Benefit usage strategy
Background
Customers have established relationship with their providers over the years. When this relationship discontinues (due to customer relocating, provider retiring or going out-of-network etc.) customers search for new providers. Using the high-performing providers customer can save money, receive personalized high-quality service and effective care.
Problem to solve:
Healthcare provider selection is made based on facts, cost, and quality. For quality reviews friends, family, colleagues are often trusted sources. As insurance company, how can we influence the provider choice decision?
How customers seek care
For critical care - quality is most important
For life threatening or chronic issues, customer don’t mind going out of the way for high rated provider that might be expensive.
For routine care - convenience is most important
For frequently sought care (PCPs, Dentists) customers want convenience (distance, appointment availability)
Users don’t trust insurance companies
When guided to specific care options, users always ask - what’s there for you? (i.e. insurance companies)
Users go by facts, not maps
Facts, costs and quality rating are critical than map location.
Desired Business Outcome
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Educate customers of their coverage and proactively engage about a covered care opportunity
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Make comprehensive data available to help customers make informed decisions
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Lower costs by reducing out-of-network clams
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Increase the use of high-performing preferred providers
Current State
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Provider search results were presented as horizontal cards. On wider view ports the page was divided in 2 columns. Left columns was the list of cards and right was map showing pins within the result listing.
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The preferred providers were prioritized on top of the list followed by all other in-network providers.
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In some locations with high provider density, the preferred providers spanned across multiple pages, lacking the opportunity to compare against all other providers.
Research
We conducted primary research and multiple rounds of surveys to understand customer behavior while selecting a new provider:
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46% of provider changes are due to relocation, network changes i.e. providers going out-of-network
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Customers consider cost by making sure provider is in network as first criteria. Then use location, reviews, years of experience, education, hospital affiliation to make their final choice.
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Customers also wanted to know if the provider is accepting new patients.
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Customers did not trust categorization by insurance company.
Provider attributes
We prioritized qualitative and quantitive attributes about providers based on the survey data.
Updates to the experience:
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Carousel listing for preferred providers: this got other in-network providers above in the list and enabled a visual comparison with the preferred providers.
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Cost: Added cost for most frequent procedure by provider type.
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Cost advantage for preferred providers: preferred providers had clear advantage by cost over other providers, this became obvious due to the layout change
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Facts first: for preferred providers displayed the facts upfront
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Personalized data: qualitative data about the provider was personalized for the logged in customer based on their age, gender, location, condition etc.
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Map view toggle: introduced toggle between list and map view
Member Expereince
Something about the member experience
