Follow-up video and service tool prototypes completed in 2010: 1. Video concept prototype developed by Interaction Design grad students at Univ of Kansas: www.youtube.com/watch?v=pnyAllwb7SQ 2. Service tool concept: "Healthy Serving" www.youtube.com/watch?v=6xWs59b7_vw 3. Service tool concept: "Better Everyday" www.youtube.com/watch?v=83nu-xaR3iw 4. Service tool concept: "Custom Cook" www.youtube.com/watch?v=ccZVAak11kY 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.

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
http://www.slideshare.net/mindcentric/
the-prescription-mobile-app

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
www.employershealthnetwork.com
St. John’s Health Plans*
Medical Management
Springfield, Missouri
www.stjohns.com
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. “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. The Premise

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. Our Study

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. 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. 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. “what is”
The economics, institutional, and market factors around
chronic disease
global
macro economic
market/industrial
organizational

11. 20,000 classifiable diseases

12. cardiovascular disease
Data Source: National Health Library, NIH Rendered with Many Eyes, IBM

13. diabetes
Data Source: National Health Library, NIH Rendered with Many Eyes, IBM

14. chronic obstructive pulmonary disease
Data Source: National Health Library, NIH Rendered with Many Eyes, IBM

15. cancer (neoplasms)
Data Source: National Health Library, NIH Rendered with Many Eyes, IBM

16. liver cirrhosis
Data Source: National Health Library, NIH Rendered with Many Eyes, IBM

17. asthma
Data Source: National Health Library, NIH Rendered with Many Eyes, IBM

18. These six diseases account for the vast majority
of deaths, disabilities & health care costs
asthma
liver cirrhosis
cancer
COPD
cardiovascular disease
diabetes

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. 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. 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. 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. 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. 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. scope of health care services, facilities, personnel

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. preventive health services
Rendered with Many Eyes, IBMData Source: National Health Library, NIH

28. managed care programs
Rendered with Many Eyes, IBMData Source: National Health Library, NIH

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. 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. 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. The human costs of chronic disease
are much higher

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. 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. 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. What’s Needed:
A Truly Patient-Centered Managed Care Model

37. dig here
physical/biological
socio-cultural
psychological
spiritual
“what is”
The human factors of chronic disease

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. 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. “Asthma: another word for frustrating”
“Marcus”
5 y/o male
Sparta, MO
Conditions: Asthma, Heart
Mom & Dad: “Stacy & Ron”

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. “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. “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. “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. “Pills, a weeks worth. A daily reminder that
at 45 yrs old my body is not well.”

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. “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. “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. “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. “Controlling
sugar levels is
a lifetime
commitment.
I am eating
smaller
amounts.
I am almost a
vegetarian”

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. “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. “I go to my doctor at SGC (clinic) in Springfield.
I have a handicap Parking pass since I can’t walk
very far.”

54. “I use a lot of medicine now. This is for my blood
pressure and breathing. Allergy medicine too.

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. “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. 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. Create a culture of wellness empowerment

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. 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. • “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. *
*
The Service Technology Platform
“My Health Network”
“My Health Portal”

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. 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. Technology Mashup

66. © Cara Miller, Boxspring Design
My Health Web Portal UI
Copyright Ricarda Miller

67. © Cara Miller, Boxspring Design,
Concept SketchMy Health Web Portal UI (drill-down)
Copyright Ricarda Miller

68. Better
Everyday
Healthy
Serving
Custom
Cook
Get
Involved
My Health Web Portal UI (mobile apps)
Copyright Ricarda Miller

69. 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=PL93019A1526F
C1BE6&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

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. 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. 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. 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