work19

The Problem

The Consolidated Appropriations Act, 2021 (CAA), specifically under Section 204 of Title II, Division BB, mandates a critical shift in healthcare reporting requirements. Insurance companies (“issuers”) and employer-based health plans (“group health plans” or “employers”) are now required to submit comprehensive data about prescription drug expenses and overall healthcare spending. This data submission is called the Prescription Drug Data Collection (RxDC) report.

Users submit the RxDC report in the Health Insurance Oversight System (HIOS). The latest RxDC submission window revealed significant user experience challenges. Approximately 15,000 HIOS help desk tickets were logged, indicating widespread issues with the process of creating a profile and accessing the RxDC application. HIOS, designed primarily for health insurance companies, was not originally tailored to the needs and roles of smaller businesses, third-party employee benefit administrators, and other types of organizations that are not health insurance companies. This misalignment led to confusion and inefficiencies among new RxDC data submitters. Furthermore, HIOS accommodates at least 23 other modules apart from RxDC, complicating the navigation for RxDC submitters.

The primary aim of this research is to delve into the user experience challenges faced by user groups when accessing HIOS for the purpose of using modules such as RxDC. Through interviews and usability testing, this study will focus on understanding user pain points related to the HIOS Portal Front-End.

Based on the information gathered, the study will propose refinements to the HIOS front-end flow. These recommendations aim to improve the initial user experience when logging in and creating a profile on the HIOS portal. Subsequently, this profile will be used to access the RxDC application, with the overarching goal of optimizing user access flow for all entities involved.

Enhance HIOS Front-End Flow to Access RxDC Application

Problem

# User Research, # User Interview, # Usability Testing, # Qualitative Research

The Approach

Identify User Pain Points: Understand the specific pain points and challenges users encounter when trying to access the HIOS portal.

Accessibility and Usability: Evaluate the overall HIOS flow to access applications, focusing on the clarity of language, ease of navigation, and any potential barriers to effective use.

User Goals and Objectives: Explore the primary goals and objectives that users have when registering with HIOS, including any desired outcomes or expectations.

Content Clarity and Understanding: Ensure that users can easily understand and complete HIOS profile registration. Assess clarity and consistency of the initial flow and steps taken by users inside the HIOS portal and related email communications, prior to gaining access to the RxDC module.

Approach

The Process

Process

1. Planning and Preparation

Develop research protocols and interview/questionnaire guides.
Recruit participants and schedule interviews.
Prepare testing environment and tools.
Train the research team and coordinate logistics

2. Task-based Usability Testing

Conduct usability testing sessions with participants.
Gather qualitative and quantitative data on user interactions.
Document observations, feedback, and pain points.
Continue recruiting and testing with additional participants if needed.
Regularly debrief with the workstream team to discuss initial findings.

3. Follow-Up Research

Conduct additional usability testing sessions as needed.
Analyze data to identify patterns, themes, and insights.
Prepare summary reports of follow-up research findings.
Reach out to stakeholders with additional clarification/information.
Up to 45 minutes in remote Zoom meeting
Using the production environment for testing

4. Data Analysis and Synthesis +Findings Report + Readout (Presentation)

Analyze all collected data from usability testing and follow-up research.
Identify common themes, pain points, and opportunities for improvement.
Create findings presentation, journey maps, or other visualization tools to represent findings.
Prioritize findings/recommendations and convert these findings into Jira Tickets.
Collaborate with ADOs to link Jira Tickets to their business initiatives/Epics.

5. Follow-Up Synthesis

Perform additional analysis, dependent on complexity of research data collected.
Work with workstream stakeholders to identify potential adjustments or refinements based on the initial findings.
Collaborate with cross-functional teams to ensure the integration of research findings into ongoing project development.

Outcomes

The Outcomes

Ideal front-end flow recommendations (+3 UX enhancements)
- "Allow users to select RxDC when they register for HIOS and continue the process in a streamlined and linear flow. Hide other HIOS functions from users until RxDC access is complete."
- "Fully explain roles and steps within the HIOS UI so that users can find definitions within the process itself."
- "Include a clear logic for users to follow when initially gaining access to RxDC."

General Recommendations (+6 UX enhancements)
- Duplicate Date Entry: "Auto-populate previously entered personal information when it needs to be re-entered"
- Email Confirmation: "Send confirmation emails with clear instructions for next steps, if necessary, and include a timeline."
- User Guide: "Provide clear and upfront guidance through a brief user guide overview to help users quickly understand the entire process and prompt them to start at the right time."

CMS Enterprise Portal Recommendations (+2 UX Enhancements)
- "Explain why personal information is required and how the CMS Enterprise Portal securely manages and stores it."
- "Update field label to “Work Email Address” to eliminate confusion and prompt users to enter their work email."

Requesting HIOS Access Recommendations (+9 UX Enhancements)
- "Discard the ‘Overview’ link and enable users to get on the HIOS application directly after clicking on the HIOS tile."
- "Discard HIOS Issuer ID option if RxDC submitter is selected from the previous step to provide only available options."
- "Update confirmation text to indicate that users should expect an email notification for role approval."

ORA (Organization Role Approver) Role Request Recommendations (+7 UX enhancements)
- "Consider incorporating the ORA flow into the RxDC module request."
- "ORA role approval email should contain the required follow-up when the ORA leaves the organization."

* Due to the NDA restrictions, the final outcomes of this project are confidential and cannot be posted on this website. Please contact me if you are interested in learning more about this project.