While it is not required, we strongly encourage you to refer to the Case Study of Mary in your submission video, and discuss how your product addresses one or more of the issues she faces.
CASE STUDY: MARY

Mary is a 45-year-old Hispanic woman who speaks both Spanish and English. She has a multitude of health issues and diagnoses, including morbid obesity, type II diabetes, hepatitis C, hypertension, congestive heart failure, renal insufficiency, and asthma. Mary is also a smoker, although she talks frequently of wanting to quit and in the past has gone as long as seven months without a cigarette.

As a child, Mary was sexually abused by her step-father. This has impacted a number of aspects of her life, contributing to a history of depression and past suicide attempts, as well as leaving her mistrustful of working with male health care providers. She also has a history of IV-drug use (individuals who have a history childhood trauma experience this at much higher rates than the general population) which is how she contracted hepatitis C, but she has been clean for over 10 years. Mary does, however, sometimes self-medicate for her depression by drinking. She recognizes that this is a problem given her hepatitis C, but she has a difficult time adhering to her medications, including prescriptions for anti-depressants, because she is currently homeless. Among other things, this makes it difficult for her to organize her pills, remember when to take them, and track when she needs to refill them.

Mary is currently unable to work, due to her many health issues, so she receives $733 a month through Supplemental Security Income (SSI). She has been living in a homeless shelter for the last 10 months, but her shelter is far away from the hospital and clinics where she prefers to get her care. It takes two buses to get to that neighborhood, and she often misses appointments. She frequently ends up in the hospital because her blood sugar is not under control, and a social worker recently assessed that Mary is not clear on how to use or read a glucometer, and as such is not always giving herself insulin shots properly. Some of this may be due to the fact that she has a fifth-grade reading level, and the diabetes management literature she was given with her glucometer uses very complex language.

Nearly every time she shows up in the hospital, Mary is referred to a variety of specialists for follow-up appointments. She always intends to attend these appointments, but she either loses the doctors’ phone numbers, or gets overwhelmed trying to manage her many different appointments.

The last time Mary went to the emergency department, she was told that her Medicaid had expired. With the help of an emergency department case manager, she scheduled an appointment to re-enroll in the Medicaid program. The appointment took five hours, and she forgot to bring a required form, so she had to reschedule for the following week to complete the process. Mary was told that several notifications were mailed to her apartment letting her know that she had to re-certify for Medicaid, but because she is now homeless, the letters did not reach her. Because her Medicaid is currently expired, and Mary is not enrolled in a Patient Assistance Program to help pay for medications on a temporary emergency basis, she has also stopped refilling her prescriptions, but says she will pick them all up again once her coverage kicks back in.

Mary has a hard time trusting medical professionals, as she often feels judged by them and like she is letting them down by not doing a better job of managing her health. She also has difficulty communicating her concerns or asking questions of providers, as they seem rushed for time. Mary has a good rapport with one primary care doctor who she has seen a few times, and gets along well with a psychiatrist at the hospital—but, these doctors work in different health care systems and have never spoken with each other to coordinate Mary’s care. She also has a case manager at her shelter who is helping her apply for housing. The case manager is good, but doesn’t really understand Mary’s health conditions. She has made a good friend at the shelter who helps her organize her paperwork and reminds her to take her medications. Mary speaks frequently with her friend about her goals for securing housing, quitting smoking, and losing weight.

Mary’s depression affects her motivation to engage with her providers and in her own care. Her housing status makes it very difficult for Mary to manage her conditions or reliably show up for appointments. And her low literacy level means that simply providing her with written instructions on her care is not sufficient.

In order to manage many of her health conditions, Mary knows that she needs to improve her diet and lose weight. Unfortunately, her current living situation does not allow her to prepare her own meals—and even if it did, there are no grocery stores near the shelter where she can get fresh produce or other healthy foods. Mary sometimes feels intimidated going into a grocery store, as she is unsure what foods to buy and how she can easily prepare a healthy meal for herself when she has the opportunity. Given her health issues, Mary is unclear about what exercises are safe or appropriate for her – and she has not been able to discuss this with her doctors, who tend to focus only on her conditions during visits. She enjoys sitting in a park that is near her shelter, but it is fairly small and doesn’t provide much opportunity for a good walk.

Although Mary is low-income, she does have a smartphone and makes sure that she pays for it each month out of her SSI check. She knows how to use some of its features—like downloading apps, texting, playing games, and using the maps feature—but she is concerned about exceeding her data plan, so she doesn’t use it for email and is still learning how to navigate the internet.