Co-Designing Health & Care with a Community

How a Prospective Provider in Boothbay Maine Is Gathering Customer Requirements

January 29, 2015

Boothbay Region Health Care, Inc. is a start up non-profit chartered to provide primary healthcare for the residents and visitors to the Boothbay, Maine region. It was created by a group of concerned citizens who believe there’s a better way to provide local care in their community. They have used customer co-design as part of their planning process in the design of their proposed Boothbay Region Health Center. Forty community members created five Customer Scenarios to capture their requirements for improved healthcare. Here are two of the Customer Scenarios the community members created.


Boothbay Region Health & Wellness FoundationSince the Spring of 2013, a group of concerned citizens has been conducting needs analysis and business planning to create an innovative health center in a coastal community in Maine. This group formed organically under the auspices of The Boothbay Region Health & Wellness Foundation to explore alternatives as our community’s local hospital and 24-hr ER were closed by MaineHealth. The group investigated many options, and decided in the end to focus on improving preventive, primary care to reduce the need for emergency services and hospitalization.

The strategic planning committee includes patients, physicians, nurses, social workers, retired healthcare administrators, business people, and retirees, as well as myself. The planning has been carried out in stealth mode for the first two years because we didn’t want to get peoples’ hopes up, tip off the incumbent primary care provider, or increase the divisions in the community. 

In early 2015, the group decided to “go public” to involve more of the community in the decision about whether to launch this new venture. The goal: a community-governed integrated primary care practice designed to serve year-round and seasonal residents. Its name is The Boothbay Region Community Health Center. If it comes into being, it will be run as a non-profit, with a board comprised of patients. No physicians nor members of management will sit as voting members on the board. The governance structure is dictated by two factors:

  1. The board that voted to shut down our 107-year old St. Andrews Hospital was comprised of 49% management and physicians who worked for the healthcare system.
  2. In order to eventually qualify as a Federally-Qualified Health Center, the board needs to be a community board with no employees or physicians as voting members.

In addition to involving many community members on the design committee, we ran a public customer co-design session in June 2014 with about 40 members of the community to “co-design the future of healthcare in our region.” This article summarizes some of the findings from that customer co-design session. As I believe you’ll see from the stories that follow, business needs analysis that relies on statistical research and customer interviews can provide the broad brush strokes. But, as customers put themselves in one anothers’ shoes to describe their real lives and what they’re willing to do to reach their goals—in this case, better health—the priorities, the constraints, and the success metrics become very clear.


Healthcare Spending in One Small Region

The year-round population on the Boothbay peninsula is close to 7,000. This swells to an additional 21,000 people in the five “summer” months. If you add the five months’ worth of summer people to our year-round population for planning purposes, the total population requiring healthcare services averages out to 14,000 people per year. If we use the State of Maine’s Health and Human Services 2009 estimate of total healthcare spending of $8,500 per person, that means that total healthcare spending in our region is $119 million/year or $1+ billion over the next 10 years.

Primary care typically accounts for only 5 percent of the total healthcare costs per person (health insurance, hospitalization, outpatient treatment, lab tests, procedures, doctors’ visits, and prescriptions and over the counter medications, etc.). According to Dr. Rushika Fernandopulle[1], if we spent 10 percent on the right kind of primary, preventive care, the total cost of healthcare per capita would be reduced by 20 percent.

Current Primary Care Services Offered

There are currently two medical practices and a walk-in Urgent Care Center available to serve this year-round and seasonal population on the Boothbay peninsula.

One doctor’s office—the Family Care Center—is run by a subsidiary of MaineHealth, the state’s largest healthcare system. The Family Care Center has three primary care physicians and a nurse practitioner serving the community. Their practice also includes a full-time social worker, a pharmacist, several nurses and medical technicians. As part of a larger regional primary care practice run by a large healthcare system, the group also provides... (more)


(Download the PDF to read the entire article.)


[1] In a speech, on May 9, 2013, at Mayo Clinic Transform 2013 -- Connecting for Change, Rushika Fernandopulle, M.D., a practicing physician and co-founder and CEO of Iora Health, a healthcare services firm based in Cambridge, Mass., discusses his mission is to build a radically new model of primary care. His segment begins about 4:00 minutes into 26:03 video.


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  • Patty_author
    Patricia Seybold on February 2, 2015 at 4:58 p.m.

    Received this comment from Sandra Raup:

    I appreciated reading your paper – thanks for sharing!  It was very interesting hearing what was lacking in the community you were studying from the consumer’s point of view.  I did have some questions and comments, however.  I wondered what type of provider input you had.  I’ve worked with these types of populations and patients for years, and although I agree that some of the problems could be dealt with more effectively, I think there are some unrealistic expectations as well.  The “Walt and Ellen” scenario.  As a dietitian, I have worked with this type of patient and family, and it’s more complicated than you can imagine, especially with all the schedule and social issues.  Very small steps at a time is what works best, in my experience, and it’s very hard for someone at that age to make major changes.  For example, it’s unlikely that anyone can stop smoking and lose weight at the same time – what’s more important? 


    But I have been working with some other developers to create a more meaningful approach to healthcare – HIT that works for patients and providers alike because it can deliver education, services and communication in an as-needed way.  If you know of anyone who’s really interested in doing this, I’d be happy to talk to them about what we’re doing.  We’re just getting started with our first project and would be happy to talk to you and them about it as well.


    Thanks again for sharing your paper – it’s at least good to show physicians, especially primary care, that providing what their patients really need is not even close to happening yet.

    Sandra Raup

  • Patty_author
    Patricia Seybold on February 2, 2015 at 4:59 p.m.
    Yes, Sandra--Actually there were clinicians involved in this co-design session. They were fully aware of the difficulty of changing dietary habits, that's why the solutions the team came up with included LOTS of coaching and one-step-at-a-time solutions--most around nutrition, diet, etc. Notice that our "customer" did not make any changes to his regime right away (other than diabetes meds), and wound up having a heart attack on his boat. It was that "call to action" that everyone (patients and docs) felt would probably be necessary to get Walt's attention. I would be very interested in hearing more about your HIT solution. We're still in the design stages of our Health Center. Thanks for the feedback. It seems to me that getting patients and physicians collaborating together is what we're all trying to do. Patty
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