IS1 Northwell 2022 Whitepaper

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INTEGRATIVE STUDIO 1

Designing the Healthcare of Tomorrow FINAL REPORT SPRING 2022 Instructors Leah Cabrera Fischer Ankita Roy

Table of Contents 01 Challenge ● The context ● The brief ● The team ● Our process 02 Research & Synthesize ● Research overview ● Healthcare today is… ● Journey map ● User personas ● Our insights 03 Redefine problem ● The challenge 04 Ideate ● Ideation sessions ● Design principles ● Opportunities

05 Prototype and Test ● User testing overview ● Prototypes & insights ● User testing findings 06 Propose Solutions ● Specialist connector ● SDOH screener ● Discover nearby ● Health advisor ● Cultural advocate ● Care nest 07 Implement ● Roadmap ● Business outcomes & Impact ● Key strategic shifts 08 Appendix ● References

2

01

Challenge

3

THE CONTEXT

A strategic partnership In Spring 2022, Northwell Health & Parsons School of Design collaborated to form a mutually beneficial partnership to address challenges with a collaborative and innovative approach.

While Northwell was seeking a fresh perspective and strategic recommendations on the digital transformation of their stakeholder experiences, graduate students from Parsons’ Strategic Design & Management program were looking to apply their learnings in the real world context through an Integrative Studio.

Over 15 weeks, the teams cracked down on making Northwell greater than it already is.

01 Challenge

The largest integrated healthcare system in New York State commied towards caring for millions of individuals and their families

The #1 design school in the U.S. and #3 globally, oering interdisciplinary programs across the spectrum of art, design, and management.

4

THE BRIEF

The design challenge

Northwell Health is a nonprofit integrated healthcare network and New York State’s most comprehensive integrated health system and its largest employer.

Northwell seeks to leverage digital tools and personalization to guide patients through their healthcare journeys. Journeys can range in complexity from simple appointment preparation to multi-faceted care coordination for patients with multiple chronic conditions.

Northwell’s goal is to understand how and when digital tools can add value to a patient’s individualized care journey based on their own unique needs and profile. Special aention will be given to social determinants of health to drive toward beer clinical outcomes.

01 Challenge

How might we… digitally transform the stakeholder experiences at Northwell Health with a special focus on the social determinants of health?

5

THE TEAM

An interdisciplinary approach Students from the Strategic Design & Management graduate program interested in healthcare came together to form an interdisciplinary team of researchers, strategists, and designers with diverse prior experiences across functions and industries.

Researchers Consultants & Strategists Experience & Interaction Designers Product & Service Designers Branding & Marketing Strategists Visual & Graphic Designers Business Designers

01 Challenge

María Altet

Shivani Bhansali

Lucia Chen

Ramey Chen

José Pablo Domínguez

Dana Duarte

Radhika Dilip Kale

Chrissie Kayode

Meshwa Kshatriya

MJ Kwon

Mikaela Li

Valentina Palacios

Soumil Panwar

Tako Sulakvelidze

Charloe Yu

Claire Zhuang

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OUR PROCESS

Design process With a research-led and design-thinking approach, the team collaborated on uncovering challenges and oering product and service-based solutions that were strategic and experiential.

Our process was rooted in a participatory approach and co-designed solutions with the Northwell team and research participants.

34 patients

5 insights

59 initial ideas

25 patients

12 caregivers

4 personas

7 prioritized ideas

9 caregivers

7 providers

4 opportunities

4 design principles

7 providers

4 experts

01 Challenge

3 experts

7

02 Research & Synthesize

8

RESEARCH OVERVIEW

Types of research To gain an in-depth understanding of the current healthcare landscape in New York State, we conducted secondary and primary research to uncover qualitative and quantitative insights that would inform the solutions we built in a participatory manner.

SECONDARY

PRIMARY

PARTICIPATORY

Why: To beer understand the market landscape and existing solutions

Why: To gain perspectives with the voice of the stakeholders and get detailed experiences

Why: To test concepts and build solutions that are desirable, feasible, and viable

How: Look into existing research on the consumers, market, and competition

How: Interview patients, caregivers, doctors, surgeons, nurses, and experts

How: Facilitate participatory workshops to elicit ideas and prioritize and test with users

Market & Benchmark Analysis

Interviews

Ideation Workshops

Podcasts

Group Discussions

User-led prioritization

Journals & Research Reports

Surveys

User testing

Northwell Documentation

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9

RESEARCH OVERVIEW

Our research plans ENABLE ACCESS

HYPOTHESIS

OBJECTIVES

●

●

Understand the motivations and journey of those who go for regular medical checkups and the challenges and barriers of those who do not.

Identify the touchpoints and communications that can help reduce barriers, and in turn, increase the number of people that aend annual health check-ups.

By increasing the access of yearly physicals, an onset of healthcare journey within Northwell can be marked.

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CARE FOR SDOH

●

●

Understand the whole experience of Northwell’s patients in managing their healthcare.

Identify the most common drop-o or pain points patients face through their healthcare journey that prevents them from accessing healthcare and opportunities to intervene.

By understanding the SDOH that most often hinder patients’ healthcare journeys and negatively impact their health, we can design interventions to help overcome these barriers.

ASSIST & GUIDE

●

●

Understand the characteristics of the population in New York that does not speak English, and their relationship with the healthcare system.

Identify the main barriers for enrolling in healthcare services amongst LEP patients.

By reducing the communications gaps and languages barriers, we can help patients with LEP to have a timely and appropriate healthcare outcomes.

SUPPORT CAREGIVERS

●

Understand how to make holistic care more accessible and approachable for individuals and families via integrative care networks in order to achieve beer healthcare outcomes.

By providing a more accessible and approachable platform, we can help patients, caregivers and healthcare providers achieve a more holistic and caring healthcare journey.

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RESEARCH OVERVIEW

Crafting our insights After the research process, we downloaded the information to understand common pain points, identify the patient’s journey and find insights representing a patient’s experience.

We created user journeys and user personas to help us land the insights to get to the insights.

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HEALTHCARE TODAY IS…

Complex & ambiguous

33%

of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill a prescription because of costs

24 days

average wait time for a new patient-physician appointment

Accessibility to healthcare in the US is governed by various factors, including but not limited to awareness, perception, costs, etc., leading to social depreciation in health and other adverse conditions. This intimidation from the healthcare system prevents millions of people from geing that first health appointment which further decides the service they need to lead a healthy life.

Source: The Commonwealth Fund, Arista MD 02 Research & Synthesize

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HEALTHCARE TODAY IS…

Complex & ambiguous How might Northwell decrease entry barriers and increase accessibility in the healthcare system?

Insurance expands the accessibility of healthcare many folds More than 20 million people use health insurance intended to put spending limits. Health insurance protects citizens with pre-existing conditions and focuses on preventive care by covering many health services. These providers must cover maternity care, breast cancer, breastfeeding support, birth control, etc., by law to prevent gender bias in healthcare. Medicaid now includes millions of low-income individuals and families without coverage.

Awareness and physical access prevents health screening People don’t get recommended health care services because they don’t have a primary care provider or live too far. Interventions to increase access to health care professionals and improve communication can help more people get the care they need.

High healthcare costs are intimidating, need to take control Healthcare in the US is more expensive than in most countries. To oset costs, healthcare providers are leveraging the increase in consumers who want to play a more active role in monitoring their health by encouraging tech that promotes vital tracking, early detection, and disease prevention.

Source: 1.hps://jamanetwork.com/journals/jamanetworkopen/fullarticle/2738025 2. hps://www.hsph.harvard.edu/news/hsph-in-the-news/understanding-why-health-care-costs-in-the-u-s-are-so-high/ 02 Research & Synthesize

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HEALTHCARE TODAY IS…

Missing context

80%

of the factors that influence our health operate outside hospital walls

$200

average cost of no-shows per patient for health systems

Studies have shown that many dierent factors can directly or indirectly impact someone’s ability to manage their health. A majority of the factors that influence our health operate outside hospital walls, such as health behaviors, social and economic factors, and the physical environment. Evidence shows that patients with one or more social needs have a higher no-show rate. Factors linked to lack of socio-economic resources are associated with higher readmission rates for patients at minority-serving hospitals. The healthcare industry is starting to adapt to address these factors at a community level, not just on an individual level in clinical seings, but more progress is needed.

Source: 1. hps://www.cms.gov/about-cms/agency-information/omh/downloads/omh_readmissions_guide.pdf, 2. County Health Rankings Model, 3. “Prevalence, predictors and economic consequences of no-shows.” BMC health services research 02 Research & Synthesize

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HEALTHCARE TODAY IS…

Missing context How might Northwell oer care for social determinants of health (SDOH) that prevent patients from staying on top of their health?

Source: 1. hps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2837459/ 2. hps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7362703/ 02 Research & Synthesize

Health in the United States is paerned strongly along socioeconomic and racial / ethnic lines Those who are disadvantaged are more likely to have nonmedical factors like economic instability that can negatively impact their health. It aects people’s access to transportation, food, medicine, their ability to take time o work to aend to their health, etc.

More coordination will enable beer outcomes Many players in the broader healthcare system – including health systems, payers, social service providers, and community-based organizations – need to share information related to SDOH to improve patient outcomes and drive sustainable change.

Addressing the root causes can help patients miss fewer appointments and reduce readmissions Patients with one or more social needs have a significantly higher no-show proportion (31.5%) than those without any social needs (26.3%).

This has implications on cost, quality, and access to health systems. Addressing SDOH can improve health outcomes and reduce costs for not only patients but also payers and providers.

The evidence base for eective ways to manage SDOH is limited, and it takes several years to see impacts Changing a community is a long-term investment. However, the shift toward value-based care has spurred investments in social needs and will continue to drive partnerships and innovation.

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HEALTHCARE TODAY IS…

Lost in translation

30.5% 3.1m of NY residents do not speak English at home

45%

of New Yorkers with LEP are native in Spanish

immigrants in NYC, of which 50% have LEP

23%

of New Yorkers identify with having LEP and associated diiculties

One of the biggest barriers to high-quality health care in the U.S. has nothing to do with medicine, it has to do with language. Language barriers in the health care system in the US are associated with a decrease in quality of care, safety, and clinician satisfaction, but what is even more worrisome is that these barriers are contributing to health disparities, even among people with insurance. Quality is improving access and disparities are not. Health care quality and access are still suboptimal, especially for racial and ethnic minorities

Source: MOIA Annual Report 2019 02 Research & Synthesize

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HEALTHCARE TODAY IS…

Lost in translation How might Northwell improve the healthcare quality and access amongst patients with Limited English Proficiency (LEP)?

Patients belonging to racial and ethnic minorities have worse healthcare outcomes Patients who face language barriers have diiculty accessing care, receive fewer preventive services, and are less likely to follow medication directions, but are more likely to end up in intensive care.

The language used by doctors is creating more communication barriers There are a considerable amount of reports presenting communication diiculties because of certain terminology used by medical professionals. "Even fluent English-speaking people often find that conversations with Healthcare professionals sound like Greek to them”. In California, patients with lower levels of education are more likely to need a translator.

Language services are oered late Language services are often only considered when the patient is siing in front of the clinician—and at that point, it is too late.

Language services should be incorporated across the clinical workflow and planned before the patient is at the doctor’s oice.

The language barrier is associated with poor quality of care and clinician satisfaction In the USA, patients who speak another language other than English at home were more likely to report poor communication with medical sta. For example, Spanish-dominant Hispanics (SDH) face challenges in understanding accurate information about their treatments.

Source: MOIA Annual Report 2019 02 Research & Synthesize

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HEALTHCARE TODAY IS…

Not caring for caregivers

23.5%

1.

of New Yorkers reported being a caregiver for family or friends

2.

26%

of family caregivers have diiculty in coordinating care for patients

3.

Healthcare is largely focused on individual concerns and issues rather than considering the family as a unit. When one person falls sick, the entire family gets aected, thereby making it important for the transformation to family-centric care.

Our system focuses on disease, specialty care, and technology rather than preventive care. The system loses out on insights from patient history and generational history.

People tend to get care in a variety of seings that may have lile or no connection to each other. That can lead to duplication of care, poor coordination of services, and higher costs.

Source: Caregiving in the US 2020 02 Research & Synthesize

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HEALTHCARE TODAY IS…

Not caring for caregivers How might Northwell oer support to patients and caregivers to improve treatment & health care outcomes?

Preventive Care

Family-centric Care

Preventative care with a holistic approach of nutrition, exercise, mental health, and primary care. Data Driven Generational Health Holistic health is an approach to life that considers multidimensional aspects of wellness. It encourages individuals to recognize the whole person: physical, mental, emotional, social, intellectual, and spiritual.

Patient- and family-centered care is an approach to the planning, delivery, and evaluation of health care that is grounded in mutually beneficial partnerships among health care professionals, patients, and families.

Generational Health The most unhealthy generations are Gen X,Y (Gen M) because of their lifestyle including alcohol, smoking, depression, insomnia, and anxiety. Gen Z is the most physically active and willing to pay a premium for wellness products and healthy foods. Overall, Gen Z takes a holistic view of health, emphasizing physical fitness, healthy eating, and mental well-being.

The most Consumer-centric technology health care generation is Gen MZ and alpha, 74% say that they’d rather see a doctor through telemedicine. And when a situation calls for more than a video chat, they tend to avoid their primary care doctor, opting for specialists and alternative solutions to solve the problem. While older generations see PCPs as the point guard for their care, millennials see them as an extra step to geing the care they really need.

44% of millennials are a minority race or ethnic group. They need to represent themselves in their own experience.

Source: hps://www.mediapost.com/publications/article/291796/what-millennials-want-when-it-comes-to-healthcare.html 02 Research & Synthesize

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JOURNEY MAP

A patient’s healthcare journey We found that a patient’s healthcare journey consisted of 3 stages: access to care, delivery of care and extended care

ACCESS TO CARE The initial step of awareness and action towards starting a healthcare journey STAGE 1

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DELIVERY OF CARE When a patient is actually receiving a healthcare service they need STAGE 2

EXTENDED CARE The path to recovery after a patient has been diagnosed and has left the hospital STAGE 3

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JOURNEY MAP

A patient’s healthcare journey Geing perspective of how this journey experience and the emotions conveyed around it.

Think of a time when you were suddenly triggered to go to a doctor. At the time, you felt scared, and a sense of urgency occurred. You tried finding the appropriate healthcare provider. You had to figure out your insurance and finally made the appointment. Unfortunately, the appointment was probably further out than what you had wanted, and two months later, it’s finally the day of your appointment. Of course, Murphy’s Law happened, and everything that could go wrong went wrong on the day of your appointment. You had to figure out how to get there, and the subway was delayed. When you arrived, you filled out a huge stack of forms and waited for what felt like hours. You got maybe 10 minutes with the doctor and left the appointment with a laundry list of tests, scans, prescriptions, and another check-up. Finally, in your follow-up appointment, you received a diagnosis and care plan and had to figure out how to manage this condition going forward.

Diagnosis

Recovery

Check up

Get appointment Awareness Trigger

Tests & scans

Identify specialist Commute

Follow up

After care

Follow care

Paperwork

Pay bill

Next, we captured dierent versions of this journey through our user personas.

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USER PERSONAS

Tia

“

I have a lot going on, there is no one to help me and I don’t want to spend my time figuring out my insurance.

”

Health Journey ● ●

Casually dating and is on birth control Started having irregular menstrual cycles and decided to visit a doctor but is unaware about her insurance coverage

Mindset ● ●

Carefree and overconfident about her own health Doesn’t think of visiting a doctor until something happens

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Healthcare Perception ● ●

Finds the system complex, confusing and unclear Thinks the healthcare services are too costly

A 25 year old graduate student from New York Supports herself financially - STRICT BUDGET

Anxious

Frustrated

Worried

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USER PERSONAS

Tia’s story Tia is 25 years old, living in New York, the city of her dreams. She is feeling carefree and overconfident about her health. She is young and healthy! And invincible- nothing can happen to her! If I don’t live it out now, when will I? She is casually dating and wants to get on birth control. She asked her friends about going to the gynecologist, but they told her that it was crazy expensive and the system was a mess.

Just get birth-control online! Since she is intimidated by the HC system and is on a tight budget, and with limited insurance, she decided she would order her birth control pills online.

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Challenge A year later, she starts having irregular menstrual cycles and finally decides it’s time to go to the doctor. There is a Northwell Hospital near her home, so she decides to go there. She is overwhelmed and confused, trying to figure out what is covered by her insurance covers and finding a good doctor. It’s all complex and confusing. After searching for five weeks, she got a 5-minute check-up and was asked to do a blood panel and see an endocrinologist to go back to the gynecologist to get her prescriptions.

She was oered a translator but felt ashamed.

Finally, she feels anxious, frustrated, and annoyed.

She felt rushed and unheard since her questions remained unanswered. It was simply not a safe environment.

● ● ● ●

Complex unguided system Weak association with Northwell Lack of precise and clear information Ambiguous cost

How might we help Northwell eliminate entry barriers by making them seem more humane, approachable, and less intimidating?

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USER PERSONAS

Luis

“

I don’t have insurance. I knew the cost might be something I could not aord, so I delayed going to the hospital until the very last minute. I left as soon as I could - I had to go back to work or I would lose my job. I didn’t come back for follow-up treatments, because I know the bill is waiting for me.

Health Journey ● ●

Over time, Luis feels tremendous discomfort and refrains from accessing care He finally gets an appointment, but with his anxiety at its peak he wishes for someone who speaks Spanish The appointment feels very quick and transactional, he lacks clarity on what his next steps should be.

Mindset ● ●

”

Unwilling to spend money on himself Very economical wants to leave the money to his family

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Healthcare Perception ● ●

Feels the system is complex, confusing and unclear Concerned about medical bills, he thinks will not be able to aord it

A 79 year old construction worker from Queens Supports family financially - TIGHT BUDGET

Anxious

Isolated

Worried

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USER PERSONAS

Luis’s story Challenge Luis is a 49-year-old immigrant from Guatemala. He is a construction worker living alone in Queens but he provides for his family back home. For him, supporting his family is his priority. Over time, Luis notices changes in his body and feels tremendous discomfort, but he’s not sure where to go or what kind of doctor he needs to see. He’s also worried about how much it will cost and ends up puing it o until the pain is unbearable.

When he gets to the doctor’s oice, he has to complete several forms, but he’s frazzled and struggles to fill them out. He feels overwhelmed and rushed during his appointment, as a result, he refrains from openly sharing his health history and other personal details. The doctor gives him a diagnosis and prescription and he’s sent on his way.

He feels there is a lack of communication and begins to feel helpless and isolated.

He finally gets an appointment, but he has to take a few hours o from work and pay an extra subway fare to get there. His anxiety grows during his commute.

When he gets there, he feels overwhelmed and isn’t sure where to go. He looks for someone who might speak Spanish for assistance.

Post the appointments Luis is confused about his next steps and wishes for some clarity and direction.

At this point, Luis is worried about his health and finds it diicult to open up to his family. He wishes there was somebody who would assist him through the process.

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●

●

●

People are not aware of the services they are eligible to receive Need for more guidance for patients who are already burdened Lack of familiarity and trust leads to puing o geing care

How might we oer tailored resources to patients from underprivileged communities and provide guided care that empowers them to prioritize their health?

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USER PERSONAS

Sofia

“

I was just about to give birth, I felt a translator would be an obstacle during the labor process, I wanted my husband to understand everything as well.

”

Health Journey ● ●

She is married and expecting a baby She has gestational diabetes and her pregnancy became a higher risk pregnancy

Mindset ● ●

Very mindful about taking nutrition and controlling Worries about the medical cost as it is unpredictable

Healthcare Perception ● ●

A 33 year old babysier from New York Supports family financially - TIGHT BUDGET

Heard about LEP service but feels ashamed to have it Having an interpreter in the room would be intimidating Anxious

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Frustrated

Worried

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USER PERSONAS

Sofia’s story Sofia is 33 years old, living in Long Island, originally from Mexico. She has been living in New York City for almost 7 years, working as a babysier for a Mexican-American family. She is married and She has to send money to her family monthly. Now she is expecting a baby and often going for control with the doctors since she has developed gestational diabetes and her pregnancy became a higher risk one. Despite the diabetes complications, the baby is growing healthy, and she is very excited about having her baby in her arms in the next couple of weeks. During the visits to the doctors, there are a couple of terms Sofia doesn’t understand, but she still feels she can communicate eectively with all the medical sta in English. Someone at the hospital tells her about the interpreter services. Sofia’s first reaction is to worry about the cost, but the person providing the information doesn’t give her a clear and satisfying answer.

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Additionally, she feels capable to understand and communicate in English. Even if it’s in Spanish, there would be some terminology used by doctors she wouldn’t understand anyway. She is concerned if she should take the interpreter service because giving birth would be intimidating. She wishes there was someone she could trust to be there with her.

Her family can’t fly from Mexico because the borders are closed due to COVID 19. Moreover, she wants her husband, who is American and only speaks English to understand everything well since this is such a special moment for the family. Lastly, she feels ashamed as a fluent English speaker to take the service. As a result, Sofia decides not to have an interpreter accompanying her through giving birth.

As her contractions become more frequent, her ability to think decreases, and she has limited capacity to answer the questions of doctors and nurses. She feels completely overwhelmed, and she starts crying.

Challenge ●

●

●

People are not familiar with the language support service and have concerned that it is going to be intimidating and trustable They aren’t certain if it is adding extra headaches like cost to their journey Some fluent speakers would consider ashamed to take this service

How might we ask people about their language preferences in an encouraging way that makes them feel more safe/supported and more ready about starting the journey?

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USER PERSONAS

Alexis and Jason

“

It takes a village to care for an unwell loved one and our family and friends support us by helping. but in certain situations, it breaks my heart to see my wife in pain. us not knowing how to provide care and what to do to help doesn’t help.

”

Health Journey ● ● ●

Alexis is quite healthy but is diagnosed with breast cancer Her prognosis requires her to undergo chemo and a surgery to prevent cancer from metastasizing Jason is her primary caregiver, with support from other family & friends

Mindset ● ●

Guilty because she needs care Anxious for her family

Healthcare Perception ● ● ●

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Appointments are not easy to get The caregivers' options are limited at the hospital The hospitals don’t prepare you well enough for when you go home

A 32 year old father of a baby and a lawyer by profession. Based in from New York Supports family financially - TIGHT BUDGET

Patient Guilt

Confused

Fear of Death 28

USER PERSONAS

Alexis and Jason’s story Alexis, an investment banker, and Jason, a lawyer, are a young married couple living with their 1-year-old in Tribeca, Manhaan. They earn a fair amount of money and their employers cover their insurance with dierent healthcare providers. One day, an otherwise fit Alexis, notices some changes in one of her breasts. Her mom had breast cancer and this gets her worried. She gets an appointment with an oncologist 3 days later who discovers she has a malignant tumor and she is diagnosed with stage 3 breast cancer. Her prognosis requires her to undergo several rounds of chemo and a surgery to prevent the cancer from metastasizing. At the hospital, the strong and independent Alexis doesn’t name any caregivers on her file because she doesn’t want to bother or worry anyone but she does tell her loved ones and take a sabbatical. As she waits for an appointment with an onco-surgeon, her treatment leaves her physically fatigued. Jason quickly steps in as the primary caregiver for her and their toddler. The responsibility and pressure of making sure he is supporting them in the best way possible while

02 Research & Synthesize

managing his work makes him anxious. The lack of synchronization between Alexis' multiple doctors doesn’t help the situation either and he has to keep track of a lot of reports and tests. Somewhere along the way, Jason trips and breaks his foot. He tries to find a professional caregiver but doesn’t find someone trustworthy and aordable. His friend steps in to help and Jason asks their parents to fly in and help. In addition to emotional support, the family works together as a unit to ensure things don’t fall o track and one person doesn’t face caregiver burnout. But due to lack of training, at times they are confused about what to do in certain situations so they reach out to the doctors again who are hard to get a hold of. Alexis is guilt-ridden about not testing earlier and needing to rely on her loved ones. The family and friends who stepped in to help don’t identify themselves as caregivers and instead say they're taking care of them out of love. The term caregiver seems transactional to them.

Challenge ● ● ●

●

Fragmented system impedes healthcare outcomes Lack of synchronization between doctors, caregivers & patients Patient’s guilt about needing care & caregiver’s aversion to the term caregiver Lack of training & reference-ability for caregivers to provide the right care

How might we connect doctors, patients and caregivers while empowering patients and caregivers with resources and knowledge to ensure beer health care outcomes through a digital platform?

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OUR INSIGHTS

Consolidating our findings Through our primary and secondary research, we identified five key insights that spanned all of our challenge areas

01

02

03

Ambiguity breeds avoidance

Familiarity breeds comfort

Trust is foundational

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04

05

Coordination is paramount

Care goes beyond the hospital

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ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

01. Ambiguity breeds avoidance

“

So I had a strong migraine and went to the hospital, I made an appointment with a primary doctor, who later directed me to a neurologist and by the time I got my results back my headache was already gone and so were my dollars. Next time I am simply going to CVS.

Priya Patient

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Patient

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ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

01. Ambiguity breeds avoidance People have a preconceived notion that the healthcare system is complex and inaccessible, which creates fear in their minds leading to avoidance.

This is because they sense that the health system is complex and hard to navigate. When they try to understand it, they face unclear and confusing information that creates distrust in the system. At times just geing to the right

___

doctor can be a hustle and not to mention time

Challenges: ▾ ▾ ▾ ▾ ▾ ▾

Perception of complexity Lack of precise and clear information Ambiguous estimates and costs Hard to figure out what doctors yours need Self-medication Distrust in the system

and budget-consuming. Every single time they go to the doctor, they face the uncertainty of what their bill will look like. Therefore, they avoid going and even recur to self-medication, taking a reactive response towards healthcare and hoping never to have to go until sometimes it is too late and when they aend, and the consequences are irreversible.

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ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

01. Ambiguity breeds avoidance Reflection Just think about how you would feel if your daughter was diagnosed with a terminal disease that could have been prevented if she had gone to regular yearly check-ups.

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ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

02. Familiarity breeds comfort

“

I was about to deliver Emilio. I didn’t take the translator service because I was worried about the cost and I didn’t want another stranger in the room.

As my contractions worsened, I struggled to understand what they were saying. I wished there was someone who could support me in Spanish, but it was too late.

Sofia Patient

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ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

02. Familiarity breeds comfort The needs of patients with LEP are often multi-faceted, ranging from functional translation supports to emotional support, advocacy, and cultural bridging.

Patients with language barriers feel self-conscious due to their disadvantage presenting the need for practical translation support and one that can help them as an advocate that allows their voices to be heard and

___

create a cultural bridge to give them a sense of

Challenges: ▾ ▾ ▾ ▾ ▾

belonging as emotional support.

Lack of empathy & belonging Unaware of eligible services & cost Lack of guidance to anticipate possible problems Service oered at the wrong moment or late Communication gap & language barriers

02 Research & Synthesize

44

ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

02. Familiarity breeds comfort Reflection Think of a time when you were on a trip to a country where you did not speak the language.

Imagine if you had an accident; suddenly, you were in a room filled with strangers examining and working on your body, saying things you did not understand.

Now pause for a second and think about how that would make you feel.

That is the situation of millions of Immigrants in the US, with the dierence that they face those situations every single day of their lives, not just on a trip.

02 Research & Synthesize

45

ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

03. Trust is foundational INSIGHTS

“

We think about people trusting us and we’re trusted messengers, but we don’t think about how they view trust. This is chronic behavior in health systems, community-based organizations. Everybody’s busy, but we forget to prioritize the people that maer.

Lisa Health Care Provider

02 Research & Synthesize

37

ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

03. Trust is foundational Reaching patients most impacted by SDOH factors requires health systems to build trust in communities that have been historically marginalized / ignored and oer resources in a respectful, dignified way.

patients from marginalized groups, such as those impacted by the social determinants of health of language proficiency, need to be reached out to in ways that help them feel they

___

are in their right to receive these services and

Challenges: ▾ ▾ ▾ ▾ ▾

In other words, what we realized was that

not in a language that can make them feel oended, disrespected, or embarrassed.

Distrust in the system Unaware of eligible services Misleading guidance Lack of belonging Feels unheard & self-conscious

02 Research & Synthesize

47

ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

03. Trust is foundational Reflection Think about how you would feel if generations of your family did not have access to these kinds of services? Perhaps you would also feel out of place and unheard in these situations.

02 Research & Synthesize

48

ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

04. Coordination is paramount

“

While I was suering in pain, my doctor and specialist kept sending me back to each other. I felt like I was running in circles with no answers and real help!

When I found a new doctor, I had to get more tests and scans because my old doctors never faxed them to the new one.

Rachel Patient

02 Research & Synthesize

40

ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

04. Coordination is paramount Communication, between a patient’s care team of doctors, surgeons, nurses, and caregivers is fragmented and siloed, often leaving the patient or caregiver chasing for answers.

Healthcare can be complex at times and can’t be siloed. Chronic cases require coordination between a team of doctors and, at times, surgeons to figure out the puzzle of a diagnosis and the next steps. If communication between

___

healthcare providers is not seamless, there can

Challenges: ▾ ▾ ▾

be delays in geing patients the care they need.

Siloed communication between doctors Lack of visibility into recovery timeline Limited ownership and control of medical report sharing

02 Research & Synthesize

49

ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

04. Coordination is paramount Reflection Imagine how frustrated you would be if the dierent doctors treating your partner were not in sync and kept referring you back and forth between them.

02 Research & Synthesize

42

ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

05. Care goes beyond the hospital

“

It takes a village to care for an unwell loved one and our family and friends support us by helping. But in certain situations, it breaks my heart to see my wife in pain. Us not knowing how to provide care or what to do to help doesn’t help.

Jason Caregiver

02 Research & Synthesize

43

ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

05. Care goes beyond the hospital Patients with chronic care situations require extended care outside of the hospital premises, however, symptom management and emergency care are barely catered to outside hospitals.

The care needed by patients with chronic conditions does not end in the hospital. It is a daily bale that involves the patient and the caregiver. Managing their symptoms and emergencies relies heavily on their caregivers in

___

their own homes.

Challenges: ▾ ▾ ▾ ▾

Ambiguous information on care Lack of emergency support & assistance Poor coordination between caregivers and care team Lack of visibility into treatment duration

02 Research & Synthesize

44

ACCESS TO CARE

DELIVERY OF CARE

EXTENDED CARE

OUR INSIGHTS

05. Care goes beyond the hospital Reflection Imagine if your mother moved to your house due to a chronic condition and can’t sleep at night because of the pain, but you cannot help her. How would that make you feel?

02 Research & Synthesize

45

03

Redefine Problem

46

THE CHALLENGE

Reframed problem space

We reframed the problem based on our research and synthesis:

How might we create a more holistic, accessible, and inclusive patient experience with a focus on family and caregiving units through the use of digital tools?

03 Redefine Problem

47

04

Ideate

48

IDEATION SESSIONS

Co-creating with Northwell After presenting our insights from sensemaking, we facilitated an interactive workshop with the Northwell team to ideate solutions for each challenge area. We reminded them the “How Might We” questions and inspired them with two sacrificial concepts per topic.

Northwell participants each came up with at least three sacrificial concepts and then voted on their top three favorite ideas.

04 Ideate

49

IDEATION SESSIONS

Brainstorming after the workshop Following the co-ideation session with Northwell, we reviewed the ideas that Northwell prioritized and identified the opportunity areas we would pursue for prototyping and testing based on potential impact and eort. We then ran these by Northwell during an oice hour to solidify the testing approach.

04 Ideate

50

IDEATION SESSIONS

Ideation Session per opportunity space

Based on the ideas produced during the ideation workshop, each of the teams prioritized and selected concepts to move forward with for prototyping and testing

04 Ideate

51

DESIGN PRINCIPLES

Our north stars The following four design principles guide us when strategically prioritizing the features to include in the solutions. We validated if we eectively applied the principles to the proposals during the prototyping and testing sessions.

Holistic Care

Empathetic Communication

Cultivate Belonging

Cohesive Experience

Care for patients by providing not only functional but also emotional support, in a warm and familiar way that makes them feel at home

Request and deliver information in an empathetic, mindful and dignified manner, making patients feel heard while creating a judgment-free safe space that enables comfort and honesty

Provide inclusive and accessible experiences that cultivate a sense of belonging while keeping in mind patients cultural, social, economic and emotional aspects

Reduce friction by avoiding unnecessary, repetitive actions and proactively share information internally so that every touchpoint with Northwell feels like a seamless continuation of the last one

04 Ideate

52

OPPORTUNITIES

Opportunity areas and solutions After selecting the spaces to intervene in the synthesis process, we worked on several solutions to create a systemic change toward beer health outcomes.

One or two proposals resulted after deciding amongst a variety of options.

How might we decrease entry barriers and increase accessibility in the healthcare system?

How might we oer care for patients with social determinants of health (SDOH) that prevent them from staying on top of their health?

How might we improve the healthcare quality and access amongst patients with Limited English Proficiency (LEP)

How might Northwell oer support to patients and caregivers to improve treatment & health care outcomes?

Specialist Connector

SDOH Screener

Cultural Advocate

Care Nest

Health Advisor

04 Ideate

Holistic Care

Cohesive Experience

Holistic Care

Cohesive Experience

Discover Nearby

Empathetic Communication

Cohesive Experience

Cohesive Experience

Holistic Care

Cultivate Empathetic Communication Belonging

Holistic Care

Cultivate Belonging

Cultivate Belonging

53

05

Prototype & Test

54

USER TESTING OVERVIEW

Our approach for prototyping & testing 1.

Prioritized a number of ideas with the most impact in each opportunity space and built their prototypes on the basis of the research and findings.

2.

Developed a testing plan to assess the users' perspectives.

3.

Conducted the prototype testing sessions with several patients, caregivers, healthcare providers and subject maer experts.

4.

During the 1:1 interviews the participants were asked questions about their preferences and most liked ideas from the ones presented.

5.

Developed a synthesis based on the interviews and gathered insights to further beer the prototypes.

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55

USER TESTING OVERVIEW

Screening criteria for user testing Team 1

Team 2

Team 3

Team 4

To test each prototype we framed four distinct set of questionnaires to filter interviewees on the basis of eligibility of the topics of each group

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PROTOTYPES & INSIGHTS

Access - Low fidelity prototype To test the the idea around easing the entry barriers to Northwell, we reimagined a patient’s journey until their first appointment and proposed interventions at required touchpoints : 1.

Scan your insurance card: This would enable the patient to fill in mandatory personal details without the hassle of manual typing.

2.

Specialist finder: This feature would allow the patient to select the pain area and its intensity and follow a test leading them to a list of relevant specialists as per their needs.

3.

Booking the appointment: Here the patient is given a choice of virtual or in-person meeting depending on the severity of their symptoms.

Once the appointment is booked they would also be given an approximate estimate of the services they would access.

05 Prototype & Test

57

PROTOTYPES & INSIGHTS

Access - Low fidelity prototype To test the the idea around easing the entry barriers to Northwell, we reimagined a patient’s journey until their first appointment and proposed interventions at required touchpoints : 4.

Pre-appointment: Here the idea was to give them options regarding their preferred mode of communication. This was done to understand the breaches in communication.

5.

Post-appointment services: The idea here was to integrate the feature for ordering lab tests, receiving test results and making claims and understand the patient’s perspective on it.

6.

Incentive: Once their appointment is booked they will be given incentives in the form of vouchers. The patients would also be incentivised on doing ‘boring’ tasks like checking-in before an appointment, updating their medical records etc.

05 Prototype & Test

58

PROTOTYPES & INSIGHTS

Access - User testing insights The five major insights we received during the user testing are as stated below: 1.

Most patients do their own research online before appointments with doctors, but they're still not sure how well the results match up with their choices. The Specialist screener tool could be used to filter doctors that are not relevant.

2.

If a health app roots itself on honesty and transparency, people build trust automatically. The patients preferred the cost estimate feature and would prefer to have it in the app.

3.

Patients have a tendency to form long-lasting bonds with primary health physicians, and this trust helps them rely on their advice for every health issue. Thus, they feel more trust when seeking medical advice from a real person than from a robot. Therefore, they tend to call customer service directly for advice because they think it’s more eicient. Hence, they would prefer a virtual call with the doctor or the clinic in case of minor issues.

4.

Post appointment communications with the doctors oice are complex. Patients often struggle to reach out for reports and suggestions from the doctor. Thus, having a feature in the app itself where they could access their test results, prescriptions and medical records was preferred by most people.

5.

The channels for receiving information are in order of eectiveness: phone calls > SMS > Email > APP prompt, but they prefer to receive information from multiple channels at the same time.

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PROTOTYPES & INSIGHTS

SDOH - Low fidelity prototype The Process Part I:

Part II:

This stage of research involved conducting user testing interviews through Northwell’s platform.The journey comprised of taking one through the Ideal healthcare journey mapped out as per our research.This allowed dialogue around the individuals personal health experiences and reflections along those lines.

At this stage we introduced the questionnaire to help set context of our strategic recommendations.The survey focussed questions around the themes of social isolation, health literacy and transportation from the social determinants of health.Through the course of filling out the survey patients shared instances that reflected certain questions in the survey.

STEP 1: THE IDEAL SCENARIO: The Ideal journey was introduced patients draw references to their own journey and address pain points and personal experiences.

STEP 2: THE SURVEY: To meet the patients where they are and more, understand their needs and requests beer and build quality care.

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PROTOTYPES & INSIGHTS

SDOH - Low fidelity prototype Part III:

Post the questionnaire, participants were asked about which part of the Ideal journey would they prefer the questionnaire to be put forth and how and by whom.

The ‘how’ involved modes of communication like texting, app, or forms.The ‘whom’ involved doctors, social workers to name a few.

STEP 3: THE WAYS OF INTERVENTION: To understand preferred modes of communication

Part IV:

Understanding the participants individual tryst with healthcare, we introduced the strategic recommendations to see the users perspective about the same.The proposed strategic recommendations included the following tools:

- Concierge Chatbot - Health Advisor - Care Your Way - Discover Nearby - Tell a Friend

05 Prototype & Test

STEP 4: STRATEGIC RECOMMENDATIONS: Users are introduced to the solutions to understand which tool would be most preferred and usable.

61

PROTOTYPES & INSIGHTS

SDOH - User testing insights 1.

Patients need to feel like they are being heard and are geing the care they intend to get. Adopting tools like surveys, reminders, and regular check-ins will not only help in diagnosis but also enable patients to share their health journey more openly.

2.

This in turn will help patients warm up and initiate dialogue with providers, understanding that this is a safe space for them to openly address dilemmas that would help elevate the quality of care.

3.

4.

Tools like ‘Discover Nearby’ empower patients to be self-suicient and prioritize their health.While the SDOH Screener is a point of intervention that can help patients reflect on their needs in a respectful manner.

Another point of intervention is the time between a patient booking the appointment and arriving at the hospital.This could elevate the potential to onboard a patient and make them feel more comfortable and cared for.

05 Prototype & Test

5.

A large part of the conversations revealed they did not prefer the automated chatbot services and rather preferred services that involved human interactions to feel more connected and guided.

6.

We realized it was important to meet patients in their preferred mode of communication rather than generating an extra learning curve for them.

7.

Unifying and consolidating information about the patient’s history helps medical providers in the diagnosis and prevents the need to ask patients to go over the same data over and over.

8.

During user testing, we also had conversations about patients understanding the value and emphasis on filling out the survey.

This involved understanding that every stakeholder would benefit from the solution and help provide care personal to each one’s need.

62

PROTOTYPES & INSIGHTS

LEP - Overview From the 7 interviews we conducted on the User Testing platform, we were able to communicate with all of them eectively in English.

User problem cases included: ● ● ● ●

Lack of guidance related to the prescriptions.

Incorrect treatment that severed the patient’s health.

Therapy process that needed for the patient to spend a specific period at the hospital.

Misunderstandings and ambiguity related to locally available medicines and their dietary compatibility with native’s religious/cultural rations.

05 Prototype & Test

“Prescriptions were the problem or to explain what I was geing back home.Drugs are so dierent and it was a bit diicult, it was hard to explain.”

Kassy, 32. Kenya

“I said yes to everything because I didn’t want problems.

Being Asian, you don’t like to ask many questions. You see them [doctors] as an authority” Kiy, 52. Philippines

“I was at the hospital for a month, and I couldn’t walk, I could not eat by myself, I felt alone. Even though there were lots of people, nobody was always there for me ” Hari, 28. India

63

PROTOTYPES & INSIGHTS

LEP - Low fidelity prototype The goal of this testing was to understand the associations, aitudes and needs of LEP patients when thinking of a needed help during their health care.

At first, the patients were asked to pick a persona(s) from 10 presented options, and share their ideas and priorities. The portraits varied by five criterias: 1.

2.

3.

4.

5.

Professional Occupation Nationality Language Gender Age

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64

PROTOTYPES & INSIGHTS

LEP - Low fidelity prototype

The testing criterias were: 1.

2.

In which stage(s) would be the “Cultural Broker” most needed Format of the help Whether or not they would be needed.

We revisited patient’s long term treatment journeys (taking the physiotherapy cluster for testing), and identified the moments in their journey where they would require the cultural broker’s help.

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PROTOTYPES & INSIGHTS

LEP - User testing insights Cultural Broker: the meaning of the notion is intuitive, but “broker” sounds a bit transactional.

All the interviews would rather have cultural broker services over interpreter services.

Almost every respondent needed cultural broker assistance with prescriptions: either to adjust them to their culturally relevant ones, or to question the doctor about the need of each medicine.

All the participants wanted to find someone from their own culture background and even in some cases the country is not enough. They were looking for someone from their same region.

The communication problems our respondents encountered were serious, but not because of the language barrier, rather because of cultural dierences.

Patients that are coming from dierent cultural backgrounds, need emotional support rather than functional help.

All respondents preferred females as their cultural advocates with an exception of caring for their reproductive health among men.

Cultural backgrounds play an important role. 8/10 respondents would choose someone from their nativity regardless of their occupation or experience.

All respondents preferred someone in the their own age range, but slightly older (+5), never younger. In certain situations they might choose someone of a “mother’s” archetype.

50% of the interviews wanted to have support from the cultural broker in-person, the other 50% wanted to have the possibility to call them or email them when needed.

Also, the preferences changed according to the stage of the journey among the same respondents.

05 Prototype & Test

66

PROTOTYPES & INSIGHTS

Caregiver - Overview ●

Our final HMW statement: How might we connect doctors, patients and caregivers while empowering patients and caregivers with resources and knowledge to ensure beer healthcare outcomes through a digital platform?

●

What we want to achieve: A One stop shop that consolidates the entire view of a patient’s journey, including roles based permissioning, calendars, and group chat communications (open chat). Accessible by patient, care provider, or caregiver

●

Since many of patients are tired of unexpected tasks and additional steps during long journey, we noticed the communication is the major factor to solve this problem. Thus we planned to ask the challenges from both side.

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67

PROTOTYPES & INSIGHTS

Caregiver - Low fidelity prototype We started to make some wireframes in Figma to visualize our solutions and showed them to interviewees during the user testing process to get feedback, see how potential users feel about the features, and how we can make the solutions more accessible.

FIRST ITERATION: Early Ideas of the Journey tracker feature, noting down all the potential features.

FINAL PROTOTYPE: Final iteration of Journey tracker design helping patients navigate their appointments.

SOS FEATURE: The Video-call feature part of the SOS tool.

05 Prototype & Test

68

PROTOTYPES & INSIGHTS

Caregiver - User testing insights We conducted 6 interviews, including 4 medical providers and 2 patients. We realized the limited number of medical providers cause the fragmented communication between hospital and patients and discourage them to keep on health journey. We asked each of interviewees of crazy idea they wish, and we came up with ideas of: ● ● ● ●

Tracker (like Uber tracker showing estimated time) Invitation of medical records (like google or zoom) Daily reminder (alarm, calendar) Video call for interactive communication

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USER TESTING FINDINGS

Findings after prototypes: The final journey

05 Prototype & Test

70

USER TESTING FINDINGS

Final version of prototypes Findings After unifying all the wireframes and ordering them by the patient’s timeline, the flow was not strong enough to emphasize the concept and impact we designed for Northwell. We decided to cut down the unnecessary parts and pick the best wireframes depicting the solution with clarity.

View Full Chart in Figma

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71

USER TESTING FINDINGS

Key takeaways from user testing ●

Northwell will be able to deliver a more holistic service to the US population as they will now have access to adequate information at various touch points of a patient’s healthcare journey.

●

Beyond caring for sickness, we provide more end-to-end and data-driven care services to support patients in navigating inconveniences and struggles before and after the limited time of meeting doctors.

●

Our prototype aims to produce more user friendly products by creating seamless support through simplified steps.

●

The strategic recommendations give patients agency to enter the network early on and not wait till something severe happens which results in a higher cost of treatment and distress for patients and their loved ones.

●

The solutions are designed in a way that allows consistent flow of communication for every stakeholder involved. This helps reduce the burden and allows medical providers to diagnose correctly and in a timely manner.

05 Prototype & Test

72

06

Propose Solutions

73

ACCESS TO CARE

01 Enable access with Specialist Connector In the interviews, we found people had diiculties finding a specialist and having precise information about the options they had. The specialist connector can be a new guardian helping patients to go through the journey by finding the right doctor according to their conditions and needs.

06 Propose Solution

DELIVERY OF CARE

EXTENDED CARE

Opportunity Area

Like when a kid comes to his mom and asks for help to identify his pain, this tool takes patients through a series of steps, helping them find the right specialist according to their needs and pains.

Opportunity Area Pain Points

● ● ● ●

Lack of precise and clear information Ambiguous estimates and costs Perception of complexity Hard to figure out which speciality of doctor is needed

74

01 ENABLE ACCESS Questionnaire

Specialist Connector

Impact & Considerations:

To help patients select the right specialist, we have checkboxes to describe symptoms like pain or discomfort.

It is important to describe symptoms accurately, or data related to the patient condition would help generate beer suggestions for them.

Step 1:

The data would also be feeded in the system so the doctor can provide more precise diagnosis and treatment.

A questionnaire asking the patient in detail about their symptoms.

06 Propose Solution

75

01 ENABLE ACCESS Questionnaire After reporting the symptoms, patients can point what part of their body hurts, we can think of “lile child telling the doctor”.

This description over the body helps is narrow down the options.

Specialist Connector

Impact & Considerations: This feature would help the doctor understand the patient’s pain area and intensity of the pain.

Also, this process would also help direct them to relevant doctors.

Step 2: The patient here would be clicking on the area of pain and will select the organ from the options suggested.

06 Propose Solution

76

01 ENABLE ACCESS Questionnaire After body scanning, We will directly show patients which department they need to go to.

Step 3:

Specialist Connector

Impact & Considerations: This feature would help connect the patients to specialists directly in case of severe symptoms, thus reducing the treatment time while moving from primary doctor to specialists.

After the patient has filled in the details they would be suggested relevant doctors as per their inputs.

06 Propose Solution

77

ACCESS TO CARE

02 Care for SDOH with SDOH Screener From the interviews and research, we realized many of patients lose the chances to get check-ups and recovery due to external conditions. By asking patients respectfully, we want to identify the social conditions they have that are highly linked with avoidance.

06 Propose Solution

DELIVERY OF CARE

EXTENDED CARE

Opportunity Area

Asking patients respectfully about external factors can help them reflect and help Northwell identify those suering from health disparities that can be geing in the way of accessing healthcare or recovering properly.

Pain Points

● ● ● ● ●

Distrust in the system Unaware of eligible services Misleading guidance Lack of belonging Feels unheard & self-conscious

78

02 CARE FOR SDOH Screener Patient might be asked to answer the SDOH screener after they join the app.

Step 1: People in need for extra help can easily answer the dierent questions in the survey, in this example we address social isolation, health literacy and access to transportation. By asking them how frequently they experience some of the problems, we can identify people at risk of suering SDOH conditions.

06 Propose Solution

Screener

Impact & Considerations: People are usually ashamed to ask for help from others.

We aim to ask users whether they need help in a more respectful and dignified way. As we can collect more data from patients, we can predict the paern of what type of SDOH services might be needed by that specific person.

79

02 CARE FOR SDOH My Profile

Screener

Impact & Considerations:

Show patients a statistic in percentage of population living with the same conditions.

We collect the data through the screener to see the problem areas of each user.

Step 2:

Then collect the services on dierent platforms and sort them out to show patients they are not alone.

After people fill in the survey, the system may present the result by representing a graph that not only shows their individual needs but also consolidated information from people with similar conditions.

06 Propose Solution

With this option our goal is to make patients aware of a social problem they are having and bring a sense of community and belonging.

80

02 CARE FOR SDOH Book Help

Screener

Impact & Considerations:

Providing insights about the kind of help the patient might need access to,through Northwell’s platform

The goal of this screen is to raise awareness about the possible solutions Northwell can provide according to patient’s conditions.

Step 3:

In order to present relevant information, we provide dierent solutions for users to choose the most suitable service for them, and users can book these services directly through Northwell’s platform.

The app will provide dierent services to solve the problems identified, a quick set of recommendations will appear soon after the patient reports her conditions.

06 Propose Solution

81

ACCESS TO CARE

03 Care for SDOH with Discover Nearby After the patient fills out the screener, the app can provide tailored resources to explore in their communities. The purpose is to deliver options that help patients stay on top of their health while having accessing support networks from people close to them in order to build trust in the healthcare system.

06 Propose Solution

DELIVERY OF CARE

EXTENDED CARE

Opportunity Area Northwell goes beyond expectations. Like a mother when her kids leave the house, Northwell cares for its patients, especially in the most diicult situations, and helps them figure out how to navigate a system and surroundings, until they are ready to do it by themselves.

Pain Points

● ● ● ● ●

Unaware of eligible services Embarrassed to ask for help Feels unheard & self-conscious Lack of sense of belonging Feeling vulnerable

82

03 CARE FOR SDOH

Discover Nearby

Discover Nearby Impact & Considerations: Show available resources and help near the patient’s location.

Step 1: We have listed some common services for users to choose from.

Patients can easily click on the corresponding icon to get the service guide near their location. If the user’s needs are not listed, they can also directly search in this interface to find out other options.

06 Propose Solution

It is usually diicult for people to obtain corresponding and reliable services from dierent platforms. This function can collect data of various integrated services and provide suggestions around them.

83

03 CARE FOR SDOH

Discover Nearby

Specific Support Impact & Considerations: Show available resources and help near the patient’s location.

Step 2: After the user chooses some specific service, patients will enter an interface where they can easily see the location through a map, as well as the details of each service.

06 Propose Solution

Healthcare is heavily local based, and community-led.

Since patients might have searched for solutions to their conditions such as childcare, food pantries, transportation suitable for people with disabilities amongst other conditions; finding solutions hard to trust and diicult to access.

Our feature provides reliable services based on their location and reducing the amount of time they need to wait to find the resources and the amount of money they have to pay for them.

84

ACCESS TO CARE

04 Assist & guide with Health advisor Complexity is one of the main barriers in healthcare. Some patients like to navigate this journey by themselves.

Others instead need assistance and guidance. Health advisors could help patients stay on top of their health and transport patients from reactive care to preventive care, inviting them to feel more comfortable with the system by guiding them and therefore improving the patient’s experience during the entire journey.

06 Propose Solution

DELIVERY OF CARE

EXTENDED CARE

Opportunity Area

Most patients do research before visiting a doctor.

However, some patients require additional support. The health advisor coaches patients according to their needs across the entire journey.

“Like an advisor for college students”.

Pain Points

● ● ● ● ●

Unaware of eligible services Perception of complexity Lack of sense of belonging Lack of clear information Siloed communication between doctors

85

04 ASSIST & GUIDE Health Advisor Remind patients about upcoming appointments.

Help patients navigate through complicated preparations.

Step 1: Health advisor sending a SMS notification to patients about their upcoming appointment and reminder to bring important documents.

Health Advisor

Impact & Considerations: Oftentimes, patients forget to bring personal documents to their appointments. These reminders can prevent those situations while seing the right tone at the beginning of the journey.

Allowing patients to ask clarifying questions is perceived as care.

Filling out forms and managing documents is complicated.

This feature builds an emotional connection between NW and the patients and makes patients feel that NW is accessible.

06 Propose Solution

86

04 ASSIST & GUIDE Language Seing Allow patients to view messages and key information in the language they are familiar with

Step 2: A notification would show in multiple languages. During Hurricane Ida, NYC and New Jersey lost over 59 lives, most of which were immigrants with LEP. This showed the importance of sending US residents SMS messages in multiple languages.

06 Propose Solution

Health Advisor

Impact & Considerations: By providing multiple languages, patients will not be able to access services that they might require but are not able to because of language barriers or communications gaps.

Over 200 languages are spoken in NY State. The ideal scenario would be that all notifications are shown in all languages, however, 85% of LEP residents of the state speak 10 languages, by providing the information in those languages, NW would be covering close to 95% of the total population in NY State, which can be a good starting point.

87

ACCESS TO CARE

05 Assist & guide with Cultural Advocate New York is the fifth-most diverse state, which includes linguistic diversity. For patients from other cultures, we have created a cultural advocate service, "Cultural advocate" encounters communication gaps, language barriers, and other cultural barriers that can arise while receiving or accessing healthcare.

EXTENDED CARE

Opportunity Area

Some patients need language assistance, while some also need to feel more understood. Having someone from their culture can make them feel at home, especially those patients who are going through long recovery processes.

Pain Points ● ● ● ● ●

06 Propose Solution

DELIVERY OF CARE

Lack of empathy & belonging Unaware of eligible services & cost Lack of guidance to anticipate possible problems Service oered at the wrong moment Communication gap & language barriers

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05 ASSIST & GUIDE Filter Patients can search for a cultural advocate based on their preference.

Step 1: Patient can search their “cultural advocate” using a matchmaking-like system.

Cultural Advocate

Impact & Considerations: User testing surfaced some of the most important factors for patients when looking for a cultural advocate.

Patients feel most understood by a person from the same generation.

Most patients chose women over men while selecting a cultural advocate because women provide “maternal care”.

Male patients said that male advocates would be preferable only in the case of male-related diseases.

06 Propose Solution

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05 ASSIST & GUIDE View Cultural Advocates The system would show patients 3 -5 qualified cultural advocates, who are also available during the time of the patient’s selected appointment.

Step 2:

Cultural Advocate

Impact & Considerations: As many of interviewees responded they mostly don’t live with their own family members who could be caregivers, a cultural advocate would be their caregiver being by the patient’s side, empowering them with emotional support and warmth.

To pick the ideal candidate, the patient can select to find more details about the cultural advocate and choose the one who makes the patient feel most comfortable.

06 Propose Solution

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05 ASSIST & GUIDE Cultural Advocate Detail Page View why the cultural advocate is passionate about their job and their availabilities.

Step 3: Reserve a time to meet before the appointment would enable the patient to feel more connected with their cultural advocate and cultural broker to have some context (patient needs) in advance of the appointment. We believe this feature would also reduce the appointment time of patients with LEP.

06 Propose Solution

Cultural Advocate

Impact & Considerations: Since 3.1 M New Yorkers are from dierent countries, many of them are living alone. The cultural advocate will be the role enabling patients to make decisions with necessary information and standing by their sides.

Due to the regulation of being an interpreter, many passionate doctors are not able to help. However, doctors can help LEP patients with the title of a cultural advocate.

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ACCESS TO CARE

06 Support caregivers with Care Nest Last solution is for patients after the doctor’s appointment. We noticed many patients feel stressed out and tired of the long journey combined with the long list of things to follow. Many of them give up on going for post check-ups.

So we would like take care of some of things from the patient’s plate which would be highly appreciated and also help alleviate their stress and ensure they do not give up in the middle of the journey.

06 Propose Solution

DELIVERY OF CARE

EXTENDED CARE

Opportunity Area

Recovery can be stressful. Taking things o of a patient’s plate to lighten the load would be highly appreciated by them. This journey tracker for patients aims to alleviate stress during a recovery process.

Pain Points ● ● ● ●

Lack of information to take control for recovery Poor coordination between caregivers and care team Siloed communication between doctors Lack of emergency assistance

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06 SUPPORT CAREGIVERS Journey Tracker Showing how far the patients need to go and how far they have come.Helps track what they have achieved so far.

Step 1: If patients go to My profile, they can find this journey tracker showing the whole roadmap.

Patients with a long history and process. Percentage will be same if the additional step is occured.

06 Propose Solution

Care Nest

Impact & Considerations: Eases the frustration caused by ambiguous healthcare journey.

Help patients feel they are in control of their healthcare journey, which is important. To help them feel in control and not feel exhausted dealing with uncertainty.

And the percentage will help them overcome their problems and keep them going and cheer them up along the way.

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06 SUPPORT CAREGIVERS Knowledge Hub Listing unexpected symptoms in the recovery process.

Step 2:

Care Nest

Impact & Considerations: Soothing patient’s anxiety by listing the symptoms, informing them it is common and there is no need to panic. It helps assure them in times of panic.

The Knowledge hub feature contains information regarding common symptoms that patients might have and first aid instructions to follow in a step by step format. This will reduce the unnecessary appointments for common symptoms.

06 Propose Solution

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06 SUPPORT CAREGIVERS Daily Reminders A to-do checklist to remind patients about the daily steps they need to adhere to..

Step 3: The Daily check list is an everyday reminder notifying patients of the instructions to follow, including medication and daily habits like drinking water, and nutritional needs, to name a few.

06 Propose Solution

Care Nest

Impact & Considerations: Assisting patients to follow instructions for fast recovery and lower the medical provider’s tasks outside the hospital. This helps them be independent and stay on top of their health.

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06 SUPPORT CAREGIVERS My Reports Sharing medical records

Step 4: Patients can share their medical records and reports with medical providers with one click. To protect a patient’s personal information and control who they can share their medical records with.

06 Propose Solution

Care Nest

Impact & Considerations: Solving the problem of having a fragmented medical history.

Patients can send invitations to medical providers to open and access their records.They also have the ability to remove the share options anytime they want.

This easy sharing might help enforce transparent communication between medical providers.

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06 SUPPORT CAREGIVERS Quick SOS actions Cuing down the steps and acting fast to help patients get urgent care

Step 5: Patients in emergencies might need access to immediate help. They can find this live call buon on the landing page to talk to urgent care before they get to the location. This tela-assistants will guide patients what to do while they are at home and help control the situation.

06 Propose Solution

Care Nest

Impact & Considerations: Help patients act faster and help NW guide patients with a quick click. For those of who are in an emergency situation, time is essential.

Hence, using the video call service as a teladoc and tela-assistants would raise eiciency.

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06 SUPPORT CAREGIVERS Quick SOS actions Cuing down the steps, and acting fast to help patients get urgent care

06 Propose Solution

Care Nest

Impact & Considerations: If patients do not need any professional care, they do not need to call an ambulance. This will reduce the waiting time in ER and also ease the stress levels.

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PROPOSED SOLUTIONS

Solutions along the patient journey This is a view of how the proposed solutions and key features impact the stages of the patient journey. Some solutions are applicable to more than one phase of the journey. There is also the opportunity to combine some of them depending on patients’ needs and preferences.

ACCESS TO CARE Symptoms survey

01

DELIVERY OF CARE

EXTENDED CARE

Specialist suggestion

Specialist Connector

Questions to identify SDOH risk

02

SDOH Screener

Resources near the patient’s location

Personalized recommendations

03 Expert helping patients navigate

Discover Nearby Personalized reminders and recommendations

04

Health Advisor Support for people from different cultures

05 Daily care routine checklist

06 06 Propose Solution

Cultural Advocate Journey tracker

Urgency video calls

Knowledge Hub & FAQ

Care Nest 99

07

Implement

100

ROADMAP

Implementing the solutions The final suite of recommended solutions is ranked into short, medium, and long-term periods using some yardsticks – mainly ease of implementation and patient’s needs. It details some of the most important operations that need to be carried out for each solution, thereby giving a sense of roadmap for Northwell.

SHORT TERM 01

Specialist Connector ▾

MID TERM 03

Data integration and standardization

Discover Nearby ▾ ▾

02 SDOH Screener ▾ ▾

Develop questionnaire Build In patient touchpoints

06

04

Identify and onboard community partners Integrate resources into app

Care Nest ▾

LONG TERM

Onboard patients and caregivers

Health Advisor ▾ ▾

05

Cultural Advocate ▾ ▾ ▾

07 Implement

Identify and appoint advisors Design and pilot program

Design program with language services program team Identify priority patients Launch pilot with priority group

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BUSINESS OUTCOMES & IMPACT

Aligning with Northwell’s business and values The business values of the highlighted solutions and how they strategically position Northwell to move from “health care today” to “healthcare tomorrow”

Increased accessibility for LEP patients

Increased touchpoints for data collection

Cost savings by reducing no-shows

Improved caregiving coordination

Faster turn around for average care time

1.93m LEP NYC residents1 (23% of total NYC population) will prioritize Northwell services for cultural dierence support

Northwell will have access to 17 more data points per user which can be used for future service development as user needs evolve

Potential annual savings of $30m1 by oering support and resources, thus reducing no-shows by 5% of all appointments (assuming 2m patients per year2)

By incorporating extended care services, Northwell will improve caregiver coordination for at least 8% of family caregivers1

Reduce average time for specialized care from 24 to under 7 days by connecting patients and specialists eectively and directly

Source 1; Source 2

Source 1

Source 1

Source 1

Northwell championing holistic wellcare and making a unique business case in healthcare history

07 Implement

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KEY STRATEGIC SHIFTS

Moving toward healthcare tomorrow FROM Complex and ambiguous Missing context Lost in translation Not caring for caregivers Healthcare today

07 Implement

TO Transparent and reassuring Identifying & addressing inequities Cultural bridging and advocacy Supporting both patients & caregivers Healthcare tomorrow

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Are you ready to build “healthcare tomorrow” with us?

✕

08

Appendix

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SDOH “How Healthy Is Your County?: County Health Rankings.” County Health Rankings & Roadmaps, hps://www.countyhealthrankings.org/explore-health-rankings/measures-data-sources/county-health-rankings-model.

Kheirkhah, Parviz, et al. “Prevalence, Predictors and Economic Consequences of No-Shows.” BMC Health Services Research, BioMed Central, 14 Jan. 2016, hps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4714455/.

Josh Lee & Sarah Thomas. Life Sciences & Health Care. “Latest News from @DeloieHealth: Deloie Us.” Deloie United States, 13 Sept.

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Lakey, David, et al. “Finding Eective Ways to Address Social Determinants of Health: Health Aairs Forefront.” Health Aairs, 22 Apr. 2021, hps://www.healthaairs.org/do/10.1377/forefront.20210420.146637.

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References LEP “Oice of Minority Health.” Hispanic/Latino - The Oice of Minority Health, hps://minorityhealth.hhs.gov/omh/browse.aspx?lvl=3&lvlid=64#:~:text=In%202019%2C%2018.7%20percent%20of,and%2079.9%20years%20for%20men.

Disparities in Healthcare Quality among RACIAL AND ETHNIC GROUPS. Selected Findings From the 2011 National Healthcare Quality and Disparities Reports. hps://www.ahrq.gov/sites/default/files/wysiwyg/research/findings/nhqrdr/nhqrdr10/minority.pdf.

Gardner, Amanda. “Language a Widening Barrier to Health Care.” HealthDay, Consumer Health News | HealthDay, 17 Dec. 2021, hps://consumer.healthday.com/general-health-information-16/doctor-news-206/language-a-widening-barrier-to-health-care-533896.html.

Abbe M;Simon C;Angiolillo A;Ruccione K;Kodish ED; “A Survey of Language Barriers from the Perspective of Pediatric Oncologists, Interpreters, and Parents.” Pediatric Blood & Cancer, U.S. National Library of Medicine, hps://pubmed.ncbi.nlm.nih.gov/16615062/.

Ortega, Pilar, and Tiany M. Shin. “Language Is Not a Barrier-It Is an Opportunity to Improve Health Equity through Education: Health Aairs Forefront.” Health Aairs, 30 July 2021, hps://www.healthaairs.org/do/10.1377/forefront.20210726.579549/full/.

CAREGIVER Jr., Steven May. “Caregiving in the US 2020.” The National Alliance for Caregiving, 11 May 2020, hps://www.caregiving.org/caregiving-in-the-us-2020/.

“What Millennials Want When It Comes to Healthcare.” What Millennials Want When It Comes To Healthcare 12/23/2016, hps://www.mediapost.com/publications/article/291796/what-millennials-want-when-it-comes-to-healthcare.html.

“What Is Parsley Health?: Assessment & Membership.” Parsley Health. Accessed May 10, 2022. hps://www.parsleyhealth.com/why-it-works/.

“The Institute.” The Institute RSS. Accessed May 10, 2022. hps://institute.org/health-care/services/services-for-families/.

Robert H. Shmerling, MD. “Is Our Healthcare System Broken?” Harvard Health, July 13, 2021. hps://www.health.harvard.edu/blog/is-our-healthcare-system-broken-202107132542.

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