Service design, behavioral design and iterative pilot testing are critical methods for creating digital health products and services that drive positive health outcomes.

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Checking Up on Digital Health

Digital health solutions are poised to transform our paradigms of care for the better. People are demanding healthcare that’s more conveniently integrated into their lives, delivered by the brands they trust. A <a href="https://www.cvshealth.com/news/innovation/consumers-want-a-more-connected-personal-health-care-experience.html" target="_blank" rel="noopener">CVS Health survey</a> revealed that consumers want to receive medical care on their own terms—with ideal experiences being ones that are convenient, accessible and affordable. The shift toward hybrid care models, accelerated by tech advancements and the pandemic among other factors, creates an opportunity to improve health outcomes and reduce costs through delivery of more streamlined, multichannel and equitable products and services.  
The opportunity to lead the market in the delivery of digital health services is ripe, and the competition is rising. Big Tech companies have been <a href="https://medicalfuturist.com/the-first-database-of-tech-giants-collaborating-with-healthcare-what-can-we-learn/" target="_blank" rel="noopener">increasingly open to collaboration</a> (e.g., Alphabet’s Verily and Mayo Clinic), building in-house and growing through acquisitions (e.g., <a href="https://www.aboutamazon.com/news/retail/what-is-amazon-clinic" target="_blank" rel="noopener">Amazon Clinic</a> and <a href="https://press.aboutamazon.com/2022/7/amazon-and-one-medical-sign-an-agreement-for-amazon-to-acquire-one-medical" target="_blank" rel="noopener">One Medical</a>). 
From a patient or care provider’s point of view, healthcare products and services are often intertwined. But from a development standpoint, they differ significantly. Healthcare products are tangible goods (e.g., monitors, surgical tools, medicine and other consumables). In contrast, services are the interactions between products, people and their environment. The key differentiating factor is people—products are the things we use, and healthcare services involve the people we need.  
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<h2>Overcoming barriers </h2>
Through our experience working with <a href="https://www.frog.co/sector/healthcare-service-strategy" target="_blank" rel="noopener">life sciences (LS) companies and healthcare delivery networks</a>, we at frog understand the barriers to deploying digital health products and services swiftly and effectively. Challenges include integration with healthcare systems, overcoming tech complexities and adopting new ways of working. Also, building a digital solution targeted to treat a single disease is often difficult, given the complexity and nuance of managing co-morbidities. Yet, to effectively service today’s growing population of discerning patients, healthcare providers must attend to their demands and deliver services to them with intention.  
LS companies and healthcare delivery networks must embrace three core methods to deliver successful digital health offerings. The first method uses <a href="https://www.frog.co/services/service-design" target="_blank" rel="noopener">service design</a> and system thinking to orchestrate holistic ecosystems that enable critical value exchanges among service providers, end users and organizational stakeholders. A second tactic is designing for behavioral change to drive positive health outcomes and achieve problem-solution fit. A third approach executes agile learning experiments to test and iterate the end user experience in real-time, de-risking product and service development.

When designing a new service, especially in complex healthcare systems, it’s necessary to design the environment and connections among users and touchpoints. It can be tempting to build a digital solution rapidly without a clear plan. Instead, teams need to define the transformative value the new service should achieve across the entire ecosystem.  
There are inspiring examples of well-executed connected health ecosystems. <a href="https://asktia.com/" target="_blank" rel="noopener">Tia</a>, a women’s healthcare solution that unites digital and physical touchpoints (such as virtual care and in-person appointments), operates in a way that responds to patient needs more holistically.  
To create solutions that truly address people’s health and well-being, we recommend approaching ecosystem design through the following steps: 
Map the current-state ecosystem. First, define the primary roles that influence end users and organizations (e.g., patients, caregivers, clinicians). Map out the key nodes (e.g., clinics, patient digital portals) and cluster them by categories (e.g., digital tools, home health services) to help organize elements logically.  
Draw and label lines that indicate the type and direction of value exchanged among players. Value flows may include exchanges of material, data, information, money or labor. The goal is to clarify complex relationships, identify gaps and opportunities in the current ecosystem and make strategic decisions about connections to build or strengthen the intended value.  
Design the future-state service system. When identifying the solution, use inputs from surveys, ethnographic interviews and other human-centered design methods to map out the future-state ecosystem using the same method outlined above. This method can help to remove friction and add value in a service by redirecting a value flow or identifying a need for a new node or role in the ecosystem.

Visualize the entire ecosystem

Designing for behavioral change is critical to driving positive health outcomes. frog has worked with pharmaceutical companies and healthcare delivery networks to successfully design and pilot behavioral interventions in applications ranging from preventative health to chronic condition management, and from hybrid service models to digital medicines and therapeutics.  
We recommend taking these two approaches from frog’s behavioral science and innovation methods: 
Determine the best way to influence behavior change. Health outcomes are influenced by a complex web of factors—everything from our individual actions to the <a href="https://www.who.int/health-topics/social-determinants-of-health#tab=tab_1" target="_blank" rel="noopener">social determinants of health</a>. To drive change in this complex space, frog employs iterative mixed methods research. This involves mapping the factors (promoting and inhibiting pressures) that make a person more or less likely to act, and then designing behavioral interventions that incorporate the strongest combination of these pressures to increase the likelihood and magnitude of change.  
Design and run behavioral intervention pilots. These experiments test and measure whether the intervention changes people’s behaviors in the intended ways. Given that the purpose of the experiment is to test the core behavioral mechanism, they can be run before and/or in parallel with product development to maximize learnings and reduce costs. Behavioral mechanism refers to the process, technique or system designed to encourage people to think and act differently. For example, one could design an experiment in which people with a heart disease have weekly honest conversations about care plan compliance (e.g., maintaining a medically recommended diet) to see if this new activity translates to them reducing other behaviors that are counterproductive to their health (e.g. eating foods their doctors recommend avoiding.) In this case, the behavioral mechanism is the weekly honest conversations. <span data-ccp-props="{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335551550&quot;:1,&quot;335551620&quot;:1,&quot;335559685&quot;:0,&quot;335559737&quot;:0,&quot;335559738&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}"> 
Pilot experiments are used to assess and iterate interventions across three key dimensions: (1) Validation: Did we identify the right pressure? (2) Effectiveness: Did our interventions change the pressures? (3) Impact: Did we create enough behavioral change? Teams should iterate and incorporate the behavioral interventions into the digital health product and service. 
To learn more about using behavioral science in product and service design, check out two of frog’s Design Mind frogcasts: <a href="https://www.frog.co/designmind/design-mind-frogcast-ep-23-the-science-of-behavior-change" target="_blank" rel="noopener">The Science of Behavior Change</a>, featuring Matt Wallaert, former frog Head of Behavioral Science and <a href="https://www.frog.co/designmind/design-mind-frogcast-ep-27-bayer-project-story" target="_blank" rel="noopener">How We Venture: Bayer Consumer Health</a>, featuring insights from the Bayer Consumer Health and frog teams on shaping a behavior-driven platform.

Design for behavioral change

Bringing new digital health products and services to life requires real-time testing of the product and service delivery model in conjunction. We recommend running these two activities to improve the effectiveness of digital health solutions, de-risk the process and reduce development costs:  
Shift the mindset and advocate for experimentation. In working with top 10 global pharmaceutical companies and premier academic health systems, we’ve observed that organizations often struggle with the most critical step in bringing digital health solutions to market—experimentation.  
For LS companies, a key challenge is obtaining organizational buy-in for experimentation methods outside the traditional drug discovery, development and clinical research paradigm. For healthcare delivery networks, a key challenge is rallying a team of clinicians willing to try new tools in their workflows and to coordinate with product development teams to share feedback and iterate in real time. In either case, piloting requires teaching stakeholders to embrace uncertain outcomes as valuable learning experiences. To build a compelling business case for investment, create an experimentation roadmap that sequences experiments in a way that maximizes learnings and reduces development costs.
Launch iterative service experiments. Before investing in a full product development cycle, consider running service experiments that test for product and service-solution fit. Unlike other assessment methods such as clinical trials or usability tests that test aspects of the experience in silos, service experiments aim to test the end-to-end experience for key users which integrates not only the digital product, but also the roles, systems, processes, data points and technology that tie the service all together. It’s also important to design a process that enables the ongoing collection of user feedback.

Test products and services in new ways

<h2>Moving forward<span data-ccp-props="{&quot;134233117&quot;:false,&quot;134233118&quot;:false,&quot;201341983&quot;:0,&quot;335551550&quot;:1,&quot;335551620&quot;:1,&quot;335559685&quot;:0,&quot;335559737&quot;:0,&quot;335559738&quot;:0,&quot;335559739&quot;:160,&quot;335559740&quot;:259}"> </h2>
In a changing healthcare landscape, it’s vital for healthcare and LS organizations to embrace new ways of working, business models, organizational structures and skillsets. When we employ these three methods—service and behavioral design and testing—to launch new digital products and services, we not only create new business value streams, but also and most importantly, we all benefit as communities and individuals. We improve the healthcare system through more accessible and affordable channels for care. We equip healthcare providers with more effective tools to deliver personalized care and make their jobs more manageable. We give our family and friends more comfortable ways of caring for themselves and their loved ones to improve quality of life.  
frog has a unique team at the intersection of its practices in <a href="https://www.frog.co/services/service-design" target="_blank" rel="noopener">Service Design,</a> <a href="https://www.frog.co/sector/healthcare-service-strategy" target="_blank" rel="noopener">Healthcare</a>, <a href="https://www.frog.co/designmind/design-mind-frogcast-ep-23-the-science-of-behavior-change" target="_blank" rel="noopener">Behavioral Science,</a> and <a href="https://www.frog.co/services/product-service-design" target="_blank" rel="noopener">Product Strategy, Design and Delivery</a> ready to take on new digital health challenges. <a href="https://www.frog.co/contact" target="_blank" rel="noopener">Connect with us</a> to discuss your needs around developing digital health solutions and the potential opportunities for your organization.

Jess Leitch

Sara  Manzini

Lauren Ianni

Carissa Lim

Authors

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Ianni, Lauren_crop (5)

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Tapping the limitless potential to revolutionize healthcare through Web3 

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Healthcare in the Metaverse

If the metaverse is the “<a href="https://www.readthegeneralist.com/briefing/decentraland" target="_blank" rel="noopener">moment in time where our digital life is worth more to us than our physical life</a>,” what role will the metaverse play in caring for our health—be it our health in real life (IRL) or in cyberspace?
While to many, the metaverse seems like a far-fetched foray into the future dystopic imaginations of tech moguls, we implore you open your eyes and look around you. Take the massively popular online gaming world of Fortnite, or the digital productivity and collaboration universe of Slack, Microsoft Teams, Miro or Figma. This is just the tip of the iceberg. The metaverse has already arrived—and it’s here to stay.
As individuals, as consumers and as citizens we all need to start imagining how the services we use in our everyday lives will show up in the metaverse, and how our lives are going to change as a result. If you are a business leader and believe that you have years before the metaverse will impact your business, think again; your business is vulnerable to massive upheaval.
At frog, we work to realize novel use cases for disruptive technologies. And through our <a href="https://www.frog.co/sector/healthcare-service-strategy">healthcare</a> practice, we have put our minds together to imagine how the metaverse stands to revolutionize the healthcare industry as we know it, and how human needs in healthcare could be solved with Web3.
Continue reading for our take on the future of health insurance, therapeutic care and hospitals. We’ll discuss how these core aspects of healthcare might interact with crypto-security (the use of blockchain, tokens and new systems of hyper-secured governance) and digital immersiveness (the rise of headsets and other virtual reality and augmented reality hardware and software to create spatial care experiences).
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<h3>Insurance is Tokenized</h3>
Health insurance is at a turning point. Consumers increasingly expect insurance companies to evolve to provide coverage that’s personalized to everyone&#8217;s needs and possibilities. Currently, insurance is a one-size-fits-all product that works by pooling and spreading risk across a population in order to minimize the frequency of bankruptcy. This allows those with insurance who need care to receive it without incurring excessive financial hardship.
In the U.S., the Affordable Care Act limits how insurers are able to measure the risk of any individual (e.g., gender is no longer a permissible dimension for premium differentials). However, in the metaverse, with the explosion of digital data, insurers will be much more apt at being able to predict—and prevent—health risks and health exacerbations. While this will undoubtedly pose significant ethical questions which will need careful thought and consideration (e.g., what information insurers should and should not be allowed to adjust premiums based on), if used appropriately it could mean individuals enjoy insurance that’s tailored to them and responsive to individual needs
In the metaverse, using crypto security, people will become the sole owner of their data. Gone will be the days where medical history is a patchwork of billable events held hostage by electronic health records providers or insurers. Instead, medical history will incorporate a comprehensive multitude of a person’s entire activity on the metaverse (alongside aspects of their life such as recipes they’ve used, where they were, what types of conversations were they having, their search history, who they engaged with, etc.). Data will be securely stored, accessed and shared by individuals using their crypto-wallets. This will encourage regulatory institutions to update some of their standards (e.g. HIPAA) that today stifle the kind of data sharing that could dramatically improve one&#8217;s health—all with increased data security and privacy safeguards for consumers.
For example, when scheduling a medical appointment in the metaverse, a person may log in to their provider platform with their crypto-wallet and choose which elements of their health history to share. The health provider and insurer gain temporary access to the wallet and results of the consultation are securely stored in the patient’s wallet. The wallet is also used to validate health outcomes, enabling a wave of new value-based offerings. For example, the meta wallet of a person who suffers from depression will be able to demonstrate the beneficial effects of a successful cognitive behavioral therapy through blockchain by proving the reduction of feeling of sadness and other symptoms typical of the condition.
Further, in the future, we predict the tokenization of coverage, powered by non-fungible tokens (NFTs). Individuals will be able to earn or acquire insurance tokens by completing preventative care measures and by behaving in ways that support health. These tokens can be used to buy down premiums or be used beyond healthcare to support lifestyle enhancements.
In this way, health insurance becomes less about spreading risk, but rather a true partner in helping keep people healthy. Insurers will become masters of curating and valuing impactful tools, resources and activities for their members to partake in. The insurers who will win in the coming years will be those whose portfolios of token yielding interventions offer the greatest impact, and the most handsome rewards. In the metaverse, the incentives and mechanisms to keep people healthy will finally be realized.
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<h3>Digital Therapeutics Marketplace</h3>
Today, people are increasingly using digital technologies—such as MyChart and Apple Health—to gather medical information, connect with other patients to garner support, book medical appointments and support their treatment routines (e.g., pill reminders). For patients, it is natural to use a combination of physical and digital services, just as they do with work and all the other aspects of their lives.
However, pharmaceutical companies are tepidly dipping their toes into the territory of digital therapeutics. <a href="https://www.grandviewresearch.com/industry-analysis/digital-therapeutics-market" target="_blank" rel="noopener">According to Grand View Research</a>, the Digital Therapeutics marketplace was valued at just under $2B in 2021, just 0.05% of the healthcare industry in the U.S.
As the metaverse continues to form, we expect that digital therapeutics will become the preferred and leading therapy of choice. Over the next few years, we anticipate a race to create the most delightful, human-centered and impactful digital therapeutics across nearly all diseases and conditions.
Pharmaceutical companies will be required to entirely upend their existing business models and operations. Gone will be the days of searching for the next blockbuster drug through intensive research and development, and slow clinical trials design. Instead, successful pharmaceutical companies will be those that look, feel and operate more like an agile tech company than a slow, risk averse and highly conservative life sciences company, delivered in combination with an unwavering commitment to rigorously tested and proven efficacy. Physicians and scientists will become digital therapeutics creators who advise at every step of the agile development of a new therapy and clinical trial, combining high medical knowledge and clinical experience with cutting-edge design and coding skills.
In the next few years, we anticipate a shift from pharmacy-derived care to an open and highly decentralized digital therapeutics marketplace where individuals can select treatment options that meet their unique needs, based on medical prescriptions that sophisticatedly triangulate data from all the patient data ecosystems. Cryptocurrency will be the currency of choice for the digital therapeutics marketplace. Insurers will provide far more flexibility for consumers to use their benefits to cover highly rated therapeutics on the marketplace.
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<h3>Meta Hospitals</h3>
Today, hospitals and providers rely heavily on geographic proximity to population centers to drive marketshare. In the U.S., hospitals are capital-intensive businesses with major retail footprints aimed at driving people through the doors to increase revenue and profitability. Even those hospitals under value-based contracts are heavily dependent on timely access to the appropriate centers of care (e.g., to a primary care clinician rather than a specialist, or an urgent care center rather than an emergency room). U.S. hospital executives are purchasing physician groups and local or regional clinics and facilities to drive volume through their main centers of care. Moreover, hospitals face particular challenges in reducing their environmental footprint. Today, hospitals are physical. In the future, hospitals will only be physical when necessary and fully digital for everything else.
Instead of insurance networks being designed based on geographic presence, the digital experience, quality of care, expertise and universal accessibility will become the key drivers for network design. No longer will caregivers miss appointments for their loved ones due to distance. Rather, all who wish to participate will be able to do so from anywhere in the world. Gone will be the days when just hospital staff are involved in the provision of care. Instead, a truly integrated and comprehensive set of services can be coordinated in real time to deliver the best care regardless of location. Gone will be the days when a Chief Operating Officer holds outsized influence on the business of a hospital. Instead, the Chief Digital Officer will be in charge. Nurses and other frontline staff will play an essential role in coordinating operations between physical and digital.
Finally, in the metaverse, mental health will no longer be an after thought, but rather a deliberately designed part of comprehensive care. Brain wearables and implants will be widely available to monitor and treat mental health, supplemented with data from the metaverse that will constantly measure mental health. A multitude of opportunities will exist to connect with trained mental health providers and digital therapeutics 24-7. And the metaverse will be filled with therapeutic escapes to help relax the mind and to make space for mindfulness.
Hospitals will increasingly expand beyond their geographic limitations and think instead of designing and realizing a global model of care. This will be driven by delightful digital experiences, universal access to the best online clinicians, AI-driven medical advice and a new era of convenience and imagination. Given the access to exponentially richer sources of data—and exponentially greater medical expertise that transcends any one geography—care in the metaverse will become the preferred mode of care delivery. And ultimately it will help hospitals deliver on planet-centered visions, by enabling them to dramatically reduce their carbon footprint.
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<h3>Healthy Futures</h3>
At frog, our job is to help our clients see the potential the future holds. We help shape opportunities for our clients and their customers to succeed in those futures. Our healthcare practice is dedicated to the relentless pursuit of designing a more human-centered experience for those who need healthcare.
The metaverse represents the newest, and perhaps the boldest, frontier for innovation in care. While there are many unknowns, rather than turning a blind eye, we invite you all to take an active part with us in shaping the opportunities this new frontier presents for us all to better serve those with healthcare needs. There will undoubtedly be serious ethical, moral and experiential considerations for us to grapple with—but we believe in human potential to propel us into crafting an entirely new healthcare universe that is more accessible, more data driven, more secure and more enjoyable for us all. How will you show up?

Viral Shah

Author

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It’s 3 a.m. and my mobile phone is ringing incessantly—it’s a research subject calling to say that he’s just discovered that his wife has turned to prostitution to pay for her drug habit. Because of this, he won’t be joining us tomorrow morning’s workshop.

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Shock Empathy: Designing an End to Hepatitis C

Missed appointments, hard to reach subjects, low control environments—these are just a few of the hurdles we encountered throughout the research we conducted in France, Sweden and the UK studying the needs of people with hepatitis C. But with extreme empathy and a newfound level of flexibility, we were able to extract valuable insights on how hep C affects those most in need, and how we might be able to design an end to the disease. The resulting documentary footage was captured over four weeks of qualitative research in the United Kingdom, where we encounter Catherine and Mick, two very different archetypes, both suffering from hepatitis C.
Trust is essential in these environments, even if it can be difficult to establish. Yet where judgement is reserved, candor blossoms. The right question can become an opportunity to contribute, and a camera can become an incentive for those hesitant, yet eager to unload their experiences. Throughout our research we translated many stories from our interview subjects into valuable insights. The result of this work was primarily a set of tools that serve as a comprehensive guide to redesigning the hepatitis C care pathway based on human needs.

Sara is a design researcher and service designer at frog, focused on designing complex product-service systems through a deep understanding of human’s needs. She is an active part of frog’s social impact practice, and also has significant experience leading co-creation and training programs. Sara is in her element when discovering new places with her old Yashica and while honing her moves on the dance floor.

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