Case Study:
Notifications for Healthcare Providers
Improve patient follow-ups and compliance
The Problem
A 2021 directive from the Centers for Medicare & Medicaid Services required participating hospitals to send ADT* electronic patient notifications to alert Primary Care and Behavioral Health providers.
These motifications are sent when a member has been in or out of the hospital or emergency room, and advises them of follow-up recommendations and timeframes.
* Admissions, Discharges and Transfers
Notification Types
Discharge Against Medical Advice
Follow-up w/ Multiple Chronic Conditions
Transition of Care Admissions
Transition of Care Discharges
Hospital Admissions
Hospital Discharges
Transfers of Care
Medicare Advantage plans support the services provided to “dual-eligible” Medicare Advantage members with individualized care plans (ICPs).
Medicare Advantage plans evaluate member health with Health Risk Assessments (HRAs).
Anthem receives member calls via NurseLine that identify medical care concerns.
Benefits
Notify providers outside of a hospital when a patient is admitted, discharged, or transferred - chart notes, discharge instructions, and medication lists.
Help ensure that patients receive appropriate care at all stages of treatment - help prevent errors and improve patient outcomes.
Help providers monitor patients after discharge - scheduling follow-ups or monitoring patients who have chronic diseases.
Alert providers to activities that need to be completed immediately - giving medication or other specific timely care.
Notifications are often available as spreadsheets/downloadable reports
The Challenge
How could Anthem get notifications to providers in a way that would be easy for them to receive … and highlight any necessary actions?
My Role
I led a team of 2 UX designers in partnership with a Product Manager and 2 scrum teams.
As UX Lead my responsibilities included planning, direction, oversight, communication, ensuring team and stakeholder buy-ins, as well as being hands-on with design concepts and research.
Discovery
Understanding how healthcare providers can make the most of notifications of ADTs and other medical events
Approach
Stakeholder Discussions
Meeting with the business to understand the opportunity
and expected outcomes.
Providers’ Experience
Interviewing providers to determine how they could best make use of notifications.
Technical/Architecture
Discussions to understand possible constraints and how
Stakeholder Goals
Migrate ADTs to an improved system that can also support other types of medical-related event notifications
Improve providers’ response time for following-up on high-priority events since as “Discharge Against Medical Advice”
(aspirational) improve Anthem’s Medicare STARS ratings as a result of better visibility of patient events as well as providers adherence to follow-up receommendations and timeframes.
(future) lower cost of care as a result of improved patient care visibility and response times
Eg. Re-admission after a “Discharge Against Medical Advice”
Stakeholder Concerns
Low adoption from providers (may not be aware or realize the requirements)
Information is all over the place (multiple systems for multiple payers)
Used to communicating by phone which has been inefficient
Providers Goals
Follow-up with my patients after medical events
Stay informed about my patients’ needs
make sure any required actions are completed so we stay in compliance
Providers Concerns
Not sure of what system to use (multiple system for multiple payers)
These requirements are new and unsure how they change our workflow
Information varies from system to system
Technical
Architecture
Issues with old app
Data in many locations, efforts to provide a central source
Integrating with EHR possible but $$ and wouldn’t make short time frame, also don’t want to take functionality away
Track providers use of app, tie in to quality measures
Focus
Help providers to …
Receive actionable notification about alerts
Find alerts and their details via application within Availity
Take action on relevant alerts
Design
Ideation and Testing
Personas
Concept Flows
UX led a collaborative design session with stakeholder, architecture, and several proxy users to walk through possible user flows.
The result was a clear direction for a web application on the Availity platform that was supported by an email notification directing providers to the application to view details about their member’s medical events.
User flows and wireframes
Proposed flow and wireframes were tested with additional
proxy users and reviewed with business.
Visual Design
Results
The team went forward with development and release in late 2022 to one market, then re-deploying it to additional markets throughout 2023.
While training was provided (as it replaced Member Clinical Events), marketing has not been rolled out yet.
In late 2023 the business did agree to user testing in 2024, but as of today that funding hadn’t been secured.
Learnings
Proxy users can be very helpful, but not as helpful as actual users.
It’s easy to say that we should have drawn the line and not let the project move forward without testing
The Indiana mandate
Still unable to talk with users
Is there more we could have done?