KelseyCare Advantage is a Medicare Advantage plan available to qualified patients in the Houston area. At the time we started this project, the back-office process for processing KelseyCare Advantage applications completed online, over the phone, or via a paper application involved several different departments using digital systems that did not interface with each other. This resulted in a lot of manual data entry, data duplication, and rework.
After meeting with the key stakeholders in KCA to get a high level overview of the problem, we started by sketching out what we knew of the business process – there were still gaps in what we knew, so we worked with the KCA enrollment department and Member Services to help flesh out the details we were missing.
I interviewed users at various points in the application management process to see what the pain points were and what we could improve on. The current business process was a huge, disorganized mess that had developed over the course of several years and organization changes. For example: at several points in the process, someone carried printouts of applications from one department to another to be reentered by hand into another system.
Once we had a good idea of what the current situation was, I met with our software architects and project manager to determine what technology we would use to bring these different systems together, and what type of technical limitations would potentially impact my design. We sketched out some ideas for how we might get past some of the manual processes, and I used those sketches to develop some preliminary wireframes.
My team met several times with users and other stakeholders to review the wireframes and refine them, making sure that we were meeting all the regulatory requirements involved with Medicare Advantage plans, in addition to improving on the current process. Once a final draft of the wireframes was approved, I worked with the developers to ensure that the implementation matched what I had designed. I also spent time working with the end users on testing the site as we developed – allowing us to fix any design issues we found along the way.
Out team implemented a custom SharePoint site that took input directly from online or phone applications, or paper application that the enrollment department entered by hand into the system. The site had several custom workflows that automatically moved the data through the various systems and departments as required. We eliminated the need for multiple paper copies of applications to be printed and re-entered into each application, and provided a digital archive of all applications that were accepted or denied as well as an audit trail for those applications.
User research, User Interviews, Wireframes, Testing
Microsoft Visio, Balsamiq