UPMC Health Plan / Explanation of Benefits
An Explanation of Benefits (EOB) is a statement sent by a health insurance company to covered individuals explaining what medical treatments and/or services were paid for on their behalf. All 4+ million of our members receive EOBs following any medical service received, making this a high impact initiative. I was asked to both conduct large amounts of research and completely redesign UPMC’s EOB document due to confusion amongst members regarding the amount of different versions per line of business, but also to reduce overhead costs of the business, increase JD Power rankings in our Billing segment, and decrease the amount of frustrated callers to our Member Services team.
MY ROLE
Lead researcher
Lead designer
Workshop facilitation
Competitive analyses
Executive reporting
METHODS
Moderated interviews
Stakeholder interviews
Design sprints
COLLABORATORS
Business partners
Product management
Customer success
Design leadership
TIMELINE
5 months
Spoilers
The redesigned Explanation of Benefits (EOB) I was able to lead in both research and design has been live for all UPMC Health Plan Members as of 2022. You can view the publication and tutorials on the UPMC website!
Over 20 different templates were created for all lines of the Health Plan business. Through the updated document, there has been over a 28% decrease in member services calls regarding comprehension of the EOB.
I. BACKGROUND
Early insights
Before I began this initiative, I knew our team had some extent of previous research conducted on the frustration amongst members and EOBs - areas of inconsistency in data presentation, medical jargon, semantics of documents,
and versioning made it difficult for members to understand what they were receiving.
Project planning
This was my planning diagram to help me understand a timeline and how to best approach different areas of this project. The diagram held several facets in areas of research, design, validation, and milestone objectives.
II. WORKSHOPS
Workshop facilitation
I was fortunate enough to help facilitate workshops and demonstrate exercises with key stakeholders in the beginning of this process.
Some exercises included having our stakeholders design low fidelity versions of the “perfect EOB” themselves, dot vote on segments of the EOB that need prioritized (per prior research), defining do’s an don’t’s of what the new EOB should accomplish, and generally aligning on a shared vision for the end product.
III. COMPETITOR ANALYSIS
Understanding information architecture and content strategy amongst our market competitors was vital to demonstrating success with this redesign.
Things observed in my analyses included:
JD Power rankings for each of these companies in Billing segments
Insight into length of their EOBs
Insight into content architecture, callouts, verbiage, and appeal pages of their EOBs
Customer experiences with their EOBs
Marketing + distribution strategies
Incentivizing members to go ‘paperless’
Risks + Opportunities
Following this comprehensive analysis, we were able to use the findings in our workshops to help identify more focalized areas to target with our redesign to gain the edge on our competitors.
Competitor analysis
Member Service Representatives
IV. STAKEHOLDER INTERVIEWS
Before I could jump into both true designs and user testing, I felt it was important to understand the issues of our current state EOB’s from the inside-out.
In my opinion, internal user testing can be just as vital, if not more, than external testing. I wanted to hear from the people on the UPMC front lines who receive calls from frustrated members who receive these documents, and have the most in-depth knowledge of areas and problems to tackle.
I began to unpack this by creating 2 early prototypes, titled “Light” (A) and “Weighted” (B) depending on the amount of content in each, and began interviewing Member Service Representatives.
This was a surface level version of an A/B test - the concepts were intentionally not fully fledged out, but were detailed enough for me to gather great information during the interviews. I asked questions around preference on prioritization of content, content placement, data visualization, verbiage used, and color schemes.
I had a hypothesis of which features on concepts A and B would test well, and this was my way of objectively validating that. The data I received from this portion of the redesign process was invaluable, and allowed me to combine the top features of concepts A and B into one, which was the official beginning to the EOB redesign.
After synthesizing data from the interviews, I was able to compile the data into a formalized findings report to deliver and present to stakeholders to come to a shared understanding of where the project was at.
Testing with Commercial members
V. COMMERCIAL TESTING
Using the valuable notes from the Member Service Representative interviews and combining prototypes A and B into one, singular prototype, I felt ready to run my first round of testing with our Commercial group members.
Commercial testing was unmoderated, included 10 commercial members, and was ran on UserZoom, which is a research platform that the UX team uses to conduct usability studies across the board. Using this platform allows us to create and tailor studies to specific audiences / demographics, with affordance to construct tests to include both open-ended and task-based questions to validate any design decisions or objectives we set prior to testing.
For this specific test, the entire test was recorded on UserZoom with the participants’ permission, and I was able to watch each test, take notes, and gather insights.
Insights
What we found from this first round of testing was, for the majority, positive. That said, there were a few areas of concern on one page of the document, being the Year to Date summary, which explains the member’s spending summary for the year - arguably the most important page of the EOB document. Our testers were having trouble identifying tasks such as comprehending their deductible amounts and out-of-pocket spending for the year, which is vital for the success of
the EOB.
VI. REVISIONS + COMPLIANCE
Legal checks
Though we had some strong and favorable data from that initial test, we wanted to, again, make sure the template was able to flex to different scenarios and lines of business without compromising readability, quality of information, or comprehension of data.
I moved into a revision phase in June ‘20, which worked in tandem with a few other things in order to tie loose ends.
These steps included…
Furthering data collection to help me gather insights and synthesize needs for improvement on the template after the Commercial tests
UX team critiques with my colleagues to polish up the visuals and information architecture of the new EOB template
Working revisions and tweaks in, with the goal of a universally appealing template
Accounting for brand checks with the UPMC Marketing team + working closely with Medicare Compliance (CMS) to ensure that the Medicare template was meeting all standards, and was approved to be tested by our Medicare members
Testing with Medicare members
VII. MEDICARE
Following the revisions from the Commercial test and approval from Medicare Compliance, I then began setting up a user study with Medicare members, using the updated designs on the EOB template.
The difference in methodology for the Medicare test versus the Commercial one was that this time around, it was moderated - meaning I directly interacted and facilitated participants through the test, giving myself the ability to ask more follow up and open ended questions, to hit home on the points I wanted to focus on for both design validation and further improvement.
Insights
With the edits made from the initial template that was tested with Commercial members, almost every score and data point was raised across the board after testing the revised version with Medicare members. This served as both design and research validation for stakeholders that the iterations made based on the first round of testing were all successfully translated.
Participant scores on the Year to Date summary which previously gave Commercial participants trouble, skyrocketed.
VIII. VERSIONING
Flexing the template
A major goal of the new EOB was to allow the document to be universal and manipulated to fit any line of business’ needs. After the Medicare test data was synthesized and presented, stakeholders approved the EOB template from a design standpoint. From then on, the template needed to be iterated content-wise so each line of business at UPMC could kickstart their production process with unique language.
This was my responsibility to go back and iterate content as necessary until all product owners from each UPMC line of business approved their respective template. Areas of iteration per document included: inclusion of the appeals page; appeals page language; spending summary verbiage; recent claim details verbiage; denial verbiage; phone numbers for members to call; and most importantly, font size. Per CMS requirement, all Medicare template versions needed to have a larger font size than Commercial / other versions - this was another design challenge to overcome, as increasing font size merited resizing all other design elements to keep visual consistency and content legibility.
By the time of handoff, I had designed 20 templates for separate lines of business.
IX. LAUNCH OF MEDICARE
First launch: Medicare
The process of content and design iteration, presentations to stakeholders, consistent compliance checks, and working with developers on print quality continued for several months until final approval was given by necessary lines of business.
Deadlines considered, the first audience to receive the new EOB would be our Medicare members.
On March 23, 2021, the new and redesigned Medicare EOB launched and is now in the hands of our members! After only 2 weeks, we received a surplus of positive calls to Member Services regarding the document change, and a spike in digital / paperless EOBs from our Medicare members.
X. TODAY
Where are we today?
The redesigned Explanation of Benefits (EOB) I was able to lead in both research and design has been live for all UPMC Health Plan Members as of 2022. You can view the publication and tutorials on the UPMC website!
Over 20 different templates were created for all lines of the Health Plan business. Through the updated document, there has been over a 28% decrease in member services calls regarding comprehension of the EOB.
XI. TESTIMONIALS
Quotes from teammates
“This redesign will absolutely revamp our modernization efforts as a health enterprise”
“This is excellent work. You’ve done an amazing job.”