Virtual behavioral health and the power of human-centered design

Ann-somer Hogg annsomers.hogg@carolinashealthcare.org
Dr. Jean Wright jean.wright@carolinashealthcare.org

Abstract

Wouldn’t it be great if every patient could get screened and treated at their primary care physician's office for anxiety and depression? What if screening and treatment didn't interrupt the workflow of the rest of the staff? What if patients could get immediate access to a licensed behavioral health provider, and then have online or in-person follow up? What if all of this care was supervised by a psychiatrist, who could provide just-in-time consults to the primary care physician while the patient was still in the office? What if this could be done without adding new employees? What if this could improve their medical and behavioral health outcomes?

Through human-centered design, our “what if’s” became reality.

In the summer of 2013, a multidisciplinary team at Carolinas HealthCare System used human centered design to create a solution to meet our patients at their greatest point of behavioral health need. Using the innovation tools of ethnography, analogous learning, constrained thinking, and prototyping, we held a design week. What resulted was a virtual behavioral health solution – a new way to screen and manage patients while at their primary care office.

Now, almost four years later, thousands of patients have been screened and treated. The outcomes far exceeded expectations. Not only did patients’ depression and anxiety scores improve – 34% of patients report no evidence of depression after participating in our solution – but their management of chronic diseases like diabetes improved too. Diabetic patients have seen a marked decrease in HbA1c. Even 83% of the patients who had suicidal thoughts at the time of the initial screen, said those thoughts never recurred after getting the appropriate treatment. Additionally, we removed the stigma of being referred to behavioral health by providing the care right in the primary care office, and by offering online cognitive behavioral therapy. With an emphasis on upstream detection and intervention, we are improving health and quality of life outcomes, reducing suffering, and lowering total costs.

We've learned a lot through the design and implementation process about the value of hearing the patient, feeling what they feel, and literally stepping into their shoes. The success we achieved by applying human-centered design to behavioral health has been so impactful, we’ve applied a similar approach to COPD care, pediatric asthma, alternative primary care, and more. We look forward to sharing our experience with you. Perhaps it can help your organization tackle the same or similar challenges. 
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