Design Innovation to Enhance Addiction Care Engagement and Reduce Patient Drop-Off Rates

Eleanor Health | UX Designer (Team of 4)

Healthcare UX

Systems Thinking

Stakeholder Mapping

Journey Mapping

Strategy

Created patient-centered solutions to improve engagement in addiction care for individuals with Alcohol/Substance Use Disorders, enhancing accessibility and reducing no-show rates through research, journey mapping, and prototyping.

Tools: 

Figma, FigJam

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Outline

Problem

Eleanor Health (EH) is a virtual-first outpatient addiction treatment program that provides online services for people in recovery from substance use disorder. They offer judgment-free support, affordable treatment and personalized care. Their approach integrates medical care, behavioral health support, and community resources to provide a comprehensive, compassionate, and stigma-free treatment experience.

EH faces challenges such as high patient dropout rates, ensuring first appointment attendance, and serving members with limited resources in a virtual-first model. Additionally, addressing co-occurring mental health disorders and overcoming stigma are ongoing hurdles.

Our goal was: how might we enhance engagement in addiction care to better support individuals and stakeholders involved in the process?

Tools

Figjam, Figma

Solution

  1. Conducted detailed stakeholder analysis, including mapping pain points and opportunities.
  2. Employed tools like stakeholder maps and ecosystem maps to visualize gaps and improve care paths.
  3. Brainstormed problem statements and generated prototype ideas, prioritized through an impact-effort matrix.
  4. Developed current-state and future-state journey maps to visualize member experiences and prototyped proposed improvements.
  5. Presented findings and recommendations in a final presentation with Q&A for the Eleanor Health stakeholders.

Duration

February - May 2024
(This was a 4-person team project as a part of my Design Innovation course at Bentley)

Defining the Scope

Project Goals

Diving Deep Into the Sponsor's Background and Objectives

Working as part of a team of four, this was an academic collaboration with Eleanor Health (EH), an addiction care center committed to supporting individuals affected by addiction in leading fulfilling lives. EH is dedicated to revolutionizing the quality, delivery, and accessibility of addiction treatment and mental health services. Our core focus was on exploring several key questions:

How might we reimagine the member journey and experience?

How might we innovate our business model?

How might we reduce the number of no-show patients?

How might we ensure members attend their first appointment?

How might we better serve members with limited access to resources, such as technology?

Defining the Scope

Secondary Research

Beginning with Project with Detailed Secondary Research Resources

We were not allowed to engage directly with patients. We were provided with valuable resources such as the Patient Experience Journey Map from Addiction Policy Forum (APF), which highlighted the detailed stages of the patient journey from the onset of symptoms through treatment and recovery. This resource offered firsthand patient quotes on both "bright spots" and "pain points," providing deep insights into the challenges faced by those seeking addiction treatment.

Key findings from the secondary research include:

The age of onset for Substance Use Disorders (SUDs) ranges from 5 to 19 years, with an average of 14 years (APF).

Young adults often perceive substance use as part of identity exploration, underestimating its harms (SAMHSA).

Certain groups, such as those with co-occurring mental or developmental disorders, are at higher risk for substance misuse (SAMHSA).

Protective programs in childhood, such as behavior modification and social-emotional skills training, have lasting effects into young adulthood (SAMHSA).

If a patient seeks help and does not receive it on the first attempt, they are highly likely to not reach out again. This is due to factors such as stigma, denial, fear of judgment, and the belief that their problem isn't serious enough—issues that are further exacerbated by a negative initial experience. (Probst et al., 2015)

Without strong initial therapeutic connections in virtual sessions, loneliness can set in, hindering recovery. (Hogg et al., 2023; Békés et al., 2021)

Defining the Scope

Business Model

Mapping the Ecosystem: Business Model and Stakeholder Insights

The process began with mapping out Eleanor Health's current business model, where we identified crucial elements like partners, activities, customer segments, and revenue streams. This initial step gave us a clear framework to understand how the organization operates.

We then focused on stakeholders, with each team member creating individual stakeholder maps. By merging our insights and refining the map together, we created a comprehensive ecosystem map. This map illustrated the relationships and pathways between internal and external stakeholders, including insurance companies, treatment centers, pharmacies, EH staff, and the broader community. It was through this collaborative effort that we were able to pinpoint the most effective routes for designing our solutions.

Defining the Scope

Defining Problems and Prioritizing Solutions

The team collaboratively brainstormed problem statements, representing the challenges of various stakeholders such as EH staff, insurance providers, the community, pharmacies, the government, healthcare providers, members, and pre-members.

Through voting, we prioritized and refined the list to eight key problem statements requiring immediate attention. To further organize and evaluate these, we employed an impact-effort matrix. This helped us identify the different view points within the addiction care ecosystem.

Defining the Scope

Current User Journey

Current State Journey Mapping: Identifying Opportunities for Change

One of EH's biggest challenges was the fact that there was a limited number of staff in the Access Team creating a bottleneck in the path from a pre-member becoming a member.
Another was the high number of no-shows to the first appointment.

Defining the Scope

Ideation

Generating and Prioritizing Prototype Ideas

Based on the member journey above, we used a brainstorming technique called Crazy 8s. Our team brainstormed 32 creative ideas based on problems from the perspectives of pre-members and members. We voted on the top 8 to focus on. These ideas were mapped on an impact-effort matrix to prioritize feasibility and potential impact based on Eleanor Health's resources.

The top 8 ideas were:

Option to reserve place in line

This idea involves creating a system where pre-members can opt to hold their place in a queue and receive a callback from EH staff, reducing wait times and frustration. It caters to both pre-members seeking initial appointments and current members scheduling follow-ups.

Rewards for Consistency

Members could earn rewards such as digital badges or physical tokens for attending appointments and completing treatment milestones. This gamification technique encourages engagement and consistency in treatment participation while fostering a sense of achievement.

Progress Charts w/ Status Updates

Personalized progress charts would visually display a member's recovery journey, tracking goals and milestones. These charts could be accessible digitally through a mobile app or physically as take-home materials, adding motivation and clarity to the recovery process.

Chat Therapy Options

Introducing a chat-based therapy platform allows members to have real-time or asynchronous communication with therapists, offering more flexible and accessible support options.

Frequent Contact and Collaboration

This idea involves more frequent check-ins with members via multiple channels like video calls, text messages, or emails. Collaborative participation in setting goals and action plans helps members feel more involved and supported throughout their journey.

Post-Session Debriefs

Following therapy sessions, members would share their thoughts on how confident they are about completing the next steps outlined for them. They could also anonymously share their opinions about their healthcare provider, and EH would ensure that any discomfort they feel is alleviated either by changing the provider or modifying treatment methods. This would ensure that members don't drop out of treatment mid-way.

Interactive Videos and Chatbots

Educational and interactive videos, coupled with chatbot support, could help pre-members understand EH’s services and members navigate their treatment plans. Chatbots would answer FAQs and guide users in a user-friendly, engaging manner.

Patient Account or Dashboard

A centralized dashboard would provide members access to their appointments, progress reports, treatment plans, and resources. This digital solution ensures convenience and helps members stay organized.

Chosen Idea: Option to Reserve Place in Line

One of EH's biggest challenges was the fact that there was a limited number of staff in the Access Team creating a bottleneck in the path from a pre-member becoming a member.

Given our limited timeline, we as a team made a unanimous decision to explore idea 1: option to reserve place in line as we believed it would take the least amount of effort by EH and would create the highest impact, especially since EH's biggest issue was a small Access team, limiting the number of pre-members signing up for treatment.

It was the most feasible and viable option.

Defining the Scope

Future User journey

Future State Journey Mapping: Re-imagining the Path

In the future-state journey, we envisioned two clear pathways for prospective members to establish contact with EH.

Via Phone

In this strategy, when a pre-member calls Eleanor Health (EH) but cannot be immediately connected, they are offered two options:

  • Stay connected while waiting for the next available staff member.
  • Opt for an automated callback system, where the caller provides their phone number and is informed of an estimated wait time based on the line’s current volume. This ensures EH can maintain contact with pre-members and call them back when availability permits.

Once the pre-member connects with an EH staff member and schedules their first appointment, EH staff could follow up with a check-in call 24 hours before the appointment. This call would confirm attendance, address any questions, and reassure the pre-member, fostering a sense of comfort and preparedness for their upcoming session.

Via Website

EH operates within specific boundaries regarding the pre-members it can accept. The pre-member must:

  • Reside in one of the states where EH has offices.
  • Be an adult.
  • Have an insurance plan accepted by EH (if not, EH encourages signing up for the relevant plan).
  • Seek care for alcohol use disorders (AUDs) or substance use disorders (SUDs), as EH does not treat other types of addictions.

If a pre-member calls but finds the phone line busy, they could be directed to visit the EH website. There, they could check their eligibility and schedule their first appointment.

In this journey map, we zoomed in on the part of the pre-member's journey between initiating contact and going to their first appointment. For each section, we considered the kinds of emotions that a pre-member may experience - some of which were informed by EH based on past experiences. The goal was to seamlessly integrate a nervous or scared pre-member into the recovery program by building hope and making them eager to attend their first session.

Defining the Scope

Phone Strategies

Web Strategies

Strategy 1: Automated Callbacks and Pre-Appointment Check-ins

EH faces challenges due to a limited number of staff managing phone calls, leading to unanswered calls when volumes are high. Research indicates that individuals with AUD or SUD who fail to receive help on their first attempt are less likely to try again due to stigma, denial, fear of judgment, or the perception that their condition is not serious enough. Each missed call represents a lost opportunity to connect a pre-member with necessary treatment. To address this, we proposed the below features.

Automated Call-back

When a pre-member calls EH and cannot connect immediately, they are offered the option to either stay on the line or request an automated callback. The system would collect the caller’s number, estimate a wait time, and assure them they will receive a call back when a staff member is available. This reduces frustration and ensures EH can follow up with every pre-member.

Business Value

  • Convenience: Handles large call volumes efficiently.
  • Accessibility: Supports less tech-savvy individuals.
  • Pre-Member Satisfaction: Reduces frustration by offering alternatives.
  • Autonomy: Provides pre-members with control over how their inquiry is handled.

Risks and Mitigation

  • Risk: Callback timing may vary due to high volumes.

    Mitigation: Send real-time updates via text if wait times change.
  • Risk: Staff may be overwhelmed by repetitive queries.

    Mitigation:
    Use IVR (Interactive Voice Recordings) for FAQs to reserve staff time for pre-member sign-ups.

Pre-Appointment Check-Ins:

Once the pre-member books their first appointment, EH staff would call them 24 hours before the session to confirm attendance, address any concerns, and set expectations. This proactive approach helps reduce no-shows and makes the pre-member feel more comfortable.

Business Value

  • Confirmation: Ensures the pre-member will attend their session.
  • Anxiety Reduction: Clarifies expectations to make pre-members feel supported.
  • Autonomy: Provides pre-members with control over how their inquiry is handled.

Risks and Mitigation

  • Risk: Calls may not reach pre-members or may be seen as intrusive.

    Mitigation: Allow pre-members to choose their preferred communication channel (e.g., phone, SMS, email). Supplement check-ins with an e-pamphlet sent via SMS or email summarizing key information.

Defining the Scope

Website Strategies

Strategy 2: Eligibility Verification Forms for Patients on EH Website

To streamline intake and handle busy phone lines, we proposed a website-based eligibility and booking system, integrated into EH's existing website.

1. Website Enhancements

A prominent “Book an Introductory Call” button on EH’s menu bar leads pre-members to a responsive landing page. This page, designed to be accessible across devices, outlines the steps to becoming an EH member, with a clear call-to-action guiding users through the eligibility process.

2. Eligibility Check Form

A four-step form evaluates pre-members based on location, age, addiction type, and insurance coverage. Pre-members who don’t qualify are directed to a page acknowledging their circumstances and offering alternative resources and helplines, reflecting EH’s empathy and commitment to care.

3. For Eligible Pre-Members

Qualifying users proceed to the final form to:

  • Enter personal details.
  • Upload insurance card images or manually input insurance details.
  • Schedule an introductory call using a plugin like Calendly for seamless booking.

    After booking, users receive a confirmation email with a calendar invite and call link.

Business Value

  • Improved User Flow: A clear, prominent CTA simplifies the booking process.
  • Higher Qualified Intakes: Eligibility checks ensure only qualified individuals proceed, saving time and effort.
  • Empathetic Engagement: Transparent ineligibility messages and alternative resources show compassion.
  • Cost-Effective Scheduling: Calendly provides an affordable, user-friendly solution with organized timeslots.

Risks and Mitigation

  • Risk: Tech Barriers - Less tech-savvy individuals may struggle with online forms, and some may hesitate to share personal details online.

    Mitigation: Allow pre-members to choose their preferred communication channel (e.g., phone, SMS, email). Supplement check-ins with an e-pamphlet sent via SMS or email summarizing key information.
  • Risk: High Bounce-Rate - Users may leave if the landing page isn’t engaging.

    Mitigation: Use EH’s style guide, fonts, branding, and illustrations to create a visually cohesive and welcoming design.

Defining the Scope

UI Design

Presenting Visuals

2. Eligibility Check Form

The form is extremely easy to understand and complete with 4 filters. This would help filter out candidates that don’t qualify for their treatment, saving the time they would spend in calling and waiting to get in touch with EH.

Location

age

Type of addiction disorder

insurance provider

Users go through the filters one by one. If they don't qualify at any point during the form, they are immediately redirected to a page that informs them that EH cannot support them at this time. This page tries to deliver the message respectfully, providing actionable resources and helplines that could assist them instead.

respectful rejection

3. For Eligible Pre-members

Individuals that are eligible for treatment can schedule their introductory call with EH by providing personal details and reserving their spot by booking a slot on Calendly.

This form essentially seeks to collect the information that would usually be discussed over phone calls during the pre-member intake phase. Internal research by EH has indicated that many pre-members express annoyance and frustration while spelling out their names, email addresses, and insurance details over phone calls. The booking form is a convenient way to overcome these pain points and reduce time on task.

To maintain safety in collecting health insurance information, EH should use HIPAA-compliant form builders such as Typeform or Jotform. To do the booking Calendly which is a convenient and commonly used option to book sessions. Once the pre-member books the call, they are notified that the call has been successfully booked, and they also get an email which contains a calendar invite and a link for the call.

Defining the Scope

Reflections

Conclusion and Reflections

Presenting our designs and strategies to the stakeholders at Eleanor Health was an enriching experience.

Wins

Accessibility

Simplifying the pathways for pre-members to connect with EH.

Resource Allocation

Tailoring solutions to create a large impact with small measures.

Pre-Member Engagement

Solving pre-member pain points during intake process.

Takeaway

This project was exciting to work on because of the opportunity to work in addiction care, which is such a sensitive and important topic. I gained insights into the complexities of addiction and the nuances of Substance Use Disorders (SUDs), including their onset, challenges, recovery processes, and the terminology they prefer to be addressed by.

This project taught me the importance of designing with empathy, understanding complex stakeholder ecosystems, and creating solutions that balance organizational goals with user-centric values. Our work not only aimed to enhance the pre-member experience but also laid the groundwork for Eleanor Health to scale their impact, helping individuals on their path to recovery.

Defining the Scope