BACKGROUND
UPMC's insurance authorization process required analysis to identify workflow challenges and improve HealthPlanet application usability.
Utilization management (UM) within the UPMC Health Plan is done through an application called HealthPlanet. This process had not been documented in some time. Our goal was to understand how insurance authorization is handled within the UPMC health plan, while identifying navigation challenges, workflow inefficiencies, and pain points in the HealthPlanet application.
SCOPE
Participated in end-to-end research to deliver actionable insights and inform design decisions.
Designed and conducted Contextual Inquiries, participated in the analysis and synthesis of findings, developed artifacts and presented actionable recommendations to stakeholders and the design team.
RESEARCH QUESTIONS & GOAL
Exploring clinician workflows and challenges in HealthPlanet's utilization management to enhance user experience.
Questions
How do clinicians utilize HealthPlanet when completing insurance authorizations?
What challenges are encountered when trying to ensure efficient and appropriate healthcare resource utilization?
Goal
To gain a comprehensive understanding of the as-is workflow of those who work on utilization management cases, create workflows, and gather insights to improve the user experience.
RESEARCH PLAN
Facilitated contextual inquiries with UM healthcare professionals to assess workflows and user experience.
Participants: Nurses, Medical Directors and other representatives with various levels of experience
Duration: 90 minutes
Environment: Virtual on Microsoft Teams
Type: Contextual Inquiry
Timeline: Nov 2023-Jan 2024
CONTEXTUAL INQUIRY
Facilitated a contextual inquiry of UM processes through screen-sharing sessions, participant observations, and HIPAA-compliant data collection.
Primary research was completed by team, which included UX Designer, Visual Designer, and Research, to gain a background understanding of how utilization management is conducted at UPMC.
Participants were recruited based on their UM role and experience level.
We conducted 11 contextual inquiries via Microsoft Teams.
All participants were asked to share their screens as they went through their actual daily workflow of insurance authorization.
Facilitator observed and asked questions for clarity, all questions from other observers were saved for the end of session.
Adhering to HIPAA regulations, sessions were not recorded.
Notetakers captured participant statements, clicks, and behaviors.
ANALYSIS
From the observations, affinity maps were created to cluster patterns and themes.
SYNTHESIS
Based on our analysis I created journey maps for each UM role while my teammates created workflow maps and personas for each.
Deliverables: Role-Specific Journey Maps, Workflows, and Personas
JOURNEY MAPS
SERVICE DESIGN BLUEPRINTS
WORKFLOWS
PERSONAS
KEY FINDINGS
Users appreciated the streamlined navigation and automation features but faced challenges with system downtime, inefficiencies in workflows, and unclear automation rules.
RECOMMENDATIONS
Recommendations focused on improving workflow efficiency, system usability, and automation in HealthPlanet, addressing key pain points like navigation, responsiveness, and communication features.
Priority 1 Recommendations
Address issues with worklist items and the CAN notes list view page.
Integrate CAN note templates into Health Planet workflows, including a voice-to-text feature.
Add notifications for attachments uploaded to UM cases.
Expand automation rules for authorizations, claims, denials, and letter template creation.
Fix bugs and resolve broken link issues.
Priority 2 Recommendations
Add a live system status indicator to inform care managers of Health Planet’s status (e.g., online, offline, maintenance).
Collaborate with the performance team to assess and improve system responsiveness.
Develop a unified template for sharing UM cases across facilities.
Simplify navigation to allow users to move seamlessly between pages.
IMPACT & REFLECTION
UM Screens are in need of further review and, while challenging, virtual contextual inquiries capture important insights.
Impact: Stakeholders discovered clinicians were not using Care Activity Note templates, prompting a review of their relevance and a broader evaluation of Utilization Management screens, beginning with Pharmacy, to streamline processes.
Reflection: Conducting virtual contextual inquiries proved challenging, but collaborative note-taking ensured key behaviors and observations were captured.