⚡ What Happened to "Human-Centered" Health Tech?

Why functional, accessible healthcare requires more than sleek design

One of Reboot's core principles is that technology is part of a system. Thorny systemic problems require a combination of technical, economic, and sociopolitical fixes — the kind of multi-pronged approach that isn't often taught in the CS classroom, as one of our past essays explains. This problem is especially evident in the American healthcare system and technology's struggles to "disrupt" it.

That's why I invited my friend Shohini Gupta, an Associate Product Manager at Oscar Health, to write today's essay. Shohini graduated from UC Berkeley and was a Managing Partner at Dorm Room Fund, where she invested in student startups and pioneered the Female Founders Track. She's interested in healthcare, power in policymaking, dance, and reading four books in parallel.

🩺 what happened to "human-centered" health-tech?

By Shohini Gupta

Since Don Norman published his pioneering book The Design of Everyday Things in 1988, the tech industry has championed human-centered design (HCD), a process for building systems with the user’s situation and psychology in mind. Norman breaks down human desire into seven simple steps, then advocates for designers to address these desires as simply as possible. Well-designed products make their functionality obvious, whether through a push panel on a door or a self-threading projector system.

This focused, structured problem-solving approach massively increased tech adoption and consequently, company revenue. Seemingly, centering users in a solution could make any system usable, efficient, and scalable.

Meanwhile, the American healthcare system is the polar opposite of what HCD aspires toward. Instead of a simple, intentional vehicle for providing a service, healthcare has developed like an overcrowded city — winding, uncoordinated, and much of it by accident. A simple trip to the doctor requires a dizzying number of entities to collaborate: the patient, their insurer, the hospital system that owns the doctor's office, the office management system, pharmacies, labs, and hundreds more. All of these contribute to the expensive care and poor outcomes we see today.

can we “solve” healthcare with human-centered design?

This is the fundamental premise behind firms like IDEO and the Stanford d.school. They consult with organizations of all kinds, purporting to solve large-scale issues like food waste, city emergency planning, and culture change in hospitals. This cottage industry around HCD extended the Silicon Valley mythos that a solution process that centers technology can solve any issue, no matter its form or cause.

But these claims deserve scrutiny.

For example, one consistent user-facing issue health-tech has tried to tackle is price transparency. Layers of contracting, insurance plan design, and billing rules make it nearly impossible for any consumer to know what they will pay when they go to the doctor’s office. One solution is to make contracting and plan design more straightforward so that consumers can get a guaranteed price.

However, the HCD process is owned by tech teams. This immediately limits the scope of the solution because the underlying assumption at any venture-backed tech company is that technology will solve the problem efficiently, while operational processes (like the negotiating and contracting process) remain legacy.

algorithmic price estimates: a case study

In the price transparency case, many health-tech companies built intensive models to generate personalized cost estimates based on other users with similar clinical profiles, zip codes, insurance plans, doctors, and reasons for visiting. Yet these computations generate estimated price ranges that are inaccurate 30-40% of the time. If a user decides to visit a certain provider based on that calculated estimate, but are charged something out of the estimated range, the health-tech companies are not liable for the information they provided. After all, they said it was an estimate!

These companies might have run countless user research sessions to determine what copy and font might provide the most reassuring explanation for why they can’t generate a guaranteed price estimate. At best, negative user feedback forces the company to move their disclaimer from the fine-print to a more prominent position on the page. The HCD philosophy inherently narrows the scope of innovation to building simpler, more intuitive interfaces, but doesn't really make prices any more transparent.

There are countless startups and legacy insurance companies building solutions like this, accelerated by new Center for Medicare and Medicaid Services price transparency rules that require hospitals and insurance companies to expose their negotiated rates. Meanwhile, the underlying problem continues to exist: complicated contracting and insurance plans.

HCD allowed technologists and their investors to believe that the solution to the complexity of the healthcare system lays in improving consumer perceptions — that the abstraction of technology complete with pastels and a sans-serif font will make things suddenly comprehensible. It allows us to continue funding technological solutions while healthcare's underlying infrastructure continues to crumble.

Examined critically, health-tech companies entrench existing systems: they would not exist without the brokenness of the status quo.

where does health-tech go from here?

The hero narrative has been central to Silicon Valley culture, but it doesn’t have to be. Instead of the utopian language of tech “solving healthcare”, health-tech founders and employees should collectively recognize that our problem-solving begins with two primary constraints — technology and profit — which often lead us to band-aid solutions rather than meaningful change.

More concretely, we can ask: How might we build more companies which can viably rebuild underlying infrastructure without being pressured into a high-growth, 10-year return timeline?

Imagine a company that provides in-home health services for seniors. This would be socially valuable: they would allow seniors to stay in their own homes instead of nursing homes, generate employment for nursing assistants, and lower facilities costs in the senior care system. This company could be bolstered by technologies like remote monitoring devices and predictive healthcare.

But a company like this doesn’t scale exponentially with technology, and it wouldn’t be able to achieve tech company margins due to its high labor requirements. Therefore, it would struggle to get capital in today’s environment. In fact, one prominent venture-backed company which tried to do this just ended up selling software to other home health companies, which just continued the broken home health system... but with more software.

Personally, I'm excited by new funding vehicles that could make longer time-scale, lower margin, and less risky technology-enabled service companies to exist. Although some prominent tech thinkers have discussed this idea (Alex Danco, John Luttig, Ben Thompson), these funding vehicles don’t quite exist yet.

In a world where companies can get funded without having to return 10x in 10 years, we might see companies that include systemic issues as part of their understanding of a positive user experience. With more deliberate building and less investor pressure to race toward revenue, we might not see as great of a tradeoff between profit and people in the process of human-centered design.

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how did you become passionate about healthcare?

I had always been interested in how to better distribute basic goods and services better, which for me was healthcare and financial services. I thought I wanted to go into policy, but the pace frustrated me (and I went to Berkeley), so tech felt like the next best path. Health-tech scratches the itch for learning how policy and tech can interact, while working on something that actually impacts people daily.

how can someone start learning about systemic issues in healthcare?

I'd suggest An American Sickness for a good overview of the whole healthcare system, and America's Bitter Pill for an overview of how the ACA was put together, which impacts much of the structure of today's healthcare system. For research specifically on systemic issues, the Kaiser Family Foundation does fantastic work. Other than that, follow researchers on Twitter who are BIPOC!

can you tell me about a book you loved this year?

Healthcare related: Food Fix. Talks about our food system and how much it impacts systemic differences in outcomes. It really changed my mind about how what we normally consider "healthcare" is really "sick-care".

Non-healthcare bonus: The Poppy War trilogy. So fun to get out of this world!

You can find more of Shohini on Twitter.

🌀 microdoses

  • ✝️ If Jesus was on Clubhouse:

💝 closing note

This week, we kicked off the Reboot Student Fellowship and onboarded our first class of 20 fellows! In lieu of the usual input from the Reboot core team, I'm including a few book recommendations from the fellows here:

  • Ivan (Brown University): Absolutely loved Educated by Tara Westover.

  • Bianca (Ateneo de Manila University): I really enjoyed Robin Sloan's Sourdough! Wholesome, tech-related...it warmed me up :>

  • Tara (University of Central Florida):Minor Feelings, Pachinko, currently on 'The Water Dancer'

  • Ethan (Duke University): Most recently Viet Nguyen's The Sympathizer and Camus' The Myth of Sisyphus.

See you next time!

—Jasmine & Reboot team