Jillian Ahrens: Designing Digital Therapeutics

Jillian Ahrens is the CPO at Realized Care, a digital therapeutics company specializing in VR solutions. She was formerly Associate Director of Product R&D at Pear Therapeutics, where she led a project developing a CBT-based AI chatbot.

Discover what Jillian learned at Pear about patient engagement with AI chatbots, and how she's taking those lessons into her cutting-edge work delivering digital therapeutics for chronic pain.

Transcript

Intro: [00:00:00] From Silicon Valley, the heart of startup land, it's Getting2Alpha. The show about creating innovative, compelling experiences that people love. And now, here's your host, game designer, entrepreneur, and startup coach, Amy Jo Kim.

Amy: Jillian Ahrens is the chief product officer at Realized Care, a digital therapeutics VR company Specializing in chronic pain management.

Previously, she was Associate Director of Product R&D at Pear Therapeutics, where she and her team pioneered the development of an AI chatbot aimed at enhancing patient engagement.

Jillian's work focuses on creating empathetic user experiences in digital health, ensuring that patients feel comfortable and understood. 

Jillian: The power of VR, you can change somebody's reality instantly. Your attention is completely immersed and engaged in an interactive environment . So this distraction [00:01:00] immediately reduces the brain's focus on different pain signals, leading to a reduction in perceived pain.

Amy: Join us as we delve into Jillian's innovative approach to digital therapeutics and learn how VR and AI are transforming patient care.

Hi, I'm here live with Jillian Ahrens. She's our special VIP guest today. You know, so much is happening in digital therapeutics and you're right there in the eye of the hurricane. 

Jillian: Yeah it took its twist and turns. I started in advertising and then that took me into this boom, of applications. When the iPhone came out, oh my gosh, I needed to create my own app, design it. So I started to get focused on digital technology. And then that took me to this whole landscape of digital health technology, digital therapeutics.

 I think I'll never look back now that I found this space. It's just been so rewarding. And from there I got introduced to this idea of how virtual reality can truly be this place for [00:02:00] changing and completely pioneering the way that we take care of our health and the way that we can get better without using pharmacologic drugs.

Amy: So what is it about VR that makes it so different from, say, an iPhone app?

Jillian: Oh gosh. The power of VR, it's been this absolutely incredible space to really think about how you can change somebody's reality instantly. We're building several programs looking at pain distraction and kinesiophobia.

This is fear of movement and stress and reducing chronic pain and how it has this almost analgesic effect. So meaning that it can create this place where your attention is completely immersed and engaged in an interactive environment . So this distraction immediately reduces the brain's focus on different pain signals, leading to a reduction in perceived pain.

And this is very different than an actual phone, right? Some sort of smart [00:03:00] device. This is incredibly informative and helpful and important.

But as far as specifically looking at maybe exposure therapy or pain reduction type of influence that VR has in the brain processes from the neurological effect. You can't compare it. The sensory inputs are very, very different. What this device can do versus a smartphone.

Amy: Thank you. Yes. So that's what you're focused on now at realized care. Part of how you got to be CPO at realized care is that You worked at Pear therapeutics, which is a real pioneer in the field on one of the chatbot products. 

I know you did a lot of different things at Pear, but I'd really like to hear the brief story of that product. And then what you thought was going to happen going into it and what you learned, which of your assumptions were completely validated and you learn something you're bringing with you now into everything you're doing with VR and AI as well, which we'll get into in a moment, and also like which of your assumptions at Pear were invalidated?

What [00:04:00] surprised you? What did you learn from running those studies and talking to patients and seeing how they reacted to what you put out there? 

Jillian: Yeah. I would say when I first started working at Pear, we had a series of prescription digital therapeutics that were highly based, you know, on specific CBT activities and tools that counselors and therapists utilized in the real world.

And they went through various different clinical studies and had specific outcomes, and this was really important and they were very effective. However, we realize when we got them in the real world, they were missing this human aspect. We had different open loops, right within our products as well.

You have many different customers when you have a behavioral health product. So you have the patient, you have the provider and it's really important that you create these closed loops between the both of them and that they are interconnected. So that was something that I learned that was Very, [00:05:00] very important that when you have those 2 stakeholders that to design them, these, these 2 experiences independently is this kind of incomplete assessment of the entire experience. So, it's really important to make sure that you have that therapeutic alliance. that the digital therapeutic helps promote, meaning it's not just an isolated tool that a patient uses, that there is a provider there and the provider needs to have the right type of feedback into their system, their EHR or wherever they're going to be getting data about their patients.

So that was a big learning moment because we weren't doing that. So that was something that was insight number one. So we're continually to do that right now in our VR products. We're making sure that we have the proper type of data that is interesting, not just to the patient, but sometimes that'll look different to the provider.

That's very important for them, but we have to be able to capture both pieces of data and to provide a lot of value. First and foremost to the patient. So we always have this mantra that I started to say value to the patient is value to the provider. And so if the [00:06:00] patient finds this valuable, they're going to engage and they're going to use it and they're going to change their behaviors and we need to be able to show those insights and that value to them.

And then that might look different over to the provider. So those are the, that's one closed loop systems of, of having these feedback loops that are in your connected your work taught me a lot of that actually Amy. And additionally, I would say, again, going back to insights. So this is very important for behavioral health products.

You have a patient and they're engaging with your product. You need to be able to show them a greater amount of value than the effort. It takes them to engage with this product. And if this is hard to do, you need to be able to collect the right amount of data to show an actionable insight.

So, how do you engage patients to be able to collect that type of data? Well, I wanted to utilize a chat bot. So this was the 1st time Pear did not have any sort of chat interface within its products. And [00:07:00] I really knew that this was an important moment. I had a chance to design a product from scratch for severe depression disorder and relapsing and remitting MS and to have that opportunity, I don't know if anybody has had that opportunity, but a blank screen in front of you of, okay, here's an indication.

And we need a behavioral health product with these outcomes that it's going to create. I was just, where do I start? And I know I'm kind of circling around here, but I found a podcast that you had done Amy way back when this is like 2017 or 16. And that was a game changer to help me with this framework that I use for this product.

But on top of that framework, I knew that I wanted something that was highly engaging. So that's what leads me to this This creating this chatbot, this relationship and just creating this anthropomorphized engagement with the product was really important. And so we began to do this. And through one trial at a time, we showed this absolutely Staggering type of engagement that people had.

Not only were they using it, but [00:08:00] qualitatively, they were saying that they developed a relationship with it. And this is a long time ago, right? We're not, we're not in the GPT phase. So we were just writing mass amounts of content and logic and baked in some, you ML. That we were able to then provide back to users to be able to inform them on some pretty compelling insights in the moment that changed the way that they they decided to behave or they decided to think, change their patterns of how they, their relationship with their pain that they had.

And so I think that's something that was really groundbreaking at that time and something that I use today, again, developing an AI digital core behavioral health product for chronic pain right now at Realized Care. 

Amy: So tell us more about what you learned struggling with this very early chatbot experience, but obviously very influential how, what you learned there is now, Being expanded and realized in the work that you're doing.

Talk to us about how you're incorporating AI into the deliverables that you're [00:09:00] working on and how you think about it and also what you're learning because we're all figuring it out as we go along. 

Jillian: Yeah, that's a great question. I have to say when we decided to do this shift, our product to this next gen within this AI that's driving it, I did dig back through the insights that I had created with this product You know, five years ago, even though the tech is vastly different.

I think the principles that were learned are absolutely applicable and the same very similar ones. And Those are around again, being able to create insights, but before you can do that, you have to create trust. And how do you create trust with a product? this is really baked in to this idea of how youTalk to somebody and how you use language.

We utilized a motivational interviewing techniques. We use utilize positive psychology and this was a way to really get people engaging with the product and feeling like this was a place where there wasn't [00:10:00] any stigma, there wasn't any judgment. We really were able to support people along the entire way of the journey despite this specific type ofbehavior that we were trying to change. 

So, meaning that this became a space for people would come, even if they knew they weren't making specific direct lines of progress or success to their outcomes of their condition. So I believe that AI is going to full stop transform healthcare and digital therapeutics.

There's nothing that is going to stop that. And there's so much opportunity that we're not even close to tapping into. But I think that the more that we can use it and think about how we give patients agency and their health care journey that we make sure that the AI, this is what we're doing, that we're letting them know that you are the only person, you are the best person to make decisions on your journey. 

And so our AI is going to encourage that for you to give that autonomy and that agency, that freedom you talk a lot about in your work self-determination. That's really important. And so we're training [00:11:00] our model around that. And knowing that AI offers valuable suggestions, it's not flawless and the AI is going to be there to help patients tailor their recommendations to their unique circumstances and giving them that agency.

Amy: That's really interesting. Let's dig in a little bit on the positive psychology aspect. I remember when we first chatted months ago about this, you told me that when you looked at the tracking data, you were surprised by how much people engaged with the positive psychology aspects of the system. 

Jillian: Yeah. That was something that we weren't intending to have right out the gate was to have this journey where we we're going to lead people through this area of really thinking about positive moments in their life. When people live with depression they're still filled with positive moments and they experience them less frequently, but how can you recognize them?

And so we found that it's really important to highlight and reinforce these really ensuring [00:12:00] reassuring moments and situations. And so, this approach in positive psychology encouraged the acceptance of the past and patients felt a greater contentment of the. Of the present and this increased hope and excitement for the future.

So I think it's about, sure, you can have these specific mechanisms of actions in a behavioral health therapeutic that you're sure that are necessary. But just when you're using user interviews and different areas and to really get to know a person, I think that that can really open it up to new possibilities of different things and different features that are really critical.

So the product basically guided them through this conversation, had different prompts to elicit these really powerful emotions that were really made people feel so empowered or happy about a past experience. And then it had prompts to guide them and to journal about these feelings and to retrain the brain to focus on these moments of positivity and people would say the positive path was absolutely preferred.

I would rather [00:13:00] look for more positive outlook on the day. And this can then catapult me to a more positive state of being. So it was just this refresher, people said that they felt like they could relive the moment and it makes them feel happier for longer. And it just made them feel so much better.

So, we overlook positive moments in the past and just remembering that people are so multifaceted and to be able to validate people and reinforce that joy and that acknowledged is really important in behavioral health products. 

Amy: That's such an interesting finding. And especially when it comes as a surprise. So there's a lot going on in the landscape right now with VR, with AI, and then digital therapeutics with all the issues about legislation and coverage, et cetera. What are the areas and trends that you are paying particular attention to? What is on your radar?

Jillian: Well, I think specifically that there are obviously very clear obstacles in this [00:14:00] landscape but I really believe that in bio pharma companies are absolutely going to have to engage in digital health. This is not going to be an option anymore. So I think that there is going to be definitely more solutions that have a model where there's, this wraparound service to appeal a digital wraparound, and that's going to really help create adherence and help overall shift this whole idea and help gain traction around value based care as well. 

So looking at outcomes while reducing costs, I think that it's going to be crucial that there is the supplemental digital health tool for specifically to help streamline clinical trials.

I think when you think about precision medicine to even accelerate drug development, and I think all of this is going to really show that this is going to improve outcomes. 

Amy: That's really interesting. So If you were talking to a designer or product manager, someone [00:15:00] who's interested in digital therapeutics, interested in the vision that you just laid out and wants to develop their skill, can you talk about maybe just one skill?

Cause of course there's many, but what's something that's going to help you if you want to get into building out this vision and working in digital therapeutics? 

Jillian: Yeah, I think that in order to create a truly meaningful digital therapeutic, you're right there. There are many things that you need to consider, but I really go back.

So I think number 1 is understanding the disease condition. Understanding it inside and out. You don't need to have had to go to medical school or have a P. H. D. to do that. Understand the medical perspective, understand the condition, understand all of the behavioral aspects to the condition. Really do a lot of research in behavioral science as well. I think that's really critical goes hand in hand. You as a designer as a product manager, you are literally creating the [00:16:00] behavioral change the new way that somebody is going to engage with the product. And then change the landscape, the shift and what it looks like for what they're going through of this chronic illness or disease.

So it's really important that you have this foundation on that clinical side of things and use a lot of different SMEs and KOLs to help inform you and guide and learn from them, do your research. And in addition to that, a part of that research is this qualitative research that you can do. Be feverishly passionate and invested in understanding your users.

And the only way you can do that is by talking to them all the time. And so it has changed who I am. It's changed who I just how I design. It changes how I coach and mentor teams. And it's really powerful and purposeful. And this will change your product. It'll change the way the features potentially that you involve in the product.

And it will change the way that you, the voice and tone in which the product has. And then [00:17:00] the way that you think about driving insights and value for patients as well. 

Amy: So you spoke about adherence a few times, and this is a big topic in digital health, which is adherence, clients, habit building.

It's the hardest thing to do. Everybody wants it. Few achieve it. So what have you learned about what works and what doesn't work? And obviously it's context dependent, right? There was one solution everybody would use it. But you must, I mean, I imagine you struggle with this just part of the job. So what are some of the things you've learned?

Do you have some rules of thumb? Have you seen something that like absolutely doesn't work? This is the golden egg, right? Adherence.

Jillian: Yeah. So adherence. You know, what makes somebody come back to your product, right? What makes them want to open that up amidst everything else that's out there that's engaging. 

You're competing with Netflix and Facebook and Instagram, right? What makes this something that they're going to go [00:18:00] into versus giving that immediate relief or distraction, right, that they would potentially otherwise want. And so I, again, go back into what drives people when they're going through a chronic illness or disease.

I personally have found that it's a deep level of empathy and again, creating this space where there isn't any judgment actually on this board right here behind me. Yeah, I was just teaching my team about this. At Pear, I had to create this onboarding experience. We were had this, it was called lost to follow up.

We had people prescribed in the software as a medical device and the drug, the PDT, but they wouldn't actually sign in. They wouldn't complete the onboarding. And they're just drop off. So in the medical space, this is called a loss to follow up and lost to your treatment that you have, maybe over the course of 12 months, you show up for a one and you drop off.

So how do you promote adherence? How do you reduce churn? Again, again, I go back to this ability to have this place [00:19:00] where you are there. And you show this, you have to show this immediately. Immediately when you open up the app, you have to be able to meet this emotional appeal and desirability.

And when you are dealing with the chronic disease, really when this comes into play is they, there's a lot of shame. There's a lot of isolation and loss of dignity. This is a big one. And when you can create a place where you have That acceptance where you have that non judgment that reduced stigma when you show how people are courageous, despite their pitfalls, you can do this by video right away, you show actual patient videos, talking about the journey, you have to show that you do get it, truly understand what it's like to have the disease.

We learned that it was not enough to say we are an FDA cleared medical device. Turns out patients didn't really care about that. So what we did at the very beginning was show that hey, we understand you and [00:20:00] we get it. And it sucks. It's really, really hard. So when we were able, so this arc right here, it's this emotional arc of engagement.

And on the X and Y axes is emotion. And the task And on the other one is revenue, because again, like you said, why, you know, this is all a part of it, right? You're, you have to understand the business aspect behind it as well. When you're designing there's definitely a big influence there. And that's very important, but the higher you're able to keep that emotion, that emotional draw on the desire, the more likely people are going to continuously stay engaged and come in and to be a part of your program. 

Design for the unhappy path, harm reduction. We talked about, and that is this philosophy where if you're able to understand that life is messy. People are imperfect, and it's really important to be able to have somebody come into this space and know that, hey, I may not [00:21:00] have returned over and over again, but I am getting celebrated for showing up, not my streaks, right?

This is very critical. And when we were able to do this, it drastically changed engagement. And people feeling like this is a space that they want to be in. So, think about these philosophies, I mean, harm reduction versus abstinence is saying that basically, you're out. You made a mistake.

You've returned back to substance use. That's what this is. Opioid and substance use disorder. And it's rooted in this understanding that some individuals will continue to engage in risky behaviors. Some individuals will can, will drop off. They won't meet their goal for the product, but how can you still be there and recognize that total behavior change, total abstinence. 

This is incredibly difficult to change immediately, or it might not ever be a realistic goal. But how can you just be there no matter what and provide these spaces where there's this deep level of respect for somebody's choice [00:22:00] without Judgment, right? There's no room for failure.

It's binary. Either you succeeded or you failed. Designed for the unhappy path. So I think that this is really important and can give people permission for room to make mistakes, to keep improving and to keep on in the program, which can change outcomes.

Amy: That's really interesting. It's such a clear point of view.

Now you had mentioned to me earlier, you had some things that you might be able to share that illustrate some of what you're talking about. 

Jillian: I sure do. 

And this was work that was done, five or so years. So I'm going to share my screen. 

Amy: Okay. So this gets back into this idea and philosophy again of harm reduction and how you can really create moments recognizing somebody, whether they were successful or not.

Jillian: So imagine you returned to substance use, or maybe you didn't. Maybe you were able to get a negative urine drug screen and you came back into the product. So this is the flow of, imagine having that as a condition in your [00:23:00] product, how do you create a space for what we would say is as failure, right?

You had a positive urine drug screen, which means you've returned to use. And what are you going to create for that moment for somebody? And this is what we tested. So pay attention to these two screens. So we have on here, you've returned to reset. That isn't nothing. It's everything. You aren't alone. For many in recovery, a return to substance use is a part of the journey.

And in order for them to continue, it's not just a continue button. It's I am not alone. So this is leveraging something called change talk. And this is utilized in motivational interviewing. So this is what I'm talking about this tone and tenor. We invited patients to co create this content with us and co design it.

So that's also something definitely keep in mind when you're using and creating behavioral health products. And the next screen is one step at a time. Recovery isn't a straight line. The progress you've made still stands. You don't start over again and look at this. What does it say? I am a work [00:24:00] in progress.

So that creates something very different than these continue buttons right? This language is so important. So, this is part of a presentation that we did on writing principles and having this person centered language. And so I'll go back to this one and I'll share this audio. So this is celebrating staying on track, right?

You did not return to substances and we, this is a whole nother mechanism. And I'm sure you know very well of this. We allow people if they had a negative urine drug screen utilizes something called contingency management, where we're basically meeting the kind of dopaminergic effect of the dopamine levels you get with using drugs with the incentive is incentivizing using monetary incentives.

So we, we actually give money out for positive behaviors, but I want you just to listen to this. So before you spin and users know that spinning a wheel, this is what I'm talking about. The monetary incentive, take a moment to recognize your increasing strength and resilience. We do. 

 It just create [00:25:00] experiences where people will feel that they actually care about what they're putting out.

Jillian: So thanks for letting me share that. I hope that was helpful. 

Amy: That was. 

Thank you so much. This was a great session. 

Jillian: Thank you so much, Amy. This was really wonderful. 

Amy: It was. 

Jillian: Thank you. Bye bye. 

Outro: Thanks for listening to Getting2Alpha with Amy Jo Kim, the shows that help you innovate faster and smarter. Be sure to check out our website, getting2alpha.com. That's getting[number]2alpha.com for more great resources and podcast episodes.