Rube Goldberg Would Be Proud

By KIM BELLARD

Larry Levitt and Drew Altman have an op-ed in JAMA Network with the can’t-argue-with-that title Complexity in the US Health Care System Is the Enemy of Access and Affordability. It draws on a June 2023 Kaiser Family Foundation survey about consumer experiences with their health insurance. Long stories short: although – surprisingly – over 80% of insured adults rate their health insurance as “good” or “excellent,” most admit they have difficulty both understanding and using it. And the people in fair or poor health, who presumably use health care more, have more problems.

Health insurance is the target in this case, and it is a fair target, but I’d argue that you could pick almost any part of the healthcare system with similar results. Our healthcare system is perfect example of a Rube Goldberg machine, which Merriam Webster defines as “accomplishing by complex means what seemingly could be done simply.”   

Boy howdy.

Health insurance is many people’s favorite villain, one that many would like to do without (especially doctors), but let’s not stop there. Healthcare is full of third parties/intermediaries/middlemen, which have led to the Rube Goldberg structure.

CMS doesn’t pay any Medicare claims itself; it hires third parties – Medicare Administrative Contactors (formerly known as intermediaries and carriers). So do employers who are self-insured (which is the vast majority of private health insurance), hiring third party administrators (who may sometimes also be health insurers) to do network management, claims payment, eligibility and billing, and other tasks.

Even insurers or third party administrators may subcontract to other third parties for things like provider credentialing, utilization review, or care management (in its many forms). Take, for example, the universally reviled PBMs (pharmacy benefit managers), who have carved out a big niche providing services between payors, pharmacies, and drug companies while raising increasing questions about their actual value.

Physician practices have long outsourced billing services. Hospitals and doctors didn’t develop their own electronic medical records; they contracted with companies like Epic or Cerner. Health care entities had trouble sharing data, so along came H.I.E.s – health information exchanges – to help move some of that data (and HIEs are now transitioning to QHINs – Qualified Health Information Networks, due to TEFCA).

And now we’re seeing a veritable Cambrian explosion of digital health companies, each thinking it can take some part of the health care system, put it online, and perhaps make some part of the healthcare experience a little less bad. Or, viewed from another perspective, add even more complexity to the Rube Goldberg machine. 

On a recent THCB Gang podcast, we discussed HIEs. I agreed that HIEs had been developed for a good reason, and had done good work, but in this supposed era of interoperability they should be trying to put themselves out of business. 

HIEs identified a pain point and found a way to make it a little less painful. Not to fix it, just to make it less bad. The healthcare system is replete with intermediaries that have workarounds which allow our healthcare system to lumber along. But once in place, they stay in place. Healthcare doesn’t do sunsetting well.

Unlike a true Rube Goldberg machine, though, there is no real design for our healthcare system. It’s more like evolution, where there are no style points, no efficiency goals, just credit for survival. Sure, sometimes you get a cat through evolution, but other times you get a naked mole rat or a hagfish. Healthcare has a lot more hagfish than cats.

I’m impressed with the creativity of many of these workarounds, but I’m awfully tired of needing them. I’m awfully tired of accepting that complexity is inherent in our healthcare system.

Complexity is bad for patients, bad for the people directly giving the care, and only good for all the other people/entities who make a living in healthcare because if it. Instead of making pain points less painful, we should be getting rid of them.

If we had a magic wand, we could remake our healthcare system into something much simpler, much more effective, and much less expensive. Unfortunately, we not only don’t have such a magic wand, we don’t even agree on what that system should look like. We’ve gotten so used to the complex that we can no longer see the simple.

I don’t have a Utopian vision of a healthcare system that would solve all the problems of our system, but I do have some suggestions for all the innovators in healthcare:

• If your solution makes patients fill out one more form, log into one more portal, make one more phone call, please reconsider.
• If your solution takes time with patients away from clinicians, making them do other tasks instead, please reconsider.
• If your solution doesn’t create information that is going to be shared to help patients or clinicians, please reconsider.
• If your solution only focuses on a point-in-time, rather than helping an ongoing process, please reconsider.
• If your solution is designed to increase revenue rather than to improve health, please reconsider.
• If your solution doesn’t recognize, acknowledge, report and act on failures/mistakes/errors, please reconsider.
• If your solution can’t simply be explained to a layman, please reconsider.
• If your solution adds to the healthcare system without reducing/eliminating the need for something even bigger in the system, please reconsider.
• If your solution steers care to certain clinicians, in certain places, rather than seeking the best care for the patient in the best place, please reconsider.
• If your solution adds costs to the healthcare system without uniquely and specifically reducing even more costs, please reconsider.
• If your solution doesn’t have built-in mechanisms (e.g., use of A.I.) to be and stay current on an ongoing basis, please reconsider.

 I’m sure all those innovators think their idea is very clever, and many are, but remember: just because an idea is clever doesn’t mean it’s not Rube Goldbergian.  They need to step back and think about if they’re adding to healthcare’s Rube Goldberg machine or helping simplify it. My bet is that usually they’re adding to it.

So, yeah, I agree with Mr. Levitt and Dr. Altman that health insurance should be less complex.   Just like everything else in the healthcare system. Let’s start taking the healthcare Rube Goldberg machine apart.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

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Some Like It Hot! A Century-Old Disease on Our Southern Shores

By MIKE MAGEE

Naomi Orestes PhD, Professor of the History of Science at Harvard, didn’t mince words  as she placed our predicament in context when she said, “If you know your Greek tragedies you know power, hubris, and tragedy go hand in hand. If we don’t address the harmful aspects of human activities, most obviously disruptive climate change, we are headed for tragedy.”

At the time, as a member of the Anthropocene Workgroup, she and a group of international climate scientists were focused on defining and measuring nine “planetary boundaries,” environmental indicators of planetary health. At the top of the list was Climate Change because, one way or another, it negatively impacts the other eight measures.

Not the least of these “human perturbations” is the effect of global warming on access to clean, safe water, and the impact of violent weather cycles and rising sea levels on concentrated urban populations along coastal waters.

A less recognized, but historically well documented threat, is exposure to migrating vectors of disease as they contact unprepared human populations beyond their traditional camping grounds. The threat of avian flu among migratory birds has been well covered. Equally, over the past decade, North America has seen a range of novel infections, especially along our southern borders, from dengue, to chikungunya, to Zika.

The southern United States and its coastal populations are firmly in the cross-hairs. Their seas are rising at an alarming rate, and fouling fresh water supply with invasive sea water. Their soaring temperatures are only exceeded by record setting atmospheric river rainfalls and flooding events, and their “extreme poverty throughout Texas and the Gulf Coast states, where inadequate or low-quality housing, absent or broken window screens, and a pervasive dumping of tires in poor neighborhoods,” as reported in this weeks New England Journal of Medicine, assures a reemergence of one of this countries most significant, but now long forgotten killer diseases.

In 1853, the disease killed 11,000 in New Orleans, some 10% of the population. Twenty-five years later, it overwhelmed Mississippi Valley cities killing 20,000. Its latest major foray in the United States was in 1905 with 1000 deaths. Its’ absence over the past century is credited to public health and structural and engineering advances. But that was then, and this is now.

The disease is Yellow Fever, and red lights are blinking in a range of southern coastal cities from Galveston, TX, to Mobile, AL, to New Orleans, LA and Tampa, FL.. Experts say they may soon be in the same boat as Brazil was between 2016 and 2019 when it experienced a threefold increase in the historic prevalence of the disease among its population.

Public Health sleuths have uncovered that the 1878 epidemic in the Mississippi Valley was triggered by an El Nino spike the year prior. The warmer and wetter conditions are believed to have supported a large increase in Aedis aegypti mosquitos, the vector for the Yellow Fever virus.

Are we prepared? Recent experience in fighting Dengue fever in the southern statesis not encouraging, with WHO chief scientist Jeremy Farrar warning that Dengue might soon “take off” absent better mosquito eradication and screening prevention. U.S. Public Health experts say a Dengue foothold is nearly secured and the disease is fast on its way to becoming endemic in southern coastal states.

As for Yellow Fever, there is an effective vaccine, but it is also associated with rare but serious side effects. Antivaccine activism post-Covid would be a significant barrier now say experts. Adding to the challenge, no Yellow Fever vaccine is currently available from the U.S. Strategic National Stockpile. Mosquito surveillance programs are currently marginal, and response capabilities for mass vaccination in affected areas are severely limited.

The Anthropocene Workgroup is fully aware of these human instigated crises. In the prior Holocene Epoch of 11,700, we prided ourselves with being able to co-exist with other lifeforms and in equilibrium with a healthy planet. But beginning in 1950, the new Anthropocene Epoch has aggressively chipped away at planetary health, disrupting stabilizing cycles, and critically raising the temperature and acidity of oceans that cover and buffer 70% of the planet.

The return of Aedes aegypti, and the Yellow Fever virus it carries, is a dramatic harbinger of additional challenges to come if we are unable to limit “human perturbations” of our planetary cycles.

_____________________________________________________________

Mike Magee MD is a Medical Historian and regular THCB contributor. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex.

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Jean-Claude Saghbini, Lumeris

Jean-Claude Saghbini is the CTO of Lumeris and also the President, Lumeris Value-Based Care Enablement. Lumeris has been in business quite a while now, providing the technology which (in general) hospitals and medical groups use to manage to their workflows predominantly for Medicare Advantage. It also owns a big medical group (Essence in St Louis) and has close connections with John Doerr of Kleiner Perkins fame, whose brother was involved in its formation. Kleiner also funded Healtheon (the precursor to WebMD) of which current Lumeris CEO Mike Long was the founding CEO. I interviewed Jean-Claude at HLTH to get the update on Lumeris. How are they helping those providers manage their patients at risk? How are those providers actually getting paid? And how that makes them behave. Plus his views on how CMS is adjusting the way Medicare scores and pays his clients! Matthew Holt

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THCB Gang Episode 137, Thursday October 26

Joining Matthew Holt (@boltyboy) on #THCBGang on Thursday October 26 at 1pm PST 4pm EST are delivery & platform expert Vince Kuraitis (@VinceKuraitis); author & ponderer of odd juxtapositions Kim Bellard (@kimbbellard); futurist Ian Morrison (@seccurve); and our special guest joining us today Kat McDavitt(@katmcdavitt) President of Innsena.

The video is below. If you’d rather listen to the episode, the audio is preserved from Friday as a weekly podcast available on our iTunes & Spotify channels

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Y2Q and You

By KIM BELLARD

Chances are, you’ve at least somewhat concerned about your privacy, especially your digital privacy.  Chances are, you’re right to be.  Every day, it seems, there are more reports about data beeches, cyberattacks, and selling or other misuse of confidential/personal data.  We talk about privacy, but we’re failing to adequately protect it. But chances are you’re not worried nearly enough.

Y2Q is coming. 

That is, I must admit, a phrase I had not heard of until recently. If you are of a certain age, you’ll remember Y2K, the fear that the year 2000 would cause computers everywhere to crash.  Business and governments spent countless hours and huge amounts of money to prepare for it. Y2Q is an event that is potentially just as catastrophic as we feared Y2K would be, or worse. It is when quantum computing reaches the point that will render our current encryption measures irrelevant.

The trouble is, unlike Y2K, we don’t know when Y2Q will be.  Some experts fear it could be before the end of this decade; others think more the middle or latter part of the 2030’s.  But it is coming, and when it comes, we better be ready.

Without getting deeply into the encryption weeds – which I’m not capable of doing anyway – most modern encryption relies on factoring unreasonably large numbers – so large that even today’s supercomputers would need to spend hundreds of years trying to factor.  But quantum computers will take a quantum leap in speed, and make factoring such numbers trivial. In an instant, all of our personal data, corporations’ intellectual property, even national defense secrets, would be exposed. 

“Quantum computing will break a foundational element of current information security architectures in a manner that is categorically different from present cybersecurity vulnerabilities,” warned a report by The RAND Corporation last year.

“This is potentially a completely different kind of problem than one we’ve ever faced,” Glenn S. Gerstell, a former general counsel of the National Security Agency, told The New York Times.  “If that encryption is ever broken,” warned mathematician Michele Mosca in Science News, “it would be a systemic catastrophe. The stakes are just astronomically high.”

The World Economic Forum thinks we should be taking the threat very seriously.  In addition to the uncertain deadline, it warns that the solutions are not quite clear, the threats are primarily external instead of internal, the damage might not be immediately visible, and dealing with it will need to be an ongoing efforts, not a one-time fix.

Even worse, cybersecurity experts fear that some bad actors – think nation-states or cybercriminals – are already scooping up troves of encrypted data, simply waiting until they possess the necessary quantum computing to decrypt it.  The horse may be out of the barn before we re-enforce that barn. 

It’s not that experts aren’t paying attention.

For example, the National Institute of Standards and Technology has been studying the problem since the 1990’s, and is currently finalizing three encryption algorithms designed specifically to counter quantum computers. Those are expected to be ready by 2024, with more to follow. “We’re getting close to the light at the end of the tunnel, where people will have standards they can use in practice,” said Dustin Moody, a NIST mathematician and leader of the project.

Also, last December President Biden signed the Quantum Computing Preparedness Act, which requires federal agencies to identify where encryption will need to be upgraded. There is a National Quantum Initiative, and the CHIPs Act also boosts federal investment in all things quantum.  Unfortunately, migrating to new standards could take a decade or more.

But all this still requires that companies do their part in getting ready, soon enough.  Dr Vadim Lyubashevsky, cryptography research at IBM Research, urged:

…it’s important for CISOs and security leaders to understand quantum-safe cryptography. They need to understand their risk and be able to answer the question: what should they prioritize for migration to quantum-safe cryptography? The answer is often critical systems and data that need to be kept for the long term; for example, healthcare, telco, and government-required records.

Similarly, The Cybersecurity and Infrastructure Security Agency (CISA) emphasized: “Organizations with a long secrecy lifetime for their data include those responsible for national security data, communications that contain personally identifiable information, industrial trade secrets, personal health information, and sensitive justice system information.”

If all that isn’t scary enough, it’s possible that no encryption scheme will defeat quantum computers. Stephen Ormes, writing in MIT Technology Review points out:

Unfortunately, no one has yet found a single type of problem that is provably hard for computers—classical or quantum—to solve…history suggests that our faith in unbreakability has often been misplaced, and over the years, seemingly impenetrable encryption candidates have fallen to surprisingly simple attacks. Computer scientists find themselves at a curious crossroads, unsure of whether post-quantum algorithms are truly unassailable—or just believed to be so. It’s a distinction at the heart of modern encryption security. 

And, just to rub it in, if you’ve already been worried about artificial intelligence taking our jobs, or at least greatly boosting the cybersecurity arms race, well, think about AI on quantum computers, communicating over a quantum internet – “you have a potentially just existential weapon for which we have no particular deterrent,” Mr. Gerstell also told NYT.   

Healthcare is rarely a first mover when it comes to technology. It usually waits until the economic or legal imperatives force it to adopt something. Nor has it been good about protecting our data, despite HIPAA and other privacy laws.  It’s made it often to hard for those who need the data to have access to it, while failing to protect it from external entities that want to do bad things with it.

So I don’t expect healthcare to be an early adopter of quantum computing. But I think we all should be demanding that our healthcare organizations be cognizant of the threat to privacy that quantum computing poses.  We don’t have twenty years to prepare for it; we may not even have ten.  The ROI on such preparation may be hard to justify, but the risk of not investing enough, soon enough, in it is, as Professor Mosca said, catastrophic.  

Y2Q is coming for healthcare, and for you.

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

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Fay Rotenberg, CEO, Firefly Health

Fay Rotenberg is CEO of Firefly Health, which is an advanced virtual primary care group (a bastardized phrase she hates). That means they are both providing virtual care, with an integrated care and health plan coverage model, and are also a risk-bearing medical group working with other payers. They adjust the model using health guides, MDs, NPs, etc. and they help their patients manage their in person experience with specialists, labs, imaging, etc. — they have 1900+ partners nationwide who will actually know the patient is coming, and is integrated into Firefly’s model. Clinical outcomes are great, and costs are 12-15% lower, yet they have 5,000 members per MD. Maybe it really is the 21st century Kaiser?

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“Doomscrolling” – Call the doctor!

by MIKE MAGEE

Exactly 1 year ago, mental health experts alerted the medical world to their version of an assessment scale for yet another new condition – “doomscrolling.”

As defined in the article, “Constant exposure to negative news on social media and news feeds could take the form of ‘doomscrolling’ which is commonly defined as a habit of scrolling through social media and news feeds where users obsessively seek for depressing and negative information.”

No one can deny a range of legitimate concerns. Faced with continued background noise from the pandemic, add global warming, renegade AI, and the Republican Congress. And now, the devastating attacks on Israel and growing instability in the Middle East. It is no wonder that we can’t turn off the Instagram feed.

With real challenges like these, our troubled world needs her doctors and nurses to stay focused more than ever on their primary professional missions – managing health and wellness, sickness and disease, fear and worry, and yes, now “doomscrolling.”

John J. Patrick PhD, in his book Understanding Democracy, lists the ideals of democracy to include “civility, honesty, charity, compassion, courage, loyalty, patriotism, and self restraint.” The 4.2 million registered nurses and 1 million doctors in America are agents of democracy.

Regrettably, they are already being drawn away from patients by three powerful forces.

1. Corporate Dislocation – To assure maximum reimbursement, doctors and nurses are routinely asked to prioritize time and contact with data over time and access to patients.
2. Health Technology and AI Substitution – Rather than engineering solutions to expand real-time patient contact, most innovations are further distancing patients from healthcare professionals.
3. Legislative Intrusion – Complex medical decisions, long entrusted to the patient-health professional relationship to negotiate, are being transferred to ultra-conservative legislators.

We live under a constitutional and representative democracy, as do two-thirds of our fellow citizens in over 100 nations around the world. The health of these democracies varies widely. The case for democracy emphasizes its capacity to enhance dignity and self-worth, promote well-being, advance equal opportunity, protect equal rights, advance economic productivity, promote peace and order, resolve conflicts peacefully, hold rulers accountable, and achieve legitimacy through community-based action.

One of the challenges of democracy is to find the right balance in pursuing “the common good” which has dual (and often competing) arms. One arm is communitarian well-being and the other, individual well-being.

Blending personal and public interests is complex. In health, one might argue, this tension has led to our dual system – one, largely profit driven, interventional and science discovery based, and the other largely public, preventive and focused on communitarian public health.

Both nursing and medicine have embraced professionalism and launched new graduates by voicing “oaths” or promises to themselves, their colleagues, and our society as a whole.  These lists of promises or pledges, their language and priority ordering, help reveal both the history and intent of these noble professions.

Of course, the most famous oath in Medicine is the Hippocratic Oath reaching back some 2000 years to Greece. In pledging to a grouping of ancient deities, it recognized that interventions should “do no harm” and that confidentiality was paramount.

By 1964, this oath was sufficiently out of date that many medical schools embraced an updated version written by Louis Lasagna, MD. The oath includes a communitarian connector: “I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.”

The Penn State College of Medicine’s Oath in 2022 offered a counter-balance by giving top billing to the patient, with the oath to the patients, not to Greek gods: “By all that I hold highest, I promise my patients competence, integrity, candor, personal commitment to their best interest, compassion, and absolute discretion, and confidentiality within the law.”

The Geneva based World Medical Association, in the shadow of the Nuremberg Trials, provided a list of pledges in

their 1946 Declaration of Geneva in order of appearance including:

1. the service of humanity
2. patents first
3. patient autonomy and dignity
4. respect for human life
5. absence of bias or prejudice on any basis
6. commitment to patient privacy
7. guided by professional conscience and dignity
8. honor the noble traditions of the profession
9. respect and gratitude to teachers, colleagues and students
10. share knowledge to advance health care
11. commit to personal health and well-being
12. never violate human rights.

Nursing has also relied on professional Oaths. The first was the Nightingale Pledge, created in 1893 by the Farrand Training School for Nurses and named after Florence Nightingale. It is believed to be based on the Hippocratic Oath and was modernized in 1935. In the 1950’s, the American Nurses Association (ANA), created a formal Code of Ethics, including Nursing’s 9 Provisions (or Pledges) committing to: compassion and respect, patient-focus, advocacy, active decision making, self-health, ethical environment, scholarly pursuit, collaborative teamwork, professional integrity and social justice.

Health professionals need to be laser focused during these troubled times on patients. Doctors and nurses, day in and day out, by managing fear and worry, reinforcing community and family bonds, and championing hopefulness, guard against a true “doomsday scenario” – the destruction of our Democracy from within. The patient is our primary concern and deserves our full professional attention.

Mike Magee MD is a Medical Historian and regular contributor to THCB. He is the author of CODE BLUE: Inside America’s Medical Industrial Complex (Grove/2020).

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CMS’s Policy on Mental Health Therapists Will Work

By JON KOLE

Nearly 66 million Americans are currently enrolled in Medicare, a number that will likely swell towards 80 million Americans within the next seven years. These are our mothers, fathers, aunts, uncles, grandparents and friends – and, maybe, you. 

A significant portion of these millions of people need mental health services – and, yet, many face long wait times or aren’t able to find a therapist at all. On average, Americans have a waiting period of 48 days before receiving mental health care. At present, two notable provider groups – Marriage and Family Therapists (MFTs) and Mental Health Counselors (MHCs), which summed to approximately 415,000 in 2021 – have not been eligible to provide psychotherapy for people with Medicare.

Currently, Medicare only approves psychologists and masters-level Licensed Clinical Social Workers (LCSWs) to provide therapy to Medicare recipients. In July, CMS proposed policies that would significantly increase access to mental health services by adding MFTs and MHCs into the ranks of Medicare-eligible providers.  At a time where access to mental health services is acutely limited, it is startling that such a large pool of providers with advanced specialized degrees are not allowed to provide care.

There are many similarities between LCSWs and MFT/MHC training. In addition to an undergraduate degree, LCSWs, MFTs and MHCs have completed a two-year Master’s program, which is then followed by two years of supervised clinical practice prior to taking a licensure exam in their relevant discipline. Once they pass that test, they are able to practice independently in a wide range of settings.

Adding these trained professionals to the roster of available providers is a meaningful step to improve access to mental health services for Medicare members.

Improving access is not just about getting to a provider, though, t’s also about getting connected to one that a patient can feel safe with, connected to, and build a strong working rapport with. According to AAMFT, the satisfaction rate among patients engaged in care with a MFT is exceptionally high, with nearly 90% reporting an improvement in their emotional health after receiving treatment.

One key element in patient-provider connection is allowing options for demographic matching. Studies have shown that when patients from ethnic/racial minority backgrounds are able to connect with providers who share similar demographics, they report better health outcomes and increased satisfaction with the care provided. In one analysis, data gathered from Black caregivers showed 83 percent felt that having a mental health provider of the same race and ethnicity was important, citing themes like relatability, diversity in cultural experiences and the overall patient experience.Adding MFTs and MHCs has the potential to improve demographic matching, given that these are more diverse groups than PhDs or LCSWs.

Given the overall supply-demand imbalance, which is only predicted to get worse, the time is now to ensure that the entire qualified mental health labor force is able to work with Medicare recipients. The CMS proposal would do that. 

It is often said in health care economics that there is an “iron triangle” of quality, access, and cost. When trying to improve any of these domains, you always risk worsening one of the other two. With MFTs/MHCs typically collecting lower salary averages than LCSW and PhDs, this addition will likely generate cost savings for Medicare, leaving a question of quality. Will a Medicare member get the same quality of care with a MFT or MHC that I would get with an MSW or PhD?

The reality is for many conditions, including some of the most common depressive and anxiety disorders, we know confidently there are a variety of therapeutic approaches that are effective. In fact, there is strong evidence that quality of the client–therapist alliance is a reliable predictor of positive clinical outcome independent of the variety of psychotherapy approaches and outcome measures. This means for many of the most common conditions affecting Medicare recipients, the most important aspect of their therapy is not the letters listed after their provider’s name, but instead their provider’s ability to make them feel seen, validated, and encouraged to share and engage with the treatment recommendations made.

Finally, and most importantly, schools educating therapy trainees of all types historically have not emphasized the most evidence-based treatments. First published in Myrna Weissmans’ “National Survey of Psychotherapy Training” and outlined in Dr. Thomas Insel’s book Healing, “over 60 percent of professional schools of psychology and master’s of social work did not include any supervised training for any scientifically based therapy.” These numbers are only slightly better than those in MFT/MHC schooling. This is not a concern to be taken lightly. For conditions like post traumatic stress disorder, obsessive compulsive disorder, and eating disorders, offering evidence-based therapies can be the difference between meaningful recovery and persistent struggling. Ensuring patients are getting high quality evidence therapy is an issue not limited to MFT/MHCs and will require commitment across professional schools.

Fortunately, for all mental health providers, education does not conclude with their professional schooling. MFTs and MHCs, like social workers and psychologists, are required to complete yearly continuing education to maintain their licensure. There is great research interest in disseminating evidence-based training to therapists of all backgrounds as this is a demonstrated need across licensure. With greater focus from insurers, employers and clinical leaders on measurement-based care and evidence-based practices, MFTs and MHCs are increasingly required to document and demonstrate the evidence-based elements of their therapy work. 

As our population ages and our mental health utilization reaches all time highs, opening the door by adding over 400,000 additional therapists to support Americans depending on Medicare is a reason to rejoice. We have a real potential to reduce costs and improve access to mental health services to this population. And as to questions of ensuring high quality, all of us in mental health care, regardless of the letters after our name, have to own this challenge with commitment to continued education in service of those we treat.

Dr. Jon Kole is Medical Director and Senior Director of Psychiatry at Headspace

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Alex Katz, CEO, Two Chairs

Two Chairs has an interesting model. Their concept is to find the right therapist for you, and they actually start a patient off with a therapist who diagnoses AND directs in a session, separate from the one who treats. Once the “right” match is made, the patient gets set up with a therapist and the results have been pretty good in terms of the patient coming back–one of a number of things Two Chairs measures rather intently! CEO Alex Katz explained the model and the business–Matthew Holt.

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The Future of Digital Health: How UX Design is Shaping the Industry

By PARV SONDHI

As the digital health world continues to expand, more and more people are turning to apps to manage everything from diabetes and obesity to depression and anxiety. People rely on these apps for their physical and mental health, so it’s crucial that product developers ensure a safe, effective, and engaging experience for them. Healthcare experts agree.

A team of researchers and health system leaders recently introduced a new framework called “Evidence DEFINED” for evaluating digital health products. This framework offers hospitals, payers, and trade organizations a precise set of guidelines to assess the validity and safety of a digital health product. It also gives digital health companies good benchmarks to work from.

As digital health companies create new products in the space, they should keep specific points in mind — from user experience design to considerations for data privacy. While clinical outcomes will always reign supreme, the framework suggests that patient experience, provider experience, product design, and cost effectiveness can’t be discounted.

Here are a few critical considerations that product delivery teams should plan for when creating digital health apps.

Clear navigation

First things first: a user won’t use an app that’s hard to navigate. To help people stick to their health goals, developers need to create apps that are intuitive and easy-to-use. When a user logs onto an app, they want to find the content they need immediately and be guided through the experience step by step.

A lot of different people use health apps, and not all of them are tech-savvy. Health apps need to be accessible to all demographics, including people of various ages who speak different languages. It’s also important to remember that digital health apps can be used across multiple platforms, so the navigation should remain clear when switching between devices.

While navigation might seem like a no-brainer, it’s often overlooked when designing for digital health.

But clear navigation benefits the app as a whole since it can help reduce the time users spend searching for what they need and increase overall engagement.

Simple user interface

Digital health apps need to have a simple, straightforward design so that users can use the product to do what they came to do: work on achieving their health goals. For example, all user interface elements should be visible simultaneously, and interactive elements should be easily recognizable as buttons, tabs, or links. Additionally, task completion instructions should be clearly explained and simple enough for users at a fifth-grade reading level to understand.

The goal should be to create an app that allows users to focus on their health needs without getting bogged down by complex features or design elements. After all, the app aims to help users in their journey to better health, not to be a distraction.

Personalization

Giving users the ability to create a customized experience within the app can help keep them engaged over time. This could involve allowing users to customize their dashboard with widgets, change the color scheme or background of the app and tailor their interactions.

In addition, consider enabling users to set up personalized reminders for activities such as taking medication, logging their moods, or completing specific tasks.

Depending on the specifics of the app, users should also be able to access and update their personal information, such as contact details, health history, etc. This ensures all data is accurate and up-to-date.

Positive reinforcement

An intuitive app gets the user started, but to keep them coming back you need positive reinforcement. A well-designed app should make achieving health goals easy and even pleasant, helping users through each step and celebrating their wins.

Developers can create apps that send users encouraging messages when they complete tasks, or awards users points or badges when they reach milestones. These things might seem small, but they can motivate users to keep using the app regularly and inspire confidence in their ability to take control of their mental health.

This might seem like an added expense or extra effort, but it goes a long way in improving user experience and engagement — which helps define whether or not an app succeeds in the digital health space.

Access to support

Integrating support in the app helps users feel like there’s always someone to turn to and provides an added layer of safety. Consider adding a feature that quickly connects users to the necessary support services in their broader health network, whether in the form of an in-app 24/7 chat or email.

It’s also helpful to provide FAQs and community support articles to allow users to opt for a self-service option. And, as always, make sure to enable robust privacy settings so users can control who they speak with and what information they share.

Education

People who use digital health apps want an action plan, but they also want to educate themselves on their health issues. Providing an education section engages users on issues that are important to them, enhancing their experience and encouraging them to keep using the app. Plus, it’s a great way to distinguish your app from others.

You can also display educational content to users as they go, offering definitions, or statistics, or links to research that they can access as they move through the stages of the program, as well as a separate education section that users can explore more on their own time.

Designing with this relevant and actionable content in mind can enhance user experience and motivate users to stick to their health goals and  continue to use the app.

Gamification

Gamification is a tool that encourages users to achieve their health goals by visualizing their progress and rewarding their persistence. Developers can use devices like leaderboards to show how a user is performing compared to other users, or streak trackers to encourage users to keep moving. Finally, developers can allow users to unlock achievements when they pass certain markers, rewarding them for their hard work.

By making health-related activities more fun and interactive, users are more likely to stick with them in the long run – which can positively impact their health. Gamifying the app experience can also help keep users engaged, motivated, and connected, creating a more positive user experience.

Integrated Care

While we’ve been talking about the digital experience, sometimes, one of the most vital pieces of the experience is the human in the loop. Teams can provide that experience by bringing in health coaches, dietitians, or therapists who can offer support right from the app. These experts engage users far more than a basic app can, and experts can offer tailored support and care for the user’s progress and suggest improvements to the member’s care plan.

Giving users access to this in-app can help them feel supported and encourage them to move the needle on their health goals and keep returning to the app.

Final Thoughts

As frameworks like Evidence DEFINED become more widely shared and developed, companies creating digital health products should consider not only whether the product is evidence-based and suitable for adoption, but also the user experience for their products.

When designing apps for digital health, it’s essential to create an experience tailored to users’ individual needs. By taking the time to understand user needs and preferences and integrating these considerations into an app’s design, developers can create products that are both accessible and effective for those struggling with health issues. With the right approach, such apps can be valuable resources in helping people manage their health and lead more fulfilling lives.

Parv Sondhi is a Group Product Manager at Vida Health

from The Health Care Blog https://ift.tt/6xEsOrU