/ Company
/ Company
/ Company
Zelis
Zelis
Zelis
/ Role
/ Role
/ Role
UX Designer
UX Designer
UX Designer
/ Date
/ Date
/ Date
2021-2024
2021-2024
2021-2024
medical
medical
medical
medical
Price
Price
Price
Price
Transparency
Transparency
Transparency
Transparency
[1]
[1]
[1]
/ About the project
/ About the project
/ About the project
New legislation mandated healthcare providers and insurers to publish their pricing. We helped guide an unprepared industry, creating compliant solutions that leverage this data to empower patients in making informed financial decisions.
New legislation mandated healthcare providers and insurers to publish their pricing. We helped guide an unprepared industry, creating compliant solutions that leverage this data to empower patients in making informed financial decisions.
New legislation mandated healthcare providers and insurers to publish their pricing. We helped guide an unprepared industry, creating compliant solutions that leverage this data to empower patients in making informed financial decisions.
[Part 1]
price transparency
for patients
/ Price transparency
/ Price transparency
/ Price transparency
In 2020, the Transparency in Coverage bill was passed, requiring providers and health plans to publish their negotiated rates of all medical services.
In 2020, the Transparency in Coverage bill was passed, requiring providers and health plans to publish their negotiated rates of all medical services.
In 2020, the Transparency in Coverage bill was passed, requiring providers and health plans to publish their negotiated rates of all medical services.
/ Existing Product
/ Existing Product
/ Existing Product
The Sapphire365 product serves as a procedure and provider directory, white-labeled into health insurance sites for their members to find in-network care.
The Sapphire365 product serves as a procedure and provider directory, white-labeled into health insurance sites for their members to find in-network care.
The Sapphire365 product serves as a procedure and provider directory, white-labeled into health insurance sites for their members to find in-network care.
/ Healthplan Clients
/ Healthplan Clients
/ Annual Users
/ Annual Users
M+
M+
M+
M+
/ Annual Searches
/ Annual Searches
M+
M+
M+
M+
/ Procedure Cost
/ Procedure Cost
/ Procedure Cost
The existing Sapphire365 platform provided medical cost estimates using averaged patient claims. However, procedure billing is like a dinner receipt, splitting out the list of services for a given procedure. The rates of these individual services are what the mandate required to be published and searchable.
The existing Sapphire365 platform provided medical cost estimates using averaged patient claims. However, procedure billing is like a dinner receipt, splitting out the list of services for a given procedure. The rates of these individual services are what the mandate required to be published and searchable.
The existing Sapphire365 platform provided medical cost estimates using averaged patient claims. However, procedure billing is like a dinner receipt, splitting out the list of services for a given procedure. The rates of these individual services are what the mandate required to be published and searchable.
/ Unpacking the bill
/ Unpacking the bill
/ Unpacking the bill
In collaboration with our clients, legal teams, engineers, and government officials, we decoded the bill and formulated a two-year product roadmap aimed at a compliant and usable solution.
This included co-informed product requirements and data infrastructure/augmentation strategy.
In collaboration with our clients, legal teams, engineers, and government officials, we decoded the bill and formulated a two-year product roadmap aimed at a compliant and usable solution.
This included co-informed product requirements and data infrastructure/augmentation strategy.
In collaboration with our clients, legal teams, engineers, and government officials, we decoded the bill and formulated a two-year product roadmap aimed at a compliant and usable solution.
This included co-informed product requirements and data infrastructure/augmentation strategy.
/ Healthcare Literacy
/ Healthcare Literacy
/ Healthcare Literacy
The fundamental insight we gained from running over 50 behavioral interviews is that the barrier to understanding healthcare is too high.
For users to comprehend procedure costs, we'd need to meet them with the right information at the right moment in their journey.
The fundamental insight we gained from running over 50 behavioral interviews is that the barrier to understanding healthcare is too high.
For users to comprehend procedure costs, we'd need to meet them with the right information at the right moment in their journey.
The fundamental insight we gained from running over 50 behavioral interviews is that the barrier to understanding healthcare is too high.
For users to comprehend procedure costs, we'd need to meet them with the right information at the right moment in their journey.
Medical Services
Medical Services
Medical Services
Insurance OPERATIONS
Insurance OPERATIONS
Insurance OPERATIONS
Coverage & Benefits
Coverage & Benefits
Coverage & Benefits
Cost information
Cost information
Cost information
/ Solution Strategy
/ Solution Strategy
/ Solution Strategy
Applying user insights to opportunities along a care journey helped identify where there were high-impact solution spaces and clarify the elements of the legislation would not contribute user value.
Applying user insights to opportunities along a care journey helped identify where there were high-impact solution spaces and clarify the elements of the legislation would not contribute user value.
Applying user insights to opportunities along a care journey helped identify where there were high-impact solution spaces and clarify the elements of the legislation would not contribute user value.
/ Personas
/ Personas
/ Personas
We leveraged the new data in ways that would fortify the existing member journey of finding care, while we separated compliance-only solutions into an "auditor flow" for health insurance experts.
We leveraged the new data in ways that would fortify the existing member journey of finding care, while we separated compliance-only solutions into an "auditor flow" for health insurance experts.
We leveraged the new data in ways that would fortify the existing member journey of finding care, while we separated compliance-only solutions into an "auditor flow" for health insurance experts.
/ Shipped [Auditor] Flow
Drag →
Drag →
Drag →
/ Core Enhancement [Procedure cost card]
/ Core Enhancement [Procedure cost card]
/ Core Enhancement [Procedure cost card]
Located on a selected provider’s profile when searching for a procedure, the cost estimate component breaks down applied benefit information to a procedure cost estimate.
Located on a selected provider’s profile when searching for a procedure, the cost estimate component breaks down applied benefit information to a procedure cost estimate.
Located on a selected provider’s profile when searching for a procedure, the cost estimate component breaks down applied benefit information to a procedure cost estimate.
/ Testing
By screening for testers with recent medical experiences, we leaned on real takeaways to iterate on the component. After several rounds of testing, we gathered insights about user comprehension to inform information hierarchy.
[01]
[02]
[03]
[04]
[05]
[06]
/ New Cost Card
/ New Cost Card
/ New Cost Card
The final design looked to highlight key information while still offering granular breakdowns. We grouped content based on procedure coverage, procedure cost, and benefit accruals to communicate a full procedure cost story.
The final design looked to highlight key information while still offering granular breakdowns. We grouped content based on procedure coverage, procedure cost, and benefit accruals to communicate a full procedure cost story.
The final design looked to highlight key information while still offering granular breakdowns. We grouped content based on procedure coverage, procedure cost, and benefit accruals to communicate a full procedure cost story.
/ Compliance
/ Compliance
/ Compliance
Following the initial 30 UI requirements, all of the developed solutions were documented and signed off by the legal teams of each of our health plan partners.
Following the initial 30 UI requirements, all of the developed solutions were documented and signed off by the legal teams of each of our health plan partners.
Following the initial 30 UI requirements, all of the developed solutions were documented and signed off by the legal teams of each of our health plan partners.
[Part 2]
price competition
among Insurers
/ Pricing Leverage
/ Pricing Leverage
/ Pricing Leverage
There's a lack of competitive medical pricing leading to excessive patient expenses, which can be attributed to –
There's a lack of competitive medical pricing leading to excessive patient expenses, which can be attributed to –
There's a lack of competitive medical pricing leading to excessive patient expenses, which can be attributed to –
[01]
[01]
[01]
Opaque pricing structures
Opaque pricing structures
Opaque pricing structures
[02]
[02]
[02]
Complex billing processes
Complex billing processes
Complex billing processes
[03]
[03]
[03]
Market consolidation
Market consolidation
Market consolidation
[04]
[04]
[04]
Negotiation power imbalances
Negotiation power imbalances
Negotiation power imbalances
[05]
[05]
[05]
Limited price transparency
Limited price transparency
Limited price transparency
/ Foundation
/ Foundation
/ Foundation
The Network360 tool existed to enable health insurance administrators to see providers in their organizations' networks.
This tool served as the foundation to inject the new pricing data into existing provider profiles and enabled the capability to display competitor pricing insights.
The Network360 tool existed to enable health insurance administrators to see providers in their organizations' networks.
This tool served as the foundation to inject the new pricing data into existing provider profiles and enabled the capability to display competitor pricing insights.
The Network360 tool existed to enable health insurance administrators to see providers in their organizations' networks.
This tool served as the foundation to inject the new pricing data into existing provider profiles and enabled the capability to display competitor pricing insights.
/ Before
/ Before
/ Before
Insures want more money,
So they increase prices.
Insures want more money,
So they increase prices.
Insures want more money,
So they increase prices.
Patients are financially uninformed,
So they’re forced to pay anything.
Patients are financially uninformed,
So they’re forced to pay anything.
Patients are financially uninformed,
So they’re forced to pay anything.
/ After
/ After
/ After
Users can choose affordable care,
So they steer pricing by demand.
Users can choose affordable care,
So they steer pricing by demand.
Users can choose affordable care,
So they steer pricing by demand.
Insures need to retain members,
So they’re forced to negotiate competitively.
Insures need to retain members,
So they’re forced to negotiate competitively.
Insures need to retain members,
So they’re forced to negotiate competitively.
/ Data Isolation
/ Data Isolation
/ Data Isolation
Network
segmentation
Network
segmentation
Network
segmentation
Provider
types
Provider
types
Provider
types
Contracted
services
Contracted
services
Contracted
services
Price distribution
and deviation
Price distribution
and deviation
Price distribution
and deviation
Geographic
network strength
Geographic
network strength
Geographic
network strength
Pricing
Patterns
Pricing
Patterns
Pricing
Patterns
Speaking directly with our clients, we uncovered how users navigate rate negotiations and market insights to inform the granularity of analysis parameters.
Speaking directly with our clients, we uncovered how users navigate rate negotiations and market insights to inform the granularity of analysis parameters.
Speaking directly with our clients, we uncovered how users navigate rate negotiations and market insights to inform the granularity of analysis parameters.
Geographic segmentation displays rich insights into the strength of a given provider network and portrays where competitor populations are being served.
Geographic segmentation displays rich insights into the strength of a given provider network and portrays where competitor populations are being served.
Geographic segmentation displays rich insights into the strength of a given provider network and portrays where competitor populations are being served.
/ Data Navigation
/ Data Navigation
/ Data Navigation
When looking for rate information, a network administrator may be looking for specific details or network patterns. Our user testing informed top-down (network first) and bottom-up (provider first) methods of navigating rate information.
When looking for rate information, a network administrator may be looking for specific details or network patterns. Our user testing informed top-down (network first) and bottom-up (provider first) methods of navigating rate information.
When looking for rate information, a network administrator may be looking for specific details or network patterns. Our user testing informed top-down (network first) and bottom-up (provider first) methods of navigating rate information.
Named "Rate Analytics", the new module pulls from our cross-product interface design system to deliver a data analysis tool with rich data visualization and enhanced segmentation.
Named "Rate Analytics", the new module pulls from our cross-product interface design system to deliver a data analysis tool with rich data visualization and enhanced segmentation.
Named "Rate Analytics", the new module pulls from our cross-product interface design system to deliver a data analysis tool with rich data visualization and enhanced segmentation.
/ Outcome
/ Outcome
/ Outcome
We effectively pioneered the first compliant product solution for health plans across the United States. This success led to Zelis's strategic acquisition of the Sapphire business, enabling growth to previously underserved markets.
We effectively pioneered the first compliant product solution for health plans across the United States. This success led to Zelis's strategic acquisition of the Sapphire business, enabling growth to previously underserved markets.
We effectively pioneered the first compliant product solution for health plans across the United States. This success led to Zelis's strategic acquisition of the Sapphire business, enabling growth to previously underserved markets.
/ Reflection
/ Reflection
/ Reflection
Leveraging continuous discovery practices, we've been able to use the new data infrastructure to improve the core product experiences and expand into rates analytical reporting.
Now that officials see the holes in the law, I'm optomistic there will be continued patient-centric revisions and data accuracy enforcement.
Leveraging continuous discovery practices, we've been able to use the new data infrastructure to improve the core product experiences and expand into rates analytical reporting.
Now that officials see the holes in the law, I'm optomistic there will be continued patient-centric revisions and data accuracy enforcement.
Leveraging continuous discovery practices, we've been able to use the new data infrastructure to improve the core product experiences and expand into rates analytical reporting.
Now that officials see the holes in the law, I'm optomistic there will be continued patient-centric revisions and data accuracy enforcement.
/ Outcome
/ Outcome
/ Outcome
This project initiated a formalization of product and design practices for this product that historically lacked investment. This included an interface migration to the organization design system, product analytics, and continuous product improvement, ultimately leading to improved client satisfaction and retention.
This project initiated a formalization of product and design practices for this product that historically lacked investment. This included an interface migration to the organization design system, product analytics, and continuous product improvement, ultimately leading to improved client satisfaction and retention.
This project initiated a formalization of product and design practices for this product that historically lacked investment. This included an interface migration to the organization design system, product analytics, and continuous product improvement, ultimately leading to improved client satisfaction and retention.
/ Reflection
/ Reflection
/ Reflection
Medical rate data is unstandardized, infrequently updated, and often inaccurate, which deteriorates the effectiveness of this tool. Until the Transparency in Coverage law is enforced, insurers will continue to delay providing satisfactory data.
We're actively exploring ways to grade the data quality in an attempt to encourage better data hygiene.
Medical rate data is unstandardized, infrequently updated, and often inaccurate, which deteriorates the effectiveness of this tool. Until the Transparency in Coverage law is enforced, insurers will continue to delay providing satisfactory data.
We're actively exploring ways to grade the data quality in an attempt to encourage better data hygiene.
Medical rate data is unstandardized, infrequently updated, and often inaccurate, which deteriorates the effectiveness of this tool. Until the Transparency in Coverage law is enforced, insurers will continue to delay providing satisfactory data.
We're actively exploring ways to grade the data quality in an attempt to encourage better data hygiene.
