Complex Patient Journeys

Complex Patient Journeys Note: Best viewed in slide show mode

[object Object],Matthew P. Hall , CEO Human Care Systems, Inc. Direct: 617.649.2118 Mobile: 617.501.1818 [email_address] www.humancaresystems.com Matt founded Human Care Systems (HCS) in 2008 in order to impact one of the largest levers in healthcare: patient self-management. HCS was spun-out from the Kerdan Group, a biopharma and medtech consulting firm. Matt co-founded Kerdan in 2001. Prior to Kerdan, Matt ran several healthcare related businesses, worked in venture capital and was a consultant at Bain & Company. Matt has lived and worked in the US, Europe, Japan, South Africa, and South Korea. Matt has a BA with honors from Williams College.

Complex patient journeys and value Understanding the complex patient journey What tools do we have to impact the complex patient journey? Case study: Helping appropriate patients initiate insulin

[object Object],Levers to impact Value Equation: Real World Outcomes Change diagnostic or therapy Change clinical practice Change patient self-management Change reimbursement Costs (financial, hassle, safety) Total Value =

[object Object],Source: New England Health Care Institute, Client Conference, May 20, 2008 Health Determinant

[object Object],Complexity and burden for the patient disrupt and overwhelm appropriate therapy initiation, adherence, effective relationships with HCPs, caregiver involvement, productive management of emotions and other critical health behaviors. Success with complex patient journeys means better care: more opportunity to intervene, greater patient adherence to therapy, better outcomes and health economics, closer relationships with physicians and better ROI from each promotional investment. These are unique journeys with common elements. They are not averages.

[object Object],[object Object],[object Object],[object Object],[object Object],Poor patient self-management: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],...due to... Your brand: What causes poor patient self-management? Can it be changed?

[object Object],When patients experience physical, cognitive, emotional, behavioral, and environmental stressors... ...they are more likely to be self-destructive, withdraw, overeat, avoid, self-medicate, become more dependent, relapse, regress, have comorbidities, and become non-adherent. Treatment effectiveness is reduced. So is brand value.

Complex patient journeys and value Understanding the complex patient journey What tools do we have to impact the complex patient journey? Case study: Helping appropriate patients initiate insulin ✔

[object Object],Complex patient journeys occur when patients have any combination of high disease burden, multiple concomitant health problems, or complex therapy. Complex patient journeys have multiple dimensions and inflection points : places where things can change dramatically toward the positive or negative.

[object Object], A patient journey has multiple dimensions : key aspects of patient experience and development.  A patient journey has critical inflection points : key moments in patient experience where variables intersect to predict outcomes. What are the key dimensions and inflection points for your target patients and product ?

[object Object],1 2 3 Guiding Questions Why it Matters ,[object Object],Which people & organizations does the patient interact with on his or her journey? Determine what communication channels can be used to reach patients at their inflection points. ,[object Object],How and why do the the specific diagnostic & monitoring tests, and classes & brands of treatment change through the journey? Identify opportunities to drive optimal use of your therapy. ,[object Object],What are the physical, cognitive, emotional, behavioral, and social experiences the patient goes through? Understand the medical and self-management needs that impact the course of the patient journey.

[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Coping Initial Treatment Help Seeking Troubling Symptoms Flare-Remission Cycle Patients are miserable and experimentation with treatment changes is high. Many patients stay on unsafe long term treatments or discontinue during remission – either path worsens outcomes. Flare Remission

[object Object],“ I need a transplant ” “ They found me a kidney ” Surgery and Recovery “ I ’ m going home ” “ I still have to actively manage my health ” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],User scenario: Patricia is a 68 year-old unmarried mother of two adult children. She works as a bookkeeper in a medium-sized company. She needs to keep her job, in part to support a disabled adult son. Following several months of fatigue and joint pain, Patricia is diagnosed with Hepatitis C. She is shocked and confused and can ’ t imagine how she got it. Patricia fears what people will think and worries about taking care of her son and staying sane if she starts treatment and feels sick all the time. Dimensions of Change Beginning Solution Result Cognitive This must be a mistake, Patricia thinks. I never used drugs! (confusion, denial, misconception) ,[object Object],[object Object],[object Object],[object Object],Patricia learns that there are all kinds of ways to get Hepatitis C and accepts that she has it. (balance, integration) Emotional It seems to Patricia that her world has stopped. Sometimes she feels numb, and sometimes she trembles with rage. (shock, anger, fear) ,[object Object],[object Object],[object Object],[object Object],Patricia moves through two stages of grief. She learns that, with proper planning and care, she can manage treatment and deal with side effects as they come. (hope, openness) Behavioral Patricia avoids starting treatment. She Googles her symptoms and changes doctors. ,[object Object],[object Object],[object Object],[object Object],Patricia schedules her first treatment, talks to her HR department and plans for extra support for her son when the side effects are bad. Social Patricia wonders if she will be able to continue working and helping take care of her son. She tests her relationships and is feels angry. (questioning self-concept, strained relationships) ,[object Object],[object Object],[object Object],[object Object],Patricia joins an online HCV support group, redefines her social identity, and finds some new hobbies for days when she feels sick. (new community, self-discovery)

[object Object],  A patient journey has multiple dimensions: key aspects of patient experience and development.  A patient journey has critical inflection points: key moments in patient experience where variables intersect to predict outcomes. What are the key dimensions and inflection points for your target patients and product ?

[object Object],A patient journey has critical inflection points... key moments in patient experience where variables intersect to predict outcomes. Patient decisions and actions at this time have a significant impact on long term outcomes. Long-time diabetic has been warned, “If you can’t control your blood sugar, we’ll have to put you on the needle.” Now is the time. 10 year-old hemophilia patient wants more independence with his condition. His mom is nervous, but now is the time. Dialysis patient finds out that a compatible kidney has been found. A new self-care routine is starting. Today my doctor told me I have Crohn’s. I feel like my whole life stopped. I’m in a daze. What do I do?

[object Object],[object Object],[object Object],[object Object],[object Object],Which patient inflection points are most important for your therapy? ✔ ✔ ✔ Small or large windows of opportunity where science helps us decide... Moments when patient risk factors and protective factors coalesce to be exponentially powerful predictors of outcome e.g., 2 nd trimester for fetal brain development, adolescence in general Life events that are physical, cognitive, emotional, behavioral, or social e.g., initial diagnosis of a condition, relapse, change in disease status

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[object Object],Six-week diagnostic: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],1 2 3 4

Complex patient journeys and value Understanding the complex patient journey What tools do we have to impact the complex patient journey? Case study: Helping appropriate patients initiate insulin ✔ ✔

[object Object],Identify major patient pathways and inflection points in patient experience using focus groups, expert interviews. Six-week diagnostic. Identify major target behaviors for patients using focus groups, expert interviews. Identify cognitive, emotional, behavioral, social barriers to adherence. Collapse core psychological themes in non-compliance among target patients, using quantitative and qualitative research methodology, framed in terms of patient need. ,[object Object],Multi-channel (web, mobile, live, printed) integrated engagement Patient management platform to connect data to effective patient self-management based on behavioral science. ,[object Object]

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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Behavior Modification Therapy Cognitive Behavioral Therapy Effective Pedagogy Thoughts Feelings Actions Classical Operant Social Integrative Personal Timed

[object Object],Physical events are one part of a complex cascade of patient experience. A patient perceives and interprets sensory and other physical information. Examples: Changing thought patterns alters brain chemistry and neuroanatomy. Cognitive activity, including meaning-making, predicts how one feels, acts, interacts: thoughts impact health. Feelings are multisystem biochemical and energy pathways. Emotions predict and derive from experience. Action are reflexive or deliberate. Either way, they are predictable from physiology, thoughts, feelings, and social contexts. Physicality, thoughts, feelings, and actions affect relationships. Quality of support relationships predicts well-being. ...and internal or external stressors can exacerbate physical symptoms. “ I was just diagnosed with Crohn’s. What’s happening to my body?” “ Is it my fault that I have this disease? I’m not sure which of my problems are symptoms and if they can be helped.” “ I’m confused, angry and embarrassed. Being tired all the time makes me feel worse. It’s not fair!” “ Everything I eat hurts so I skip meals and snack on junk. I don’t talk to my doctor about it – what’s the use?” “ I leave business meetings and family functions suddenly and my boss and children get fed up with me.” Best viewed in slide show mode ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],Source: Wright JH, Wright AS, Albano AM, Basco MR, Goldsmith LJ, Raffield T, Otto MW. Computer-assisted cognitive therapy for depression: maintaining efficacy while reducing therapist time. American Journal of Psychiatry . 2005; 162:1158–1164.

[object Object],In a trial of medicine adherence (refills) among 50 diabetic patients (42 completed), behavior science significantly improved adherence. Trial conducted March 1, 2009 to August 31, 2010 in United States

Complex patient journeys and value Understanding the complex patient journey What tools do we have to impact the complex patient journey? Case study: Helping appropriate patients initiate insulin ✔ ✔ ✔

Insulin initiation: Patient journey inflection point “ I have diabetes” “ I need injectable insulin” “ I still have to actively manage my health” ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],User scenario: Mary is 58 years old with Type II diabetes, and is married with three grown children. She is an administrative assistant in a medium-sized company and looks forward to retiring some day. Mary’s doctor has told her to get her blood sugar under control, lose weight, stop smoking, and avoid stress. Mary has avoided injectable insulin for years because of needle anxiety, and she also feels overwhelmed by all the big changes she is being asked to make. Dimensions of Change Beginning Solution Result Cognitive There’s no way I’ll be able to inject myself for the rest of my life, Mary thinks. I hate needles! (confusion, low self-efficacy, misconception) ,[object Object],[object Object],[object Object],[object Object],[object Object],Mary learns that insulin injections can be simple and routine. With a guided self-care program, she prepares and injects insulin for the first time (balance, integration) Emotional Mary is embarrassed. She’s disappointed in herself, but blames her doctor too. How can she change after all these years? (shame, anger, fear) ,[object Object],[object Object],[object Object],[object Object],[object Object],Mary discovers that her anger comes from fear of losing control and not meeting others’ expectations. (hope, openness, self-efficacy) Behavioral Mary avoids starting insulin. She still smokes and overeats, telling herself, I just need to live in the moment and get through each stressful day. (cycle of triggers and consequences) ,[object Object],[object Object],[object Object],[object Object],[object Object],Mary initiates insulin. She replaces her mid-day work snack with nicorette gum and starts going on a 15 minute walk over lunch. (reconditioning through contingency planning) Social Mary fears being ridiculed at work and stops lunching with others. At home, she refuses to talk about her health and focuses on the problems of others too much. (isolation, strained relationships) ,[object Object],[object Object],[object Object],[object Object],[object Object],Mary joins an online diabetes community and discovers several blogs. She learns new communication skills. She walks daily with a coworker. (new community, self-discovery, authenticity)

[object Object],Mary, continuing to engage through multiple channels, builds sustained change into her life via Behavior Modification Therapy Mary decides to try the website where she experiences effective education, based on Pedagogical Science. Her husband gets involved as well. Mary gains insights into thoughts and feelings that might be getting in her way, using the tools of Cognitive Behavioral Therapy. Mary uses the web and speaks with a nurse on the phone. Mary might initially learn of the program through a clinician, disease advocacy group, pharmacy, DTC or other channels Take Action Engage Gain Insight Learn

[object Object],Social conditioning involves interactions with others, including modeling, coaching, social learning, contracting, and interpersonal support.

[object Object],Remind Mary of her motivation Guided step-by-step process Mary’s guide

[object Object],Engaging myths and misunder-standings. Use of cognitive dissonance (“is that a myth?”) drives authentic insight and prepares user to internalize new information. More chunked, timed, titrated, tailored information according to the well-researched science of teaching and learning. Interactive and fun.

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[object Object],Fear, anxiety, guilt, shame, anger are five emotions that can be internal barriers to initiating insulin injections.

[object Object],Patients require multi-dimensional assistance for internal and external environments including prohibitive thoughts and feelings like shame, anger, fear, guilt, anxiety. Smart software predicts and times Mary ’s questions. Guides are selected based on decades of robust socio-cultural research including micro-expression analysis. The system knows Mary struggles with shame. Just like in a therapist ’s office, Mary quantifies her feelings. These are included in her treatment algorithm. Mary ’s profile tells the software that her fear immobilizes her, keeping her from compliance and healthy habits. According to her profile, Mary will become activated by converting fear to anger. Adherence to therapies involves mind / body learning. Information combined with the right emotional engagement leads to insight. You may have strong feelings when you think about insulin.

[object Object],Four popular techniques to control autonomic nervous system response: deep breathing and counting, meditative walking, sensory grounding, progressive muscle relaxation.

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[object Object],Guided visualization to explore unforeseen reactions, rehearse details, hilite perceptions of difficulty, recondition sympathetic ANS response.

[object Object],Hierarchical exposure activity for anxiety-producing steps if needed. Worksheets to plan the cognitive, emotional, behavioral, social details of injecting for the first time.

Complex Patient Journeys

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