Case Study:
Atypical Healthcare Providers Experience
Understand atypical providers and their needs when working with payers to help them better serve their patients
The Problem
2019 market research by Anthem showed that atypical providers struggled with Anthem’s online claims tools because they were designed for medical providers.
The forms are very long, difficult to complete and require details that atypical providers do not have. This meant atypical providers were still faxing claims and spending long amounts of time on the phone with Anthem.
In addition, while atypical providers did use existing applications like Eligibility look-up, other functionality they needed (eg., authorizations, member rosters) were available but do not support their needs.
Atpical Providers
An entity that offers medical assistance programs and/or related non-health care services that does not meet the definition of health care provider.
The Challenge
Provide atypical providers with the functionality suited for their needs
as part of caring for their patients.
My Role
I led a team of 2 UX designers in partnership with the Long-Term Care Business Owner, a Product Manager and scrum team.
As UX Lead my responsibilities included planning, direction, oversight on all design decisions, communication, ensuring team and stakeholder buy-ins, as well as coaching and mentoring my designers.
Discovery
Understanding the atypical provider experience
Approach
Stakeholder Deep Dive
Worked with the Long-Term Care team to understand the wide variety of services offered by atypical providers so that we could begin to define their needs.
User Interviews
We then met with the health plans and many atypical providers in Florida to better understand their experience … this would later be validated through follow-up discussions to review flows and wireframes.
Affinity Mapping - who are atypical providers and what do they do?
Groupings with stakeholders and validating with providers
Journey Mapping (and gap analysis)
Mapping journeys to the atypical experience
What we learned
While atypical providers have many unique needs based on their services, common functionality needed includes:
Member rosters
Authorizations
Claims
Referral Management
Resources
These functionalities are available for medical providers, but they don’t translate well to atypical providers.
Atypical providers spend much less time using these applications than medical providers,
Across the board, atypical providers wanted these applications in a central location
Focus
Help providers to …
Manage their members
Create and complete work authorizations
Submit claims
Get help and resources
Design
Ideation and Testing
Design Concepts
Design Concepts
User Feedback
Providers understood the site organization
For those familiar with the Availity platform at all, the look and feel is familar and appreciated have all functionality in one place
Not clear on how this will link to Electronic Visit Verification (EVV) system
There were minor UI concerns
Next
Organization change
Design moved forward to development
After repeated delays - user testing funded for fall 2024 in Texas
Lessons Learned
Find workarounds for user research and testing
Tell the user’s story as much as possible - make people believe