The Future of Healthcare: “The extraordinary influence of the social determinants of health”, with Anthony Pannozzo, Executive Creative Director at frog

We used to think the three things that determined our health were behaviors, genetics and luck. We now know about the extraordinary influence of the social determinants of health. The social determinants of health include factors like socioeconomic status, education, neighborhood and physical environment, employment, social support networks, as well as access to health care. […]

We used to think the three things that determined our health were behaviors, genetics and luck. We now know about the extraordinary influence of the social determinants of health. The social determinants of health include factors like socioeconomic status, education, neighborhood and physical environment, employment, social support networks, as well as access to health care. These factors can affect your ability to eat healthy, access quality care or maintain independence as you age.

Ihad the pleasure to interview Anthony Pannozzo. Anthony is Executive Creative Director at frog where he leads the firm’s healthcare practice. In this role, Anthony is responsible for overseeing frog’s creative teams and client relationships, ensuring frog’s work has the desired impact on the world. As the lead, Anthony focuses the practice on bringing healthcare products and services to market.

Thank you so much for joining us Anthony! Can you tell us a story about what brought you to this specific career path?

While I was at RISD, I was really interested in what I would call “design as art.” This included furniture, housewares, and objects that expressed beauty, with maybe a bit of function thrown in. I was interested in materials and form. Philippe Starck was an early inspiration. After graduating, I worked at Arnell Group doing three-dimensional advertising for clients like Donna Karan. This included hang tags, store fixtures and displays. I thought design was about making things cool and elegant.

When my mother was diagnosed with cancer, I began spending a lot of time with her as she navigated the healthcare system. I was with her at chemo treatments, multiple hospital visits, and hospice before she passed. I witnessed the poor design that existed in the healthcare system. There were machines that beeped loudly throughout the night, interrupting her sleep, and hospital rooms that were not designed to accommodate her visitors, who often stayed by her side overnight. I felt that healthcare design was not human-centered.

As an industrial designer, I was able to pivot into healthcare via the MedTech space. I worked on diagnostic and lab equipment as well as one of the first AEDs to be operated by ‘lay’ rescuers. I also helped design instrumentation for knee replacement surgery. I remember looking at the instruments on the first day of that project and thinking, ‘my can opener has better ergonomics! Something here is not right.’ While I still enjoy working for fashion clients on occasion, I feel a greater sense of purpose working in healthcare.

Can you share the most interesting story that happened to you since you began leading your company?

It’s been fascinating to see the pharmaceutical industry’s foray into digital health and how the most important thing, outside of the entire drug discovery process, is getting people to take their medicine. During my time at frog, I’ve worked with pharmaceutical companies that have wanted to use apps to get people to adhere to their prescriptions. The challenge is that, if somebody doesn’t build a habit to take their medicine, what makes you think that he/she will download an app and learn how to use it in order to regularly take their medicine? We’re not solving the problem of behavior change simply by creating a digital tool. While the long-term outcome may be better (e.g. patients adhering to their prescriptions, their health improving, and prescription refills ordered regularly), the short-term incentive isn’t always there.

Can you tell our readers a bit about why you are an authority in the healthcare field?

I am not a clinician. However, I do understand the challenges and experiences of people practicing medicine, and also the effort that goes into trying to live a healthier life or managing a chronic condition. As a design practitioner, I have conducted research with nearly every stakeholder in the healthcare ecosystem. I’ve gained perspective and understanding of the functional and emotional needs of nurses, primary care physicians, surgeons, in-home caretakers, people with chronic conditions, people who’ve needed emergency surgeries, insurance companies, pharmaceutical companies, MedTech companies and more — I understand what they care about and the challenges they face trying to achieve better outcomes at a lower cost.

What makes your company stand out? Can you share a story?

As a design and strategy firm, frog is unique for three different reasons. First, we are insight-driven, applying both qualitative research methods like ethnography, with quantitative approaches from our applied data practice. With this approach, we can understand more deeply what’s important from a human perspective. Second, we are really good at defining the right problems to solve and measuring a solution’s impact in total medical cost reduction or how patient outcomes have improved.

Lastly, at frog, we believe that every idea and strategy is simply a well-informed hypothesis that needs to be tested in the real world as quickly as possible. As a company, we are good at finding ways to generate meaningful feedback loops that inform our iterative approach. We are strategic thinkers with the DNA of a design firm that knows how to ‘make’. We can build physical and digital prototypes and experiences that small samples of people can use to understand whether a hypothesis delivers the outcome we predicted.

Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?

Our focus right now is working with clients on what we call a ‘virtuous intelligent system.” Virtuous Intelligent Systems are essentially digital platforms that provide value to the user through advice and guidance that is based on both personal and aggregated data, both passively and actively collected. Waze is an excellent example of a virtuous intelligent system: you tell it where you want to go, it uses aggregated data to find the best route, and delivers guidance in real time to help you make smart decisions about your journey. It also shows you the benefits of actively providing data (like potholes or speed traps). Because you are part of a community, you want to augment the data richness because it benefits the whole.

Healthcare does not yet have a virtuous intelligence system where people recognize the value of contributing data, either passively or actively, and getting immediate feedback from that data through both their own use and the collective use of others. We are helping our clients look for this in healthcare.

Are you working on any exciting new projects now? How do you think that will help people?

At frog, we worked with Amicomed, a Swiss based startup, that has developed the first fully digital consumer hypertension lifestyle modification program. Their app provides people with a schedule of when they need to measure their blood pressure to understand the pattern of how blood pressure fluctuates (average blood pressure is not an accurate measure). An algorithm can interpret the data and provide precise and personalized recommendations on diet and exercise (e.g. eat this, do this now, etc.). In a study conducted in Italy, 70% of those who signed up and stayed with it were able to achieve in three months a systolic blood pressure reduction of up to 20mmHg, with an average reduction of 5mmHg across the entire group.

What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)

  1. Healthcare has both a service component and a clinical component. There’s the clinical component we are familiar with (such as an annual wellness exam, a trip to the emergency room, or a surgery). But there is also a service experience of healthcare, like making an appointment, finding the right doctor or making sure you’re covered for care.
  2. You need a code to be used in the healthcare system. For example, there are codes for when a doctor gives you an aspirin or orders a blood test. These codes are agreed upon standards that define what insurance will cover.
  3. Healthcare doesn’t always encourage innovation; reducing costs are often more important. When I was at RISD, I completed a project designing a walker with Rhode Island Hospital by talking to nurses and people recovering from injuries. We learned at the end of the process that insurance companies probably wouldn’t pay for it because the idea was more expensive than the standard walker. It was a big learning for us that insurance likely wouldn’t cover it fully, and that only people who would be able to afford paying the difference between what the insurance company would cover would be able to benefit from our design.
  4. Behavior change is key. Changing behaviors is extraordinarily complex and emotional. There was a recent study featured in The New York Timesthat described how experts now view procrastination as an emotional challenge, not one of time management. We really procrastinate because we are avoiding the emotions that we feel when carrying out the tasks we are avoiding, even if completing those tasks are in our long-term best interests. Similarly, we often engage in unhealthy behaviors, despite the fact they are not in our long-term best interests.
  5. We used to think the three things that determined our health were behaviors, genetics and luck. We now know about the extraordinary influence of the social determinants of health. The social determinants of health include factors like socioeconomic status, education, neighborhood and physical environment, employment, social support networks, as well as access to health care. These factors can affect your ability to eat healthy, access quality care or maintain independence as you age.

According to this study cited by Newsweek, the US healthcare system is ranked as the worst among high income nations. This seems shocking. Can you share with us 3–5 reasons why you think the US is ranked so poorly?

One part of this is that we have a system largely driven by private insurance under the age of 65. The competition between insurance companies on who can provide the lowest cost service translates to fewer benefits and limited coverage. When you buy a healthcare plan, it’s hard to imagine buying for the future and anticipating high medical bills from diseases that you didn’t anticipate.

In the U.S. healthcare system, there is also a cultural factor: we do everything possible to save and extend a life. There are limits to what other systems will do because the data might show that it’s not worth it. In this country, most healthcare costs are incurred over the last six months of our lives, because we’re doing everything we can to extend our lives.

Ironically, the best research in the world is being done in the U.S. I know from doing research with Mayo Clinic that many people who live in emerging markets come to the U.S. for care if they can afford it because they are seeking out the top hospitals.

You are a “healthcare insider”. If you had the power to make a change, can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each. It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?

Our policy makers and legislators need to recognize the influence and burden social determinants of health have on the costs of the healthcare system. We need to be less individualistic about this and have more empathy for circumstances that make sustaining a healthy lifestyle difficult for many people.

We all need to recognize that good health should never be taken for granted. Regardless of who you are, being healthy beyond your 40s and 50s is a chronic condition in and of itself. In order to stay healthy, you have to do healthy things. It’s a two-pronged approach: at a certain point in your life, your body reaches maturity and starts to decline. You need to be taking care of yourself to minimize that decline over time. Subsequently, we can’t just think that everyone has the power to be individual, because there are circumstances that make it impossible for them, even with the best intentions, to live the healthiest possible life.

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