual “what is” The human factors of chronic disease
  38. 38. 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
  39. 39. 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”
  40. 40. “Asthma: another word for frustrating” “Marcus” 5 y/o male Sparta, MO Conditions: Asthma, Heart Mom & Dad: “Stacy & Ron”
  41. 41. “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.”
  42. 42. “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”.
  43. 43. “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, MO Conditions: Type 1 diabetes, hypothyroidism, hypertension, asthma, severe allergies, depression & anxiety
  44. 44. “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.”
  45. 45. “Pills, a weeks worth. A daily reminder that at 45 yrs old my body is not well.”
  46. 46. “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.”
  47. 47. “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, MO Conditions: Diabetes, high blood-pressure, high cholesterol
  48. 48. “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.”
  49. 49. “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.”
  50. 50. “Controlling sugar levels is a lifetime commitment. I am eating smaller amounts. I am almost a vegetarian”
  51. 51. “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
  52. 52. “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.”
  53. 53. “I go to my doctor at SGC (clinic) in Springfield. I have a handicap Parking pass since I can’t walk very far.”
  54. 54. “I use a lot of medicine now. This is for my blood pressure and breathing. Allergy medicine too.
  55. 55. “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.”
  56. 56. “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?
  57. 57. 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.
  58. 58. Create a culture of wellness empowerment
  59. 59. 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 6 GOOD HEALTH AT RISK POOR HEALTH
  60. 60. 1 2 3 4 5 6 GOOD HEALTH AT RISK POOR HEALTH Work with people where they’re at John “Mr. Indestructible” Age: 26 Non-Profit Admin MBA Single Weight: 150 lbs Height: 5’-8” High cholesterol Non-smoker Margo “Ms. Denial” Age: 45 High School Staffer Married, 2 Children Weight: 175 lbs Sedentary, Overweight High cholesterol Non-smoker ➔➔ Stuart “Down but not out” Age: 63 Retired Salesman Married, 2 Children Weight: 165 lbs High blood pressure Diabetes Melanoma ➔
  61. 61. • “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
  62. 62. * * The Service Technology Platform “My Health Network” “My Health Portal”
  63. 63. WELLNESS CONCIERGE 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”
  64. 64. 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”
  65. 65. Technology Mashup
  66. 66. © Cara Miller, Boxspring Design My Health Web Portal UI Copyright Ricarda Miller
  67. 67. © Cara Miller, Boxspring Design, Concept SketchMy Health Web Portal UI (drill-down) Copyright Ricarda Miller
  68. 68. Better Everyday Healthy Serving Custom Cook Get Involved My Health Web Portal UI (mobile apps) Copyright Ricarda Miller
  69. 69. xaR3iw&list=PL93019A1526FC1BE6&ind ex=32&feature=plpp_video v=6xWs59b7_vw&list=PL93019A1526F C1BE6&index=25&feature=plpp_video v=ccZVAak11kY&feature=related My Health Network: Service Video Prototype My Health Portal: Smartphone App Video Prototypes click links to view
  70. 70. *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 Improved Chronic Disease Prevention and Management? (in Billions)
  71. 71. 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 population would save $1.65 trillion over 10 years, and save over 1 million lives. 1 2 3 4 5 6 GOOD HEALTH AT RISK POOR HEALTH
  72. 72. 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.”
  73. 73. title slide Service Innovation Design & Development by Michael Eckersley, PhD HumanCentered Except where otherwise noted, this work is licensed under a Creative Commons Attribution 3.0 License. Service tools for innovating chronic disease management