This month’s guest article is written by Iswarya Srinivasan a doctor of nursing practice student at the University of Pennsylvania’s School of Nursing. Here she explains how clinicians can use human-centered design and design thinking to improve healthcare delivery using the value-based care model. Using a human-centered approach in collaboration with care models such as value-based care enhances the goal of improving the quality of care our patients receive.

Four years ago, I accidentally stumbled upon the payer world. As a nurse who is used to the clinical setting, understanding the payer world and business side of healthcare was very new to me. This is where I was introduced to the topic of value-based care and the idea of improving healthcare quality for patients by preventing problems before they start. Value-based care incentivizes providers and health systems based on patient outcomes instead of the traditional fee-for-service model. The aim is to be proactive instead of reactive by focusing on prevention and reducing unnecessary, expensive medical procedures.

My journey as a doctor of nursing practice student at the University of Pennsylvania has led me to learn about human-centered design, which effectively allows us to develop a deeper understanding of human needs and how we respond to those needs. The implementation of value-based care initiatives can be seen as provider-centered or payer-centered because the focus of these initiatives is based on who it benefits the most. As a result, our patients may suffer. How can we approach value-based care by putting humans at the center of that care? Humans refer to anyone who impacts the care process by either providing or receiving care.

Using the five steps of human-centered design, we can examine opportunities to provide value-based care and improve the quality of our healthcare infrastructure by using a collaborative, human-centered approach.

1. Get to know your patients: Study the healthcare landscape and empathize to better understand needs. This basic understanding will allow you to develop actionable insights to improve care delivery. Lack of understanding fundamental needs can make or break your value-based care initiative. For example, if your patients struggle with lack of transportation or other social determinants of health, it will not make sense to impose prior authorization limitations to monitor utilization on these services. There must be a better way to determine the appropriateness of this service. Often, we are guilty of wanting to fix a problem before understanding the underlying issue. Using an empathetic approach of appreciating our patients’ needs intrinsically and extrinsically will allow for that deeper understanding to occur.
2. Define your healthcare problem: Leverage your knowledge and the knowledge of your stakeholders (the people affected by the problem) to understand the landscape and define the healthcare problem. What are you trying to solve for? What is affecting your patient population and/or healthcare workers? Taking the example of patients experiencing transportation barriers resulting in idle providers, you would want to write a problem statement that outlines the gap, describes when and where the problem was observed, quantifies the extent of the gap, and explains the importance of the problem from the point of view of your patients.
3. Ideate your value-based care initiative: Now that you understand your healthcare problem, what are some ideas to solve the barriers to transportation? Brainstorm big themes and creative, innovative ideas to solve your problem. Exercise your mind and work collaboratively with multidisciplinary members of the care team and patients (remember, human-centered means collaborating with the people the problem affects) to ideate potential solutions. Like the human-centered design process, value-based care is not meant to be a siloed operation but a collective approach to solving healthcare’s most complex issues.
4. Prototype your value-based care initiative: Based on the ideas that you developed with your multidisciplinary care team and patients, choose the low-fidelity idea that best addresses the problem to build into a working model that can be tested. Choosing a low-fidelity idea to prototype allows for flexibility to test your idea and improve your design; if the idea is not working quickly and cheaply you can iterate and start again. Your care team could decide that partnering with a local transportation company to provide free transportation to appointments is one way to solve access to care issues. Your team could construct and model this idea into a working process that can be developed and tested with the key stakeholders.
5. Test your value-based care initiative: Take your low-fidelity prototype out into the environment where the problem is taking place and test it with your key stakeholders. Between prototyping and testing, this is an iterative process used to refine your idea. Your care team might test the free transportation workflow and find it to be helpful, but perhaps the rideshare company is overwhelmed and limited in its capacity to cater to all the patients requiring transportation assistance. If that’s the case, go back to the prototype to refine the workflow and consider other methods of care delivery, such as telehealth (when appropriate) to get your patients what they need.

At the end of the day, the decision to apply human-centered design to solve value-based care challenges is an asset to developing simple, innovative solutions by keeping patients at the center of healthcare quality improvement. The importance of focusing on a comprehensive approach to healthcare can benefit everyone providing and receiving care. It is important to remember that there is no idea that it is too big or small to implement, especially if it meets the needs of our patients and means improving the quality of care. 

References

Centers for Medicare & Medicaid Services. Value-based programs. March 31, 2022. cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs.

Melles M, Albayrak A, Goossens R. Innovating health care: Key characteristics of human-centered design. Int J Qual Health Care. 2020;33(Suppl 1):37-44. doi:10.1093/intqhc/mzaa127.

University of Pennsylvania School of Nursing and Rita & Alex Hillman Foundation. Design thinking for health. designthinkingforhealth.org/the-course