This was the question Highmark posed to the team at the start of this project. Sounds simple enough, right? As we would discover, this problem was anything but straightforward. For more information about the problem’s context, importance, and our client, visit our Problem Page.
To answer this question, we needed to know the players in the space. We created a stakeholder map and service blueprint with our clients at Highmark and grouped the stakeholders into four main categories:
With a user-centered design approach in mind, we focused on insurees first. We conducted semi-structured interviews with 10 insurees; we extracted quotes and findings, then created an affinity diagram.
01 Insight
Members want to effortlessly interact with care
Navigating health insurance is complex. What’s worse, insurees typically do so when they’re sick or recovering, so staying on hold for hours or learning that they got charged because they didn’t understand a complex term is the last thing they want.
02 Insight
There are two types of members:
Members who were knowledgeable, usually because of prior experience and members with little FHL and little interest in insurance
To further investigate why members didn’t want to learn about financial health literacy, we decided to conduct walk-a-mile immersion research to see how members experienced their health insurance. This phase of our research included a Highmark Store visit and an insurance plan read through.
01 Insight
Even after months in the problem space, we still didn’t known which plan was best for us
We learned that financial health literacy wasn’t just about knowing the terms: it’s also knowing our own health and financial situation and weighing our risk for apetite.
02 Insight
Members are expected to know terms and the consequences of complex plans. Even with the support we received, there is high cognitive load and high stakes
To understand why people were so reluctant to engage with insurance and learn about an important space, we turned towards existing literature about learning theories, motivation, and understanding to better understand insurees’ behavior.
01 Insight
Learning areas that are perceived to be difficult
People who have not interacted with the system approach it with a negative mindset, which then paves the way for poor motivation and a negative outcome
02 Insight
People can only process a certain amount of information
Providing too much info will confuse the insuree, so we need to provide the minimum amount they need in order to understand
01
Some FHL is better than none, but it’s one tool in a larger toolbox, not a silver bullet
02
People don’t want insurance to be their primary focus
03
The health insurance space is not user-friendly, and FHL puts the brunt of the burden on the user
To understand why people were so reluctant to engage with insurance and learn about other players in the space, we looked at different domains.
Why
Abridge.ai transcribes conversations between patients and doctors. We wanted to understand if this method improved patient health literacy in the hope of leveraging a similar technique to improve financial health literacy on the insurance side.
Findings
Motivation is a key to literacy
Patients are inherently motivated to closely monitor their health. Abridge.ai found that this motivation led their users to their app, which opened the doors to understanding and literacy.
Why
We also looked at analogous domains to see how innovations were made in those spaces and how we might apply those ideas and methodologies to Highmark’s problem space.
Findings
Members generally understood what their plans were, but not the specifics. While people understood their plans at a high level, they wouldn’t know what they would pay when given specific scenarios. This underscores the importance of delivering detail when it’s needed. It also resonated with our findings that people don’t want to learn about complex spaces.
Why
After spending a few weeks in the weeds of health insurance, it was time for a birds-eye view of the space. We went to an event hosted by Carnegie Mellon Heinz College on Medicare for All. Speakers included experts like Martin Gaynor, Amelia Haviland, and Jean Abraha.
Findings
Access to healthcare is a multi-layer issue
Factors that affect someone’s access to healthcare include the affordability of plans, the quality of care that their health necessitates, and the quality of care that they have access to. This talk grounded us by showing us how vast and systemic some of healthcare’s problems can be. Because of the scope and timeline of this project, we saw that we’d only be able to tackle a tiny sliver of this problem space.
Due to the private nature of employee health data, we couldn’t observe employers and benefits managers in their day-to-day work, but we could learn more about their perception of the insurance space, their experience dealing with providers, and their interactions with employees about the plans they offer. We conducted structured interviews with benefits managers from Carnegie Mellon University and the Carnegie Museums.
01 insight
Employer appreciate transparency
Employer perception of insurance benefits from an increased transparency into the system
02 insight
High latency in company adoption of changes and consumer understanding the changes
A lot of employees have the same plan for long durations. They don’t want to know what has changed
In our interviews with benefits managers, we noticed many companies utilized an insurance broker when shopping for insurance plans to offer their employees. More striking, the opinion of the brokers and the jobs they do were overwhelmingly positive. This exemplified the type of relationship we hope to foster between Highmark and its members, pushing us to dive into this area deeper to uncover what brokers might be doing to evoke these reactions.
We conducted a structured interview with an insurance broker from HUB International, who was referred to us by the benefits manager at the Carnegie Museums.
01 insight
Advocacy for the customer
Brokers strive to maintain positive relationships with insurance, and leverage these relationships to get what they need for their clients.
02 insight
Targeted expert care
Insurance brokerages leverage their workforce by having teams become experts in one specific area, rather than trying to understand the entire system
03 insight
Personalized attention
People love brokers for the personalized attention and case-by-case problem solving services they provide
04 insight
Employers love their brokers
Employers love their brokers since they help make sure their employees do not incur unnecessary charges.
01
Insurance brokers have more positive outcomes and favorable reviews due to the existing relationships they have with insurance companies and their domain expertise
02
Employers have a more favorable view towards insurance because of increased exposure and because it holds more value for them than the care itself
03
Lack of attention to insurance, combined with surprise bills and negative experiences, create a negative feedback loop that ultimately hurts the member-insurance relationship
In our stakeholder mapping, we wanted to understand the relationship between the doctor and the patient. Specifically, we wanted learn about how doctors navigate the medical insurance process and pain points they faced. We conducted a semi-structured interview with a medical resident who specialized in in-patient care. We wanted to address what questions we had for them (their role, their day-to-day, their systems) while allowing the conversation to flow in productive directions.
01 insight
No formal insurance training
Doctors don’t have any formal training on components of insurance, they usually have to read on their own.However, they have other people who can inform them in regards to insurance such as social workers and admins.
02 insight
Minimal conversation about insurance
They don’tmuch abouinsurance as that won’t prevent them from saving a life.
03 insight
Positive Conversations
Conversations with doctors are about health and getting better and being healthy, conversations with insurance are only about payment.
04 insight
Persona or Face for Providers
Medical service providers have a persona or face associated with them, insurance does not, as a result, they seem more distant/ unapproachable to the people.
Early in our research, we identified admins as a crucial link between medical providers and insurance; however, we were unsure what function they served in the ecosystem and decided that it would be pertinent to further explore their role. We chose to interview an admin in the dental field specifically because we wanted to branch out beyond simply primary care and specialist doctors. We also chatted with the Carnegie Mellon University Health Services. We wanted to interview them because we wanted to understand how an entire hospital administration works, right from the patient setting up an appointment to the patient receiving the bill.
We conducted a semi-structured interview so as to address what questions we had for them (their role, their day-to-day, their systems) while allowing the conversation to flow in productive directions.
01 insight
Admin as an educator
Oftentimes, it’s the admin’s job to coach the patient through what is covered and what isn’t. Much of the time, patients opt only for care that is covered.
02 insight
Long wait times for cost estimates
Not only do surprise bills come at unexpected times for patients and cause distress, but estimations take a long time, too. Admins can give patients a pre-treatment estimation of cost; however, it can take up to 4 weeks for insurance companies to reply - a further inconvenience for the patient.
03 insight
Short-sightedness
People are short-sighted and prefer to pay less now without thinking or planning for the future.
04 insight
Unsupported transition to adulthood
Parents shield kids from insurance, no discussions or learning. When a child turns 26, he has to deal with his own insurance without knowing anything about it. Usually ends up making bad decisions.
01
Lack of integration of the providers and the insurance companies lead to delay in the billing process
02
The immediate cost dictates the care people decide to receive
03
Time is a sensitive factor in the billing process for both providers and patients as delay bring unnecessary stress for both parties
04
The doctors’ main focus is on providing care, not the cost of care