Strategy // Service Design // Digital

Redesigning Members’ Experience for Managing Healthcare Finances

We redesigned a key member touchpoint by applying an understanding of consumer needs to a operationally complex operational and highly regulated environment.

THE OPPORTUNITY

Our client, a leading health insurer, recognized their existing explanation of benefits (EOB) was causing frustration and confusion for their members and customers as they navigated the already complex process of managing their healthcare finances. The EOB was outdated and designed around the business, not the member. Where it should be a tool to aid the process it was creating additional tension. They asked Rêve to help identify the biggest opportunities for redesign and to lead them through an engagement to create an improved version of the EOB built with the member experience at it’s core.

OUR APPROACH

Over the course of 8 weeks we worked alongside a client team consisting of representatives from customer experience, operations, sales, and legal/compliance to understand the current competitive context and member experience, ideate and develop an improved future experience, and develop a plan for implementation.

To begin, we completed a deep dive assessment of the role the EOB played in the current member experience and the pain points and frustrations it caused in it’s existing state. We also performed a competitive assessment of 10 other health insurers, and reviewed similar artifacts and experience from 3 external industries (e.g. financial) as sources of inspiration. From this research we discovered common themes of complicated industry language, visually cluttered layout and content lacking focus or relevancy. This all combined to hinder the member’s ability to reconcile their healthcare finances and drove frustrated.  We identified 6 critical design factors and 8 areas of opportunity to guide a redesigned EOB specifically created to enhance the member experience. Armed with these insights, we led the client through a collaborative ideation workshop where we began creating new visions for the EOB through brainstorming and rapid prototyping activities.

In a single week we turned the workshop output into three high quality prototypes introducing simplified language and improvements to content, visual display, and associated operational efficiencies. The first prototype was built with feasibility in mind and would allow our client to make immediate, incremental improvements (less than 1 year). The second prototype overhauled the EOB and established an alternative delivery cadence that took cues from other industries. The third and final prototype was a customizable, fully digital-based experience that aligned with the organization’s long term digital strategy. We conducted a second workshop with the client team to collect feedback, iterate and improve on the prototypes. We also conducted internal stakeholder interviews to uncover operational considerations and other obstacles we would need to account for to bring the future state to life. Finally, we developed a package of implementation materials, including a service blueprint identifying key people, systems and processes required for the future state, a short-term roadmap of next steps for advancing the prototypes, the outline of a business case and socialization materials. Following the engagement, the redesigned EOB was validated through consumer testing with overwhelmingly positive feedback on design and ease of use.

14

COMPETITIVE ASSESSMENTS

8

OPPORTUNITIES IDENTIFIED

3

FUTURE STATE PROTOTYPES
Key Activities
RESEARCH

Current state assessment
Competitive assessment
Opportunities + design factors

FUTURE STATE

Ideation sessions
Prototype development + iteration

IMPLEMENTATION

Internal stakeholder interviews
Future state service blueprint
Strategic Roadmap

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