Over the past half-decade, fellowships in healthcare innovation have become increasingly popular. The Health for America fellowship, which matriculated its second full-year class this September, is dedicated to developing innovative solutions for a different chronic disease each year.
“The bottom line is that we want to use design and entrepreneurship to improve healthcare outcomes,” says Ellen Kourakos, Health for America’s Chief Operations Officer. Last year the fellows worked to design a sustainable solution for patients living with congestive heart failure; this year the fellows are tackling type 2 diabetes.
Each Health for America class consists of four young professionals from interdisciplinary backgrounds. According to Kourakos, who herself is an alumna of Health for America, the choice to award the fellowship to non-physicians is deliberate. “We want people thinking outside of the box and thinking differently about healthcare,” she explains.
The fellowship is divided into three phases. First is exploration. “In this phase they’re learning all about the healthcare system, how money flows, who are the different stakeholders, how policy influences how care is delivered,” she says. “They’re also learning about the disease— what it means to live with the disease, what are the co- morbidities, what are the social challenges that make it challenging to manage the disease.”
The second phase is the ideation phase in which the fellows consider problem areas and identify potential solutions based on insights from providers, patients and entrepreneurs.
Finally, fellows are expected to execute their solution. Kourakos explains, “We want to create solutions that best fit the problem—so whether that’s an app, for example, or a physical product, or a process improvement, or something that’s based around efficiency—we want to keep it open so that they can focus on really creating whatever is the best solution versus shoving a square peg into a round hole.”
Throughout the program, the fellows receive access to myriad professional resources including crash courses, medical and entrepreneurial conferences, mentorships and workshops. One of the most unique resources available to the fellows is a clinical partnership with MedStar Health, which gives the fellows access to doctors, patients, nutritionists, care managers and educators.
This year’s fellows are in the exploratory phase of the fellowship. An important objective of the exploration phase is to teach the fellows about the human centered design process and build empathy for people living with diabetes.
To understand the challenges of managing chronic illness the fellows are simulating living with the disease. For two weeks each of the fellows adopts the persona of a person managing type 2 diabetes and, in some cases, a host of co-morbidities. The fellows simulate the life of their persona as closely as possible; they monitor what and when they eat, regularly measure glucose levels, abide by exercise requirements, and take a host of placebo medications.
Fellow Dan Hoff, a healthcare consultant who majored in biomedical engineering at Brown University, is simulating the experience of a 75-year-old man who, in addition to type 2 diabetes, has chronic kidney failure, a history of coronary bypass surgery and a variety of vision and neurological problems. One of the major challenges Hoff has faced is managing his diet given his persona’s co-morbidities.
“When you’re trying to construct a diet you say, ‘Well the main emphasis is on limiting carbs, so I’m going to have a low carb diet,’” he explains. “But then you consider the history of heart problems and you say, ‘Okay I also have to cut down on fat.’ Then you take the kidney problems and you say, ‘Oh it looks like I have to cut down on protein, potassium and phosphate.’ What you get is this highly restrictive diet.” Although implementing all of the dietary restrictions at once has been important for Hoff’s understanding of living with type 2 diabetes, he concedes that real patients would be encouraged to take small continuous steps when transitioning to a healthier diet.
Scheduling has also proved a significant challenge. Fellow May Paquete, a health policy research analyst, is simulating the experience of a 64-year-old woman managing type 2 diabetes, hypertension and high cholesterol. Her persona lives in section 8 housing, is unemployed, takes eight different medications a day and uses the bus to get around.
“When you have all of these co-morbidities, it’s not really up to you to determine your schedule,” she explains. “I have to eat at the same time every day, but I also have to catch the bus, so I need to make sure to know the bus schedule so that I know where I’ll be when I need to eat. The scheduling is very complicated.”
Both fellows agree that the simulation has been an important part of their attempt to empathize with patients managing type 2 diabetes. Says Hoff, “I have so much respect for people who have to make these wide-sweeping lifestyle changes.”
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