5 Anticipated Rules for Healthcare Sustainability

With so much change in healthcare systems, and more likely to come, design plays a role in addressing challenging problems, often with competing variables.

Essential’s work with healthcare clients has shown us some fundamental principles with the potential to make healthcare more financially balanced. Our team has been interested in psychosocial trends intersecting with health and wellness for some time. With so much change in healthcare systems, and more likely to come, design plays a role in addressing challenging problems, often with competing variables. What can be done to improve outcomes? What patient-centered opportunities exist to control costs? How can more sense be made of collected data (for individuals and patient populations)?

It is well understood that in the US, our health outcomes, compared with the percentage of GDP, lag those of most developed countries. Our 50% higher costs per capita, ironically, come with fewer doctor visits per year on average. Health outcomes can, in many instances, rely more on service design principles and behavioral science than on insurance plans, public policy, actuarial stats, or bureaucracy to reduce these inefficiencies.

Jay Parkinson put a fine point on it several years ago in The Future Well, observing that “most healthcare problems aren’t medical, they’re social.” The following principles characterize some opportunities for healthcare to work more systematically and sustainably, whether it’s public or private, Obama/Trumpcare, Accountable Care (ACOs), or self-funded employer plans.


1. Ounces of prevention versus pounds of cure

At a design conference not long ago, during a presentation about the reality that most healthcare costs are typically incurred near the end of patients’ lives, a creative director with a national health plan quipped that healthcare in the US “isn’t really ‘healthcare.’ It’s ‘sickness and death care.’” He’s right: everyone stands to gain by making healthcare more universal in the conventional sense, moving away from its break-fix mentality, toward prevention, wellness, and expectations for accountability, from patients, payors, and providers alike. This will be a challenge for design, to develop systems with an enabling personality rather than a judgmental one.

One example of opportunities in prevention can be found in nutritional education. A client endocrinologist-turned-entrepreneur once told me that “doctors spend about 15 minutes learning nutrition while they’re in medical school.” This was likely an exaggeration, but there is a lot of discussion about preventing, if not reversing, diabetes or heart disease through diet (look up: Caldwell Esselstyn, MD). As a result, some wonder why natural foods are not subsidized, for environmental health if not human health, while much of what goes into processed foods actually is subsidized.

For healthcare to work smarter rather than harder, we need to start thinking about it as ‘an operating system’ in which each component plays a part over time rather than as a collection of disjointed transactions.

2. Mutually beneficial engagement

Shifting the provider-to-patient service dynamic toward one of shared value and effort – collaboration – benefits both parties: accountable patients not only experience better outcomes but also incur less cost, helping their providers to also be more ‘accountable’ to medical economic expectations. And the research community has long observed that engaged patients, especially those with chronic conditions who are more mindful of their conditions, fare better than those who view their doctors with deference or paternalism.

Doctors are too busy to live up to the omniscient, omnipresent, and unrealistic ideal that has been projected upon them. Empowering patients with informed choices in light of their risk factors – knowledge delivered through appropriate learning styles – coupled with distributed disease management and communications platforms, can not only improve health and wellbeing, but also control costs of acute care and co-morbidities. In addition, preventing the domino effect of complicated drug regimens, with its attendant adherence challenges, can mitigate indirect costs. Self-actualized patients develop better strategies for symptom management, often providing advocacy to other patients, too.

Essential’s Katherine Belk recently posted a blogpost outlining some observed patterns increasing the likelihood of improved patient outcomes. These can be powerful enablers toward sustainable healthcare and offer inspiration to anyone developing disease management platforms.

3. Sustainability will be people-centered, not patient-centered

With health services becoming more measured, lifestyle expectations have amplified. For example, insurers have long charged higher premiums to smokers. Progressive’s Snapshot® rewards safe driving habits. And just recently, our health plan at Essential began offering $300 incentives for submitting health status reports from members’ doctors, which for many, is simply a matter of scheduling a routine (and free) physical exam.

For several years, our health plan has modestly subsidized gym memberships based on general evidence that healthier plan members induce lower claims costs. In fact, one of our clients, Healthways, built an entire business on this principle called SilverSneakers: a free fitness program for seniors which also provides revenues for participating gyms based on utilization. But even with free gym memberships, one could not assume that seniors would show up consistently. We discovered that stickiness improves through tighter emotional ties to the program and its members: reasons to want to be at the gym, which are social in nature, beyond fitness equipment and classes.  This led to the exploration of a member toolkit: a service blueprint characterizing services adjacent to the core program to amplify its overall impact. Other work with MeYou Health (formerly a subsidiary of Healthways) supported a series of personal wellness apps leveraging social networks to deliver ongoing knowledge and action plans methodically aligned with the Gallup-Healthways Well-Being Index, an often-cited public health indicator.

4. Healthcare and The Third Wave of Digitization

Many people know more about the performance of their car, their computer, or their retirement plan than they do about their bodies or the influence their lifestyle has on them. One has to measure it before being able to manage it: the tools to provide patients with self-directed, actionable transparency have been, until now, inaccessible, expensive, or non-existent.

The ‘universality’ of insurance-for-everyone healthcare depends on more than just coverage. It will need to be an infrastructure of components offering an exchange of value, not merely producers providing service for consumers. Fast Company tells us that artificial intelligence in healthcare will grow tenfold in 5 years. Biomarkers have long been used in managing chronic disease. Economic pressures of pay-for-performance could eventually lead to biomarkers also being used to determine penalties and bonuses for providers; they can and should also be used to nudge patients onto healthier paths. The Third Wave of Digitization will play a substantial role in the economic sustainability and patient engagement, addressing chronic inflation through imagination and execution. See Chris Parlato’s perspective on the Internet of Things.

A few of our medical clients are realizing the value of the drug/device/disease data they’re able to capture, if not for their own businesses, for other constituents in the healthcare ecosystem. The old world of episodic testing, prognosis, and titration, with high latency of cause-and-effect, will transition into more continual awareness of one’s next actions rather than waiting until a next medical appointment. This transformation could mirror the advent of digital photography: we were all able to take better pictures when we knew what we had.

5. Creating the pull

Bundled payments or accountable care organizations are not only meant to streamline reimbursement/administrative paperwork, but also to provide doctors with more autonomy and discretion. With more latitude in treatment plans, we can reasonably expect improved patient outcomes as as well as dividends in clinical time for doctors to see more patients.

A sustainable healthcare ecosystem isn’t just tied to economics (the end goal), but also to behavioral economics as means to that end. A simple example: working with a biotech company, we met with one clinic who now provides patients with self-addressed, stamped envelopes to return their patient-reported outcome forms. Previously ad-hoc at best, the clinic now receives 100% of the forms for entry into an important global registry of rare diseases. This simple mechanism took most of the friction out of the process. Precision Medicine may therefore not merely be in the domain of genomics; it could also incorporate neuroscience, choice architecture, and decision support to better orchestrate the delivery of care. Related to the digital photography example, homeowners who are able to view their high electricity consumption in comparison to their neighbors typically change their behaviors to avoid being outliers. Similarly, bio-sensors, data tracking, and processing acumen continue to improve, and at shrinking costs. Finding points of leverage through incentives, defaults, loss-aversion, and comparisons – anticipating the biases that all we humans find challenging to avoid – can improve adherence to positive, short-term actions. These actions result in better long-term versions of ourselves, individually, and collectively, as substantial and sustainable components of the healthcare cosmos.

Just as real-time feedback of digital cameras created a pull toward better photos for everyone, designers, who are collectively demonstrating more interest in problem-solving for social causes, can steer the path of healthcare toward a more sustainable and effective model.


Bill Hartman is a Partner and Director of Innovation Strategy at Essential Design.

Essential Design is a leading Innovation Strategy & Design consultancy. We work across the healthcare, consumer, and commercial industries, helping our clients conceive and drive to market comprehensive digital, physical, and service experiences.