SixMed’s Design Values
Fixing healthcare for millions of underinsured Americans will take comprehensive policy and systems change. In the meantime, sixMED can help address patients’ information gap.
THE SYSTEM COMES UP SHORT
After graduation, I worked at Stanford as a research administrator in the Lucile Packard Children’s hospital. I supported physician faculty and finally got a behind the scenes look at what impressed me so much as a child. What I saw was a bureaucratic mess. I had many encounters with regulations that were counterintuitive to patient care. I saw physicians frustrated and wanting to focus more time on their patients. I worked in the clinic so I also saw lots of worried parents and sick children. You were constantly reminded of them but somehow in the work, they took the periphery. I saw a need to center the patient more in care.
WHY sixMED?
Millions of Americans are underinsured by their healthcare provider and still struggle to find adequate primary care services. Of the approximately 41 million underinsured Americans, 60 percent qualify as low-income. In addition to making up the majority of the underinsured population, low-income Americans are also disproportionately impacted by chronic illness partially due to preventable causes. I am developing sixMed Health- a product and service aimed at supporting the health and wellness of low-income New Yorkers. The service centers around a chatbot interface that automates the patient intake and referral process, ascertaining their individual wellness needs and connecting them to relevant resources. The larger service aims to explore ways in which a cutting edge health tech service can be adapted at an affordable price point and applied to additional markets.
sixMED Health is meant to fill a gap in knowledge and accessibility for uninsured and underinsured patients. The cornerstone of the service is the chatbot- sixMED. I was inspired by Association to Benefit Children’s service model for the Saturday Program. My goal is to automate that service and make it available at any time at the touch of a finger. Connecting people to resources may seem simplistic but I’ve found through my research and user testing that there is a gap between patients’ ability to understand and communicate their individual health needs and then go out and find services that match those needs. sixMED Health aims to match those needs on an affordable basis.
Other health tech services like Oscar and Forward also focus on leveraging tech to support a patient’s holistic wellness, their price points are high and largely inaccessible to my target population. My goal is to create a comparable service at a more affordable price point and target the users that these services miss. If Forward is the Uber Black Car, my goal is to make sixMED the Uber Pool of B2C health tech providers and introduce a tech-assisted approach to maintaining wellness to the population that needs it the most.
Today’s vision, tomorrow’s work
My primary goal in this project is to design an intervention that empowers vulnerable patient populations and is accessible. I do not wish to approach this discovery process from the lens of reform. I’ve worked within the bureaucracy of healthcare and I’ve seen how much friction comes with reform. My theory is that the best point of entry is from the patient perspective and will demystify much of the behind-the-scenes action of healthcare to a degree that allows the patient to advocate for the outcomes that work best for them.
I focused initially on primary care because of the growing need for access to primary care in the US. In 2010, 65 million Americans lived in primary care shortage areas. With the growing population and fewer physicians choosing to specialize in primary care it is projected that by 2020 the U.S. will be short 400,000 primary care physicians. There is a real need for the U.S. to become more intentional about health and wellness.
DESIGN VALUES
My target audience is low-income and underinsured New Yorkers, particularly immigrants. It was important to choose a form that was accessible to this population. I also wanted to leverage technology to promote affordability. With these values in mind, I chose the form of a conversational UI enabled by a Facebook Messenger chatbot. Eventually, I would like the platform to exist as a native app but for the initial rollout, Messenger chatbots were the best development option for several reasons:
Messenger chatbots work across web and mobile operating systems
66 percent of American adults living below the poverty line are Facebook users. That is second only to YouTube usage (68 percent) at that income level.
Facebook Messenger has built-in language translation from English to Spanish allowing greater accessibility to migrant Latinos representing a large part of my target population.
My primary focus has remained centered on the patient experience. I initially explored design solutions that supported the patient more indirectly, like improved oversight of the billing and coding process. However, with my new focus on supporting wellness, I realized that it was critical to focus the solution more directly on the patient. My primary design value is to make the experience accessible to low-income individuals. This is why I focused my solution on a chatbot interface. Chatbots use a low amount of data for users who are subscribed to more affordable data plan options. Chatbot interfaces also lower the barrier of entry because the interface is a simple conversation and with the right technology, can be carried out in multiple languages.
My final design values are to ensure that the product is community-based and collaborative. I have cultivated two direct partnerships from my community of practice that I am leveraging to help develop the chatbot. My primary partnership is with the Association to Benefit Children. I will be piloting the product at an Open Door Saturday program. I was also given access to the NeedyMeds.org API to allow my chatbot to query their free and sliding scale clinic database.
