3. PROBLEM DEFINITION
How might insurance companies
engage their members to maintain
relevance in the healthcare value chain
and establish a competitive advantage?
How might we create
valuable touch points?
4. TOUCHPOINT
A point of interaction involving a
specific human need in a specific time
and space
7. Hailey
“I purchased insurance because it
is the responsible thing to
do…
I hate the billing process,
the system makes me feel
anonymous and lost. Wish there
was a ‘turbo tax’ for insurance”
8. HAILEY
Gets bill for
medical expenses
Clarifies with
insurance provider
Recognizes that it
is pointless
Asks to speak
to Supervisor
Doctor and prescription
charges are very high
Doctor is out of
network
Calls the
doctor’s office
Gets prescription changed &
referral to another doctor
Frustrated with
ignorance &
process
Annoyed because she
called to check first
9. Ted
“I purchased insurance because of the
tax I had to pay. I used it once and
it was a waste of time”
“I’m really busy and I take
take care of my self, eat well and
exercise. I wish there was a
way to benefit from what I do”
10. TED
$2000 tax bill
Search
Visits MD health
exchange
Seeks advice
less than $200
Looks for doctor
Books
appointment
6 weeks later
Ted gets prescription for "pain", and referral for
physical therapy
fills out new patient intake
premium = 300
13. Pay to Pay
-> premium -> co-pay ->
deductible
Customer Service
“waiting on the phone for
customer service about a bill”
Clarity & Understanding
“wish there was a turbo tax for
insurance”
Feeling Anonymous & Lost
“lost in translation”
PAIN POINTS
19. REMINDERS
+ add to dashboard
Remember to ask
Dr. Green about
a mammographyYou have had a
cold for 6 days. Dr.
Green is available
Tuesday
Make appointment
21. COGNITIVE BIAS:
IKEA EFFECT
Norton, M. I., Mochon, D., & Ariely, D. (2011). The'IKEA effect': When labor leads to love. Harvard Business School Marketing Unit Working Paper, (11-091).
22. HAILEY
Reoccurring
Headaches
Enters Info
On Healthcare
Dashboard
Triggers
Notification Referral Telemedicine
Appointment
“We Would Like To
Sent Your Health
Dashboard To Your
Specialist”
Appointment
With A
Specialist
Lunch =
Chinese
Food
Reminder Solution!
NEW
JOURNEY
OLD
JOURNEY
Accomplished! People get
Health Insurance to feel
responsible
BEFORE: The cost of
medication and a Specialist
prevent members from
reaching a resolution
23. USER TESTING
“I don’t have any health apps to speak off, but
would appreciate passive data gathering, if I
gained rewards for it”
“I prefer a tutorial to swipe through
that explains the options. Then I
would like to put what I like on each
page”
“These questions are abrupt, Ok .. i
guess a little personal…”
“My friends swear by the sleeping app… people
have different beliefs about losing weight but
something that explains the activity & food in an
easy to understand way would be great”
24. VALUE
• Create positive touch-points
• Triage patients
• Create knowledgeable providers who “know me”
• Bring value to doctor-patient interaction
• Reduce medication interactions
26. 1900s
<$100 per
year
1920s
expecting doctors
to cure them
1909 1st drug
to cure illness
Salvarsan
Cheaper Than
Rouge
Justin Ford
Kimball of Baylor
$6 a year for 21
day.
1933 H.J. Kaiser &
Dr. Sidney Garfie
AHA
adopted the Blue
Cross symbol in 1939
63%
1943 NO taxes on
insurance ?
1954 NO taxes
on insurance !
9%
History
• Healthcare began to evolve into its current
form back in the 1920s and 30s. It can be
linked to two pioneers: HJ Kaiser and JF
Kimball. They were visionaries who began to
combine the employer Insurance provider
and member model that typifies the structure
we see today.
• Till date only 63% of the population is
covered by Health Insurance
27. HAILEY
Reoccurring
Headaches
Enters Info
On Healthcare
Dashboard
Triggers
Notification
STEPS
Hayley suffers from recurring
headaches
She uses her phone to access the
Virtual healthcare app named
“Koala” and enters information
about her headache and what she
ate.
Hailey continues to enter
information about her diet and
headache frequency. This is
collected on her healthcare
dashboard
Healthcare dashboard? Eventually this triggers a
notification from Koala. “Hi Hailey,
we think your headache might
need a closer look. We would like
to send your Healthcare
Dashboard to your PCP” Hailey
Clicks “OK”
One hour later, Hailey gets a
referral to an Ear, Nose & Throat
specialist from the PCP. Koala
supplies Hailey with seven
different options.
Hailey chooses the specialist that
is available for a Telemedicine
appointment because she will not
have to take time off work and it
was the earliest available
appointment
Koala notification: “We would like
to sent your health dashboard to
your specialist. Is that OK? This is
a HIPPA compliant transaction.”
Hailey Clicks “OK”
Koala sends the health dashboard
over to the Ear, Nose & Throat
specialist.
At the appointment the Specialist
notices that there is a link between
Hailey’s migraines and eating out.
Perhaps it’s an MSG allergy?
He’s not definitive but he asked
her to continue recording her diet
and pay close attention to
additives and preservatives in the
food.
For lunch Hailey has Chinese food,
and experiences a major migraine.
She enters her symptoms into her
symptom tracker
Two weeks later, Koala care
reminds Hailey to submit her
healthcare dashboard. Haley
submits her dashboard to her
Specialist. He messages back
saying that he has received it and
will reply back
Within four hours the doctor
confirms the MSG allergy and
provides Haley with a couple of
options. Either to get tested for
MSG allergies, which is probably
redundant, get a prescription for
headaches or avoid MSG.
Hailey decides to fill one
prescription just in case she gets
weak and orders take out. She lets
the doctor know which
prescriptions from his list he
should write a script for and the
doctor send this directly to CVS
FEELINGS
Distressed that the headaches are
recurring. She is pessimistic and
frustrated because she has never
been able to resolve the problem.
She tentatively hopes that
diligence in keeping a record will
help her to resolve the problem.
Hailey is afraid to hope, and hates
the uncertainty.
Hopeful and anxious Hailey fluctuates between being
passionate about and comfortable
with the dashboard.
Hailey feels alarmed that there
might be something wrong. She is
keen to learn the cause. She is
satisfied to know that the data she
worked hard to create has been
helpful.
Accomplishment, success
achievement and a sense of
responsibility.
Feels optimistic about finding a
solution to her headaches and
pleased that she does not have to
miss work.
Feels safe and in control because
the Health dashboard is in Hailey’s
control
Hailey feels responsible, as she
has accomplished one more thing
on her to do list..The Specialist
feels confident, this will help him
understand Hailey’s story.
Disappointed to potentially lose her
favorite indulgence but excited
that she might not have to go on
medication. Besides the cost of
medication, Hailey feels that there
are lots of side affects to
medication so she is excited to
hear of other options.
She hates feeling sick, but thinks
her doctor might be onto
something. Hailey is engaged in
the process and optimistic about
the solution
Hopeful and anxious Elated! At first but then when she
realizes her favorite Chinese food
restaurant has tons of MSG she is
a bit sad
Resolution and happiness.
Success! Patient reported getting
insurance out of a sense of
responsibly. An insurance
company that makes people feel
responsible and productive as
important as making them healthy
WHAT PAIN
POINTS DOES
THIS
RESOLVE?
People report feeling lost. We hear
people say “Know Me” or “I wish
there was a turbo tax for health
insurance” Koala is a virtual guide
that keeps health insurance
navigation connected and clear..
Attributes like symptom checking
against other data gathered via
member’s cell phone personalizes
the experience.
Information members have on
themselves goes to waste either
because there is too much or too
little “patients that have chronic
diseases …can improve quality of
care by maintaining a journal …
these things help us understand
how the disease is progressing.
You can make much greater
quality improvements based on
this data” DR. B Singh
The healthcare dashboard mirrors
a generic patient intake form but
includes a summary or highlights
from the members activities and a
list of issues that concern the
member. As people begin to
measure themselves with different
devices and phone apps, the
excessive information is generated
is too much for a doctor to grasp in
a 15-minute appointment. This
summary helps patients and
doctors get the most out of the
appointment.
Creates a positive touch point.
Koala and is looking out for
potential problems. Also utilizes a
cognitive bias called the IKEA
effect “The increased valuation
that people have for self-
assembled products compared to
objectively similar products which
they did not assemble.” By
entering her own data, Hailey is
assembling her healthcare
dashboard that will help get her to
the solution
Currently members like Hailey
have 3-4 health related apps on
their phones, from diet/nutrition to
activity trackers to schedulers and
nothing is connected. Koala
integrates apps and aggregates
the data for a seamless
experience. Similar to the Amazon
shopping experience
People have busy lives. Koala
made sure Hailey had all the
resources at her fingertips. 80% of
Americans avoid Preventive care,
because of scheduling and it’s the
preventive care that makes a big
difference in costs
Each doctor’s office has a new
form. The health dashboard
should remove friction from the
process and make sure everyone
has identical information.
Patients forget their stories and
important details about their health
history. Gaps in their story can
lead to misdiagnosis. There are
thousands of health applications
and most people have three or
four on their phone but very few
doctors want all of the detailed
information as it is too much and
unorganized.
It takes a lot of time to get to the
bottom of the story with the patient
as often details are missed.
Doctors write prescriptions but
often people prefer non-
medication/holistic options.
Doctors are also the only human-
to-human touch point patients
have with insurance companies.
More value could be derived from
this interaction. The 15 minutes
that patients have with their
doctors leaves them wondering
“was this worth my time?”
Hates waiting for results! Previously the dashboard patients
might not know what details are
valuable for their doctor to know.
BEFORE OUR
INTERVENTION
WHAT
HAPPENED?
Hailey would have looked up her
conditions on WebMD. Their
symptom checker has only a 30%
accuracy rate. “43 percent of
Americans said that it is easier to
diagnose their own condition” but
this is not as effective as people
think
People enter and collect their data
all the time. It is rarely used to
benefit them or other people.
People often complete their annual
check up and then remember
something that had been
bothering them that they forgot to
mention. Often patients did not
know and are not told when to get
certain age and gender specific
screenings. When members enter
a doctor’s office the information
form is redundant and tedious and
they forget allergies and other
symptoms.
Insurance companies had fewer
touch points that were often about
making the customer pay more
money, or explain a confusing bill.
The quality of the experience was
poor. Members Members
experience cognitive bias. It is
referred to as loss aversion as the
costs increases starting with the
monthly premium report feeling
“dissatisfied”, “confused” and
“lost”.
With out this intervention Hailey
would have opened ZocDoc
directly and looked up a specialist,
then manually filled out the new
doctors form. This is tedious,
redundant and prone to human
error.
Telemedicine option is not widely
available to anyone. Before Hailey
would have to take time off to
travel to a Specialist. The cost of
transport and the time off is only
added to the cost of the Specialist.
“I wish I could afford to see my
specialist it’s just too expensive…
my problem is only getting worse”
Without the Health dashboard the
Specialist may have received
different information from the PCP.
In the old system the cost of
seeing the specialist was too
expensive, and what made it
worse was the cost of
prescriptions were also high.
People often drop out of the
process before getting a solution.
Previously people kept each of
these apps and their phones for
their own personal satisfaction.
Health problems are linked to
behavior. Mapping these can help
people and their doctors see the
links and determine better care
plans
Before the Specialist was very
expensive and would have to ask
the patient for the whole story.
Some patients become frustrated
because there is an assumption
that the medical records have this
information. Often the medical
records only have clinical data.
When retelling stories, details can
be forgotten and this can lead to
misdiagnosis. This problem is
exacerbated when patients have
co-morbidities and then they often
have a half dozen specialists.
“It’s always taught sorting out
patients health history”“I thought I
had the patients story correct… I
checked back in to realize the
symptoms started occurring moths
before I initially thought…this
changed the course of testing… I
would have missed it if I had not
stopped to check” Dr R. Myers
Previously she would have had to
go back to the doctors office
taking more time off and paid
another co-pay.
Connections, drug interactions and
annual screenings are missed
because there is so much to keep
track of.
The cost of medication or specialist
prevent members from reaching a
resolution
Doctor writes prescriptions with no
inclination of how much it might
cost the patient. This often leaves
the member at the drugstore
counter after 6 pm trying to reach
someone in the office that can
change the prescription to
something they can afford. Millions
of dollars are wasted by
abandoned unfilled prescriptions
BEHIND THE
SCENES
Any apps that are linked into Koala
are synchronized with data that
Hailey manually adds. Information
is synthesized over time.There are
both active and passive methods
of gathering data. Experts predict
that numerous conditions like
depression could be detected by
passively detecting changes in the
speaker’s voice.
Patients information is collected
and matched against all the other
members self reported data and
any filed claims to improve the
predictive ability. Accuracy of the
prediction is also displayed. In
Hailey’s case a warning is
triggered and her PCP is notified.
The dashboard uses the patients
date and gender to trigger
reminders and issue warnings
about potential drug interactions,
out of date vaccinations, essential
recurring visits as well as follow-up
appointments
Based on Hailey’s data the system
compares her eating habits,
exercise habits and other similar
patients. It integrates the
information and recommends a
doctor based on this information.
This is a HIPPA compliant
platform, patients own the
information and have to give
permission for data to be utilized
or sent to doctors.
This action is simply an API that
utilizes ZocDoc or any preferred
search/schedule tool. The
difference is that a list is
automatically generated based on
the PCP referral and Pushed to
the member rather than requiring
users initiative.
API for Teladoc or CareClix The same dashboard is sent to the
Specialist. Any proof needed in
order to file a claim with the
insurance is identified and Koala
the virtual health care social
worker notifies the specialist and
Hailey immediately.
The dashboard has her health
history including family history, it
links activities with the times that
she has a headache and food that
she eats. This provides the Doctor
with highlights.
Koala care acts as a virtual
healthcare social worker so that
the patient and doctor get the
most out of their time. Koala
aggregates the patient’s medical
history, records symptoms and
ancillary data from apps like
mycalorie count. It utilizes
methods such as co-occurrence
groupings to prioritize patterns that
might be missed otherwise
Koala has an API to My Headache
and Calorie count. Calorie Count
had a database of foods and
ingredients. Koala links this
occurrence and over the next two
weeks recognizes a continuous
pattern
Dashboards submitted to the
Specialist via a HIPAA compliant
virtual healthcare social worker
called Koala
Koala care links to CVS App via an
API and allows her to check the
prices
Koala has an API to the CVS app.
This lets the doctor and Hailey
decide which prescription he
should write.
Referral Telemedicine
Appointment
“We Would Like To
Sent Your Health
Dashboard To Your
Specialist”
Appointment
The Specialist
Lunch =
Chinese
Food
Reminder Solution!
NEW
JOURNEY
OLD
JOURNEY
Accomplished! People get
health Insurance to feel
responsible
BEFORE: The cost of
medication or specialist
prevent members from
reaching a resolution
