A regional health insurance company need a better experience for teams to authorize coverage for medical procedures.
Streamlining communication and collaboration to improve efficiency and transparency
The client was using an outdated, homegrown utilization management tool that focused on functionality, not usability. The information-dense screens were difficult to analyze and time-consuming to teach to new employees. There was no built-in task notification, so users had to check other communication channels to know when they had a record to review. Each record had to be reviewed in a timely fashion, so numerous staff members were working overtime to get through their queues.
I joined the project mid-way to refocus requirements-gathering with research and workshops. When our insights made it clear that we needed a custom solution, I stayed on to design an experience that would blend seamlessly into a larger implementation and Salesforce as a whole.
What is Utilization Management?
I put together a 3-5 min overview of the utilization management process and key players to give you some helpful context. Beneficial, but not required to get value from this case study.
I recognized the source of the frustration right away. Our team had been gathering "requirements" by asking the client, "What do you want to see?" and then building those elements into screens. The client had a viscerally negative reaction to the screens that they couldn't articulate, our team was building against subjective success criteria, and no one was happy.
I designed a client workshop to help bridge this gap. To prepare, I created a Miro board with one sticky note for every data point that was captured on the authorization record. With the client, we first identified all of the jobs to be done on an authorization and then, job-by-job, assigned each data point to one of three groupings - entered net new, consulted or not consulted for this job. Finally, we stack-ranked the data points by priority.
A more intuitive authorization creation flow
One of the client's biggest complaints about Salesforce's out-of-the-box utilization management product was that it didn't feel integrated enough into the platform. Though authorization records are created for existing members, and usually off of other authorization records for those members, the only way that Salesforce allowed you to create them was from the homepage.
One of the first design decisions I made was to move the authorization creation function directly onto member and authorization records. It was a more intuitive starting point, and allowed the platform to inherit more information from the starting record.
From there, I created a simple guided workflow that would conditionally display different information depending on the authorization type. This reduced the cognitive load of seeing unnecessary fields as well as the risk of errors. We also utilized the groupings from our research exercise to lay out the fields here.
Scrolling vs. tabs
Tackling the main authorization record page layout was a beast. Even though we could more intuitively organize the data based on our research, there was still just so much to place somewhere. I took all of the data we had and prototyped two experiences:
Long scroll: All data would live on one page, with the ability to open and close different sections.
Tabs: Users would click between tabs to see data. Data that didn't live in the active tab would be hidden from view.
Though the tabs experience was cleaner and felt less overwhelming, I had a suspicion that the client would prefer the long scroll. For one, it seemed like a more palatable change from the data-rich screens they currently loved so much. For another, each subsequent user who needed to work on the record relied upon the information entered by their previous teammates to complete their work. It was a more natural flow for them to read through the previous data, then have their fields appear down below, than have to click between numerous tabs to gain the context they needed to do their work.
Our user testing confirmed my theory, so we set about creating a custom, complex page layout with an emphasis on the long scroll.
Addressing all of the little details
Authorizations can be created about all types of medical procedures and, as such, need to be flexible enough to display a wide variety of data for a wide variety of situations. I needed to design a handful of custom card layouts to handle different authorization use cases, and each one had many variations to consider.
This project gave me such rewarding validation about the power of UX to quickly gather requirements and create an informed vision that sets projects back on the right path. Design workshops and rapid prototyping helped to unblock conversations as well as allow frustrated team members who'd been spinning their wheels on this project for months to get some of their ideas out on paper.
