overview
With our evolving clinical model, Care Pathway was introduced as the new suite of business solutions that represent both a set of enhancements to the current Ontrak program, as well as new solutions designed to drive ROI for the less medically acute populations. There are 8 corporate objectives for the Care Pathway solution, where the main objectives are growth, to expand Ontrak’s total addressable market by 3x, as well as providing our HP customers with evidence based coaching and performance measurements that we can obtain by performing a series of behavioral assessments through member journey in our program.
The 11 enhancements outlined below that are core to the Care Pathway program suite:
All enhancements and business goals shape how we build our products, some with direct impact on mobile workflow, dictate metrics that we need to be tracking, how content is built and distributed on mobile or otherwise, while others have indirect impact.
I will be focusing on how we introduce Behavioral Health Assessments and how we implement it on Ontrak mobile app here.
problem statement
We want to conduct Behavioral Health Assessments in order to track members’ progress as they enter Ontrak’s program until they graduate. We want to use Ontrak mobile app as one of the modalities to administer and record these assessments.
research
With input and interviews with our Clinical team, I learned that there are 2/3 separate BH Assessments that Ontrak will administer throughout our program. They consist of:
- PHQ-9: a multipurpose instrument for screening, diagnosing, monitoring and measuring the severity of depression
- GAD-7: instrument used to measure or assess the severity of generalized anxiety
The PHQ-9 and the GAD-7 assessments are to track member progress and improvement. The very first 6-question behavioral health screener is comprised of 2 clinically supported assessments: the PHQ-4 and the TICS-2. The PHQ-4 is an ultra-brief measurement of core signs of depression and by combining the PHQ–2, consisting of core criteria for depression, as well as a measure for anxiety (GAD–2). An elevated PHQ–4 score is not diagnostic but is an indicator for further inquiry to establish the presence or absence of a clinical disorder warranting treatment. The TICS-2 is another brief measure used to determine if the member should have more detailed diagnostic assessments for an alcohol or drug problem.
These two will be administered within the first 60 days and prior to the member to be referred to a provider. Depending on the results, the PHQ-9 and GAD-7 will then be administered 6 months after enrollment and then again at 12 months after enrollment for members who are still enrolled.
The DAST-10 and AUDIT-C assessments occur only once and are used to assess the acuity of member's condition. Because the DAST-10 and AUDIT-C are not trackers, they will not presented at the 6 month and 12 month intervals.
In short, the behavioral health screener is administered to members soon after enrollment to quickly discern if they should be subject to further inquiry for depression, anxiety, substance abuse-related mental illness.
constraints
We don't want to present multiple assessments at the same time. We want to let members answer the first before sending the second.The challenge really is to understand the logic on when to call up specific questions depending on the score of each question.
process & responsibility
Assumptions
The results of the BH screener determine what assessments are recorded and sent to the member.
The BH assessment(s) will be delivered via typeform.
The typeform link is member-specific and will send data to the member's dataset in Ontrak data foundations.
I began to map out the logic as best I can with my product manager.
Workflow above illustrates how mobile can administer the necessary screeners within the first 60 days and prior to the member to be referred to a provider, meeting our business goal.
Scenario: Introduce the BH Screener
Given that I am a registered/signed-in member,
Then explain/introduce the BH Screener and why that is important for me to complete the screener
Scenario: Link to complete the BH Screener
Given that I am a member that clicks on Typeform link to complete the BH screener
Then the Ontrak app opens a webview for me to complete the BH screener
And my answers will be sent Ontrak data foundations so that my care team can see my answers.
Scenario: Thank the member for completing the survey
When I complete the screener,
Then close the webview and show a "Thanks" message
Then close the webview and take me back to the Training tab
Scenario: Member closes out the survey without saving the responses
Given that I have NOT yet submitted the BH screener survey
And I sign back in to the Ontrak app
Then I should continue to be presented the Intro screen until I complete the survey as Typeform does not record incomplete flow.
User testing
With the above workflow, BH screeners will need to be included into the onboarding flow for mobile. However, we already have many unskippable onboarding criteria to meet. After member has successfully signed into our app, they will have to choose a coach, choose a program, and choose a habit in order for appropriate content to populate the app. On top of these, we now have to include the BH screener questions.
In order to ensure a good onboarding user experience, we conducted user testing with 3 participants who matched our member demographic.
Key Learnings
Surprisingly, all 3 participants did not think the onboarding flow was too long, or that the screener questions were too personal, they all understood that the information we are collecting are all necessary for us to help them.
Did not anticipate learning that all 3 found the tab “portal’ confusing, not what they expected, should be renamed
CTA for onboarding complete should be ‘Let’s Go!’ or something similar, instead of “Close’