I designed a future-state HMO experience for BCBSM, introducing virtual-first primary care, digital touchpoints, and member-centered journeys that reimagined how people access and manage care.
Through design sprints, research, and prototyping, we created a north-star vision that improves satisfaction, streamlines digital interactions, and positions BCBSM to compete with more agile insurers.
The Problem
Born out of the pandemic of 2020 were new expectations for care and, in the case of this health insurance client, a need to innovate their HMO plans to stay relevant in the minds of their members. Satisfaction scores that had gradually risen in years past had for the past few years plateaued and remained stagnant. Cost centers continued to eat into budgets. And competition from a smaller but innovative insurance company in the western part of the state was heating up. How was this business going to adjust to new realities and member expectations for care now and in the future? What were the options? And just what did that look like?
What We Did
1.Virtual First Product Design
Bringing a virtual primary care solution to life that provides members with more holistic and proactive care by leveraging a vendor’s virtual capabilities. Team engaged members to design and validate features across the virtual experience.
2.End to End Member Experience
Envisioning the end-to-end member experience focused on defining the end-to-end future state member experience. Team engage members and stakeholders to shape and map the HMO experience vision across key aspects of the member journey.
3.Network Sculpting
Provided member insights to inform network optimization and next gen HMO product. Team created research studies with members and prospective members that explored what they value most and what product/experience tradeoffs they are most willing to make in the interest of affordability and convenience.
Timeline
With a strategy and timeline in place, we would use agile methodologies and a human-centered design approach to hypothesize, conduct research, synthesize, and share out our findings with key stakeholders at the conclusion of each design sprint. This work would ultimately serve as a ‘north star’ for downstream execution work and would act as a catalyst for incubating innovative member experience initiatives.
Sprint One
For this first sprint, we determined that we would design how members learned about the new online visit capabilities, begin to establish their PCP preferences and quickly find the right care.
Initial research suggested these key points of friction with the current experience.
“I want a tutorial to get familiar with the mobile app when I use it for the first time”
“I need to see a Doctor now”
“I want to finish setting up my preferences”
Those outcomes helped shape our first round of concepts.
Care Guide (Symptom Checker)
Triage to determine the best course of action through a guided experience
Care Guide (Digital Intake Process)
Symptom checker outcomes with the ability to add additional details sent directly to the doctor before the online visit.
Care Guide (Recommended Action)
Recommendation of best course of action based on your situation.
Best Doctor Match
Recommendation of best doctor match based on symptoms, preferences and earliest availability. 1). Personalized based on member’s preferences and health assessment 2). Presented with other options to give member flexibility 3). Seeing availability and pricing
Care Guide (Preferences - Change PCP)
Helps the member set their preferences and build a more robust profile including viewing and changing their PCP.
Care Guide (Preferences)
Helps the member set their preferences and build a more robust profile (health, history, information, etc.) so that the experience is more personalized and they receive better recommendations. (from L to R / High-fidelity view and due time constraints a low-fidelity wireframe done in MURAL)
Tutorial
Quick information page providing basic info about the new online visit capability and the tools they can expect in the mobile experience. (Low-fidelity MURAL wireframe)
Sprint Two
For the second sprint, we placed the focus on what could be in-market for 2022. There was a refinement in understanding what we were driving towards. Some highlights of that were around the virtual PCP and that they would be an add-on to the traditional HMO plans - not replacing the traditional PCP model. Virtual Primary Care (VPC) would continue to be positioned as a convenience and that the team would focus on member PCP interactions (not specialists’ interactions). Digital touchpoints that the virtual product track would continue to ideate for was the native [client name] mobile app - we would not focus on [client name] Online Visits, [client name] Coordinated apps, etc. We would continue to prioritize key moments and features from a member’s perspective. Not every moment or every feature for every member.
Let’s imagine an all-encompassing [client name] mobile app where we allow members to set up their preferences, manage their PCP and schedule appointments with their PCP all in one place.
Directionally, this focus helped shape our second round of concepts.
Testing Outcomes
Outcomes
For Sprint 3 + 4, the work dealt mainly with research into a vendor solution that would help fill the need as discovered and ideated upon in Sprints 1 + 2. The following is a sample of the final share-out to the client with respect to both tracks of work, considerations for research, concepts, considerations, and a service blueprint.
