Posts Tagged ‘exchange’

All Consumers Want for X-changes is a User-Friendly Interface

December 19, 2011

The holiday season is upon us, though far from sugar plums, visions of insurance exchanges are dancing in the heads of state officials across the country (for a recap of current state progress on exchanges, be sure to check out this recent State Refor(u)m blog). Of the many exchange components states are currently working on, one that is particularly important for eventual exchange users is the development of the user-interface or in non tech terms the website or web portal. Specifically, through this interface, consumers should be able to apply for coverage programs, calculate expected tax credits and cost-sharing, and obtain standardized comparative information about available qualified health plans.

The look and “user-friendliness” of the web portal will be especially important in drawing consumers to an exchange and to make sure that they get the help they need to choose a plan, enroll, and stay covered. Among the many design considerations, states will need to be especially aware of keeping information at appropriate literacy levels for consumers as well as how best to display relevant data to consumers. To delve further into these design issues, 11 states (including SHAP grantees Colorado, Minnesota, New York, and Oregon) are participating in the Enroll User Experience 2014 (UX2014).

UX2014 is a project charged with “developing a first-class user experience design for health insurance exchanges.” Distinct from other exchange development efforts, UX2014 is philanthropically funded and centers on the philosophy of what makes a good user experience in any context. I recently had the opportunity to interview Jim Jones, Senior Consultant, Sellers Dorsey, about his work with UX2014. He shared some early lessons from the project:

  • Be wary of the written word. In writing text for the exchange, developers should use clear and direct language written at an appropriate literacy level so that it can be easily read and understood by consumers. Developers should also be aware of potential intonations and nuances that may impact consumer reaction to the exchange or skew responses needed for accurate eligibility determinations. For example, instead of asking, “List your earned income” it is more appropriate for an exchange to ask, “What do you get paid from your job?”
  • Design for a varied audience. Exchange consumers will vary in the level of assistance or independence and the amount of detail they will desire or need as they navigate the web portal. Designs should account for the variability of consumers and empower consumers to self-navigate through the enrollment process while also providing ample mechanisms for consumers to get assistance or explanations about available coverage options.
  • Build environments that foster consumer trust. Consumers will be expected to share personal data with the exchange, and so exchanges must be designed in a way to build trust with consumers. While serving different functions than the exchange, developers may want to look to popular websites for examples of successful personal data gathering, including banking websites, tax preparation websites (e.g. TurboTax®), travel sites (e.g.®) and dating websites (e.g.®).
  • Gauge consumer expectations on data sharing. Data sharing capabilities between federal and state hubs and the exchange will facilitate the process of data verification and eligibility determinations for consumers applying through the exchange. However, Mr. Jones noted that users have conflicting reactions to these data capabilities. Where some will be frustrated by sharing information they believe the government should already have access to, others will be deterred if an exchange seems to know too much. Developers should be sure to gauge the attitudes of intended audience so that they can build compromises to optimize data collection. In addition, the user interface will need to account for situations where the data sources aren’t available for that person at that time or contain dated information that no longer reflects the current status of the family (composition, income, etc.).
  • Consider the needs of navigators. While consumers looking to obtain information about health insurance and subsidy options will be the primary users of the exchange, it is also important that exchanges work for the various entities designated to assist these consumers through the navigator program. Designers should consider embedding tools into the exchange portal so that these assistors can be more successful including account management capabilities.
  • “You only have one right foot, and you need to get off on it.” Although, states face fast approaching deadlines to implement exchanges, it is important that states build-in adequate time to conduct testing and work out any programmatic kinks. It will also be important to manage public and political expectations at the launch of the exchange. According to Mr. Jones, “nothing is perfect at the beginning,” yet early design flaws may put the exchange at risk of building a negative reputation that will deter future users. “Consumers will only embrace the system [once] it is proven to work for them.”

Free resources from UX2014, including a variety of deliverables and design guidance, will be publicly available to states in 2012. For more information about the design principles of UX2014, as well updates about the project, be sure to check out their website: For more information about state specific activity related to creating a user-friendly exchange, be sure to check out resources posted on State Refor(u)m.


Takeaways from a State-to-State Exchange on Streamlining Enrollment

April 1, 2011

[note: this article was originally posted at State of Implementation, NASHP’s new blog on State Refor(u)m]

Last week, I had the good fortune to attend a NASHP event in Boston, MA. Officials from eight states who participate in the Robert Wood Johnson Foundation-supported Maximizing Enrollment initiative came together to learn from one another about their ongoing efforts to streamline enrollment in health coverage programs, and prepare for implementation of new enrollment systems for individuals who will be newly eligible for public and publicly subsidized programs in 2014. Many of the discussions involved ways that states can use technology and systems solutions to minimize unnecessary paper-based processes.

  • Howard Caplan, Director of the MassHealth Virtual Gateway, described Massachusetts’ Virtual Gateway, a centralized portal for health and human services eligibility determinations. The Virtual Gateway allows intake workers, application
    assistors, and healthcare providers to enter eligibility information for clients that is then routed to appropriate back-end systems. Individuals can also use the system to screen for eligibility for a range of public benefits. Caplan encouraged states to borrow from each other in developing these interfaces. In addition to the Virtual Gateway in Massachusetts, other systems to consider as models include ACCESS in Wisconsin, COMPASS developed in Pennsylvania, and UtahClicks.
  • Lynn Andrews, Director of Change Management for MassHealth Operations, explained the state’s plans for moving from paper documentation to digital images.  The Electronic Document Management initiative will scan paper documentation in a central office and make scanned images available to caseworkers electronically on the day they are received. Scanned images allow workers to access information more efficiently and enhance customer service since documents are more easily tracked. Andrews highlighted the attitude shift for eligibility workers whose work environment changed dramatically. Wisconsin experienced a similar shift when moving from face-to-face to electronic applications. Both states emphasized the importance of helping eligibility staff adjust to the culture changes that accompany major eligibility process changes.
  • John Bogasky, a consultant with Advancier LLC, outlined key considerations for state leaders of IT system change initiatives. When contemplating IT system changes, he advised states to “begin by defining what you want, rather than worrying about what your current system can’t do.” Participants agreed that the ACA provides a unique opportunity for large-scale system upgrades that is rarely seen, but that the timelines are challenging. In New York, the state, with support from an Early Innovator Grant, plans to build on its MMIS infrastructure to have ACA-required components in place by 2014, and to keep making improvements over time.

Does your state have materials to share about technology and systems solutions to minimize unnecessary paper-based processes? Please share them with us and other states by posting them on your state page at State Refor(u)m. To engage in a cross-state discussion about this milestone, visit State Refor(u)m’s national discussion page.