The MIT Designing for Health Conference took place at MIT Sloan on December 6, 2018. The conference brought together academics as well as government and industry leaders to unpack the problem of quantifying the impact of health programs that focus not just on delivering medical care, but dealing with the underlying social determinants of health such as food insecurity, systemic inequality, and others. From the program:
“In fact, while anecdotal and qualitative observations are suggestive, there is little rigorous evidence on the quality and economics of a proactive health system: one that integrates many of today’s isolated medical, social, and public health services.”
I attended the conference with a contingent of athenahealth UX Designers. Here were some of my key takeaways.
The shift to Value-Based Care requires different medical professionals, often in different organizations, to work together to treat a patient’s condition. One of the challenges to this is getting Value-Based Care providers to partner together with providers who are billing Fee for Service; the incentive structures are different for each.
Joe Doyle talked about using Big Data to build credible evidence for holistic approaches to health management. The challenge with “letting the data speak” in Big Data is that it’s easy to get correlation, but not necessarily causality; by finding ways to conduct randomized experiments within the data, it’s easier to build the evidence for more holistic interventions. He also warned how easy it is to focus on the noise of the data, and it needs to be interpreted carefully or else you get a bunch of false positives.
Several discussions focused on Social Determinants of Health, and the rise in so-called “Diseases of Despair,” including alcoholism and opioid addiction. The idea is that treating the person once they’re sick, or incident-based care, is not enough. The person’s work/home environment, systemic inequalities they might be facing, etc. all have a significant impact on a person’s overall health and need to be considered as well. Oh, my favorite part of the Opioid talk was the discussion of how alcoholism is a much bigger problem/killer than opioids, but we don't talk about it because it's socially acceptable to drink.
In particular, food insecurity (i.e. living in places where nutritious food is difficult to access, or being unable to afford fresh produce) was seen as a major barrier to health, resulting in a series of food-based approaches to public health. The panel Food as Medicine: Building the Evidence, included representatives from several community-based meal programs, including Boston-based Community Servings. These programs, which deliver medically-tailored meals to critically ill patients, have seen impressive impacts on patient outcomes.
While I have long believed in the ability of food to improve one’s health, I hadn't really thought of it along the lines they were talking about. I loved this line from Community Servings CEO David Waters: "Sick people don't have appetites. If you give them institutional food, they won't want to eat it." I also appreciated that they focused on meals and groceries, rather than "superfoods" (which I tend to think of as pseudoscience). The fact that the panel was focused on the evidence behind some of these things, and they looked at the whole picture of food/health (rather than promoting a single, specific foodstuff or way of eating) made it more credible to me.
The panel Food System Interventions to Curb Chronic Illness and Promote Health focused on preventive measures, including the agriculture system and getting fresh, nutritious produce to underserved communities. A significant part of food waste is due to the expense of donating, and concerns about running into regulation issues. In the State of Rhode Island, the Department of Health realized that restaurants weren’t donating their excess because they were worried about running afoul of the DoH. Boston Area Gleaners works with local farms to help them distribute their excess to needy families, something many smaller farms are unable to do because of cost (according to Executive Director Laurie Caldwell, “it costs as much to donate the food as it does to sell it”).
Personally, I thought the conference was very useful for me as a designer. Mainly because understanding the different aspects of the healthcare problem helps me better understand how the different systems work together. It's very easy to focus only on the EHR, or only on the Revenue Cycle side, and forget that there's a whole ecosystem of healthcare that has nothing to do with those things.