/ Company
/ Company
Zelis
Zelis
/ Role
/ Role
Sr. Product Designer
Sr. Product Designer
/ Date
/ Date
2021-2024
2021-2024
medical
medical
medical
medical
Price
Price
Price
Price
Transparency
Transparency
Transparency
Transparency
[3]
[3]
/ About the project
/ About the project
A new law required healthcare providers and insurers to publish their prices for procedures. As the sole designer on this initiative, I led the effort to translate this mandate into tools that helped patients make informed financial decisions — and guided an unprepared industry toward patient-centric solutions.
A new law required healthcare providers and insurers to publish their prices for procedures. As the sole designer on this initiative, I led the effort to translate this mandate into tools that helped patients make informed financial decisions — and guided an unprepared industry toward patient-centric solutions.
A new law required healthcare providers and insurers to publish their prices for procedures. As the sole designer on this initiative, I led the effort to translate this mandate into tools that helped patients make informed financial decisions — and guided an unprepared industry toward patient-centric solutions.
[Part 1]
price transparency
for patients
price transparency
for patients
/ Price transparency
/ Price transparency
In 2020, the Transparency in Coverage bill was passed, requiring health plans to publish their negotiated rates for all medical services. Nobody in the industry was ready for it.
In 2020, the Transparency in Coverage bill was passed, requiring health plans to publish their negotiated rates for all medical services. Nobody in the industry was ready for it.
/ Provider Directory
/ Provider Directory
Sapphire365 is a procedure and provider directory, white-labeled for health insurance sites to help members find in-network care. This is where I started.
Sapphire365 is a procedure and provider directory, white-labeled for health insurance sites to help members find in-network care. This is where I started.
/ Healthplan Clients
/ Healthplan Clients
/ Annual Users
/ Annual Users
M+
M+
M+
/ Annual Searches
/ Annual Searches
M+
M+
M+
/ Procedure Cost
/ Procedure Cost
Until this point, cost estimates were based on averaged patient claims — a zoomed-out estimate of a full procedure cost at best.
The new data changed that. Individual billed services for a specific procedure are now viewable. These service-level costs are what the mandate requires to be published and searchable, not the full procedure cost.
Until this point, cost estimates were based on averaged patient claims — a zoomed-out estimate of a full procedure cost at best.
The new data changed that. Individual billed services for a specific procedure are now viewable. These service-level costs are what the mandate requires to be published and searchable, not the full procedure cost.
/ Unpacking the bill
/ Unpacking the bill
I led the cross-functional effort to decode the bill — working with clients, legal teams, engineers, and government officials to translate regulatory requirements into a two-year product roadmap aimed at a compliant and usable solution.
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
After running over 50 behavioral interviews, the fundamental insight was clear: the barrier to understanding healthcare costs isn't access to information — it's comprehension. To help users understand procedure costs, I needed to deliver the right context 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
I mapped user insights to the care journey to identify high-impact solution spaces and filter out legislative elements that wouldn't add value to patients.
The focus landed on two surfaces: search result pages where users compare providers, and provider profiles where they see detailed cost breakdowns.
I mapped user insights to the care journey to identify high-impact solution spaces and filter out legislative elements that wouldn't add value to patients.
The focus landed on two surfaces: search result pages where users compare providers, and provider profiles where they see detailed cost breakdowns.
/ Data utility
/ Data utility
I leveraged the new data to strengthen the existing member journey of finding care, and designed a secondary flow for compliance-only solutions — tailored for health insurance experts and auditors rather than patients.
I leveraged the new data to strengthen the existing member journey of finding care, and designed a secondary flow for compliance-only solutions — tailored for health insurance experts and auditors rather than patients.
/ Procedure cost card
/ Procedure cost card
The cost card sits on a provider's profile, breaking down benefit information into a procedure cost estimate. This was the hardest design problem on the project — making dense financial and medical data feel understandable without oversimplifying it.
The cost card sits on a provider's profile, breaking down benefit information into a procedure cost estimate. This was the hardest design problem on the project — making dense financial and medical data feel understandable without oversimplifying it.
/ Before
/ Before
/ Testing
/ Testing
I ran iterative usability tests to make the cost information more digestible, applying what the research taught us about healthcare literacy.
I ran iterative usability tests to make the cost information more digestible, applying what the research taught us about healthcare literacy.
[01]
[02]
[03]
[04]
[05]
[06]
/ Updated cost card
/ Updated cost card
The final design highlights key information while still offering granular breakdowns. I grouped content into three layers — procedure coverage, procedure cost, and benefit accruals — to tell a complete cost story.
The final design highlights key information while still offering granular breakdowns. I grouped content into three layers — procedure coverage, procedure cost, and benefit accruals — to tell a complete cost story.
/ After
/ Compliance
/ Compliance
All solutions were documented against 30 UI requirements and signed off by the legal teams of each health plan partner.
All solutions were documented against 30 UI requirements and signed off by the legal teams of each health plan partner.
/ Patient outcome
/ Patient outcome
The tool was white-labeled across 400+ health plan implementations, each with unique branding and data configurations — serving millions of patients annually.
The tool was white-labeled across 400+ health plan implementations, each with unique branding and data configurations — serving millions of patients annually.
[Part 2]
price competition
among Insurers
price competition
among Insurers
/ Pricing Leverage
/ Pricing Leverage
Patients pay more than they should because medical pricing isn't competitive. Five structural factors drive this:
Patients pay more than they should because medical pricing isn't competitive. Five structural factors drive this:
[01]
[01]
Opaque pricing structures
Opaque pricing structures
[02]
[02]
Complex billing processes
Complex billing processes
[03]
[03]
Market consolidation
Market consolidation
[04]
[04]
Negotiation power imbalances
Negotiation power imbalances
[05]
[05]
Limited price transparency
Limited price transparency
/ Foundation
/ Foundation
Network360 was an existing tool for health insurance administrators to view providers in their networks. I designed the rate analytics module that gave it teeth.
Network360 was an existing tool for health insurance administrators to view providers in their networks. I designed the rate analytics module that gave it teeth.
/ Before
/ Before
Insurers want more money,
So they increase prices.
Insurers 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.
/ After
/ After
Users can choose affordable care,
So they steer pricing by demand.
Users can choose affordable care,
So they steer pricing by demand.
Insurers need to retain members,
So they’re forced to negotiate competitively.
Insurers need to retain members,
So they’re forced to negotiate competitively.
/ Data Navigation
/ Data Navigation
Network administrators navigate rate information in two ways — top-down (network first) or bottom-up (provider first). I identified both patterns through user testing and designed the navigation to support them.
Network administrators navigate rate information in two ways — top-down (network first) or bottom-up (provider first). I identified both patterns through user testing and designed the navigation to support them.
/ Rate Analytics
/ Rate Analytics
Rate Analytics is a data analysis module I designed with visualizations and enhanced provider network segmentation. Speaking directly with plan administrators, I mapped how they navigate rate negotiations to inform the granularity of analysis parameters.
Geographic segmentation surfaces the strength of a provider network and where competitor populations are being served.
Rate Analytics is a data analysis module I designed with visualizations and enhanced provider network segmentation. Speaking directly with plan administrators, I mapped how they navigate rate negotiations to inform the granularity of analysis parameters.
Geographic segmentation surfaces the strength of a provider network and where competitor populations are being served.
Speaking directly with plan administrators, I mapped how they navigate rate negotiations to inform the granularity of analysis parameters.
Speaking directly with plan administrators, I mapped how they navigate rate negotiations to inform the granularity of analysis parameters.
Geographic segmentation surfaces the strength of a provider network and where competitor populations are being served.
Geographic segmentation surfaces the strength of a provider network and where competitor populations are being served.
/ Outcome
/ Outcome
This was the first compliant product solution for health plans nationwide. The work led directly to Zelis's strategic acquisition of the Sapphire business, expanding into previously underserved markets.
This was the first compliant product solution for health plans nationwide. The work led directly to Zelis's strategic acquisition of the Sapphire business, expanding into previously underserved markets.
/ Reflection
/ Reflection
The hardest part of this project wasn't the design — it was the data. Medical rate data is unstandardized, infrequently updated, and often inaccurate. Until the Transparency in Coverage law is properly enforced, the data quality will continue to limit what any tool can do. Designing around that uncertainty — building a product that's useful even when the data isn't perfect — shaped how I think about every complex system I've worked on since.
The hardest part of this project wasn't the design — it was the data. Medical rate data is unstandardized, infrequently updated, and often inaccurate. Until the Transparency in Coverage law is properly enforced, the data quality will continue to limit what any tool can do. Designing around that uncertainty — building a product that's useful even when the data isn't perfect — shaped how I think about every complex system I've worked on since.
