Antonia Aglialoro

Background

Covered California, the health insurance marketplace for the state of California, has been providing coverage to Californian’s since 2013. Starting in June of 2016, I have been working with a small team to redesign the online portal that nearly 15 million Californians use to apply for and manage their health care. The redesign for the intake application was launched in early 2017 and we are currently iterating on what has been released as well as rethinking other aspects of the online experience. The design team is made up of one design director, one interaction designer, two visual designers, and one content designer.

My responsibilities on the project include:

• Planning and conducting regular in-person user research and testing 
• Facilitate client workshops to uncover business needs and align on priority 
• Creating and presenting research and testing plans, findings, wireframes, logic diagrams, and interactive prototypes

Challenges

Designing for Everyone

As designers, we’ve all heard the phrase “if you design for everyone, you design for no one”. When creating most products, it is possible to identify a core group of users and create a design that specifically meets their needs. However, when designing a product that is inherently meant to be used by all, we must embrace the challenge. Our team decided that designing for everyone didn’t mean designing every imaginable use case. Instead, we decided to prioritize our MVPs, or “most vulnerable people”. We defined MVPs as users who might have a disability, lower tech proficiency, lower reading levels, etc.

Policy Centered Design -> User Centered Design  

Healthcare is really complicated. Designing healthcare products is even more complicated. Looking at the original Covered California online application, it was evident that the design was heavily driven by policy. It felt very much like a government website; impersonal, unintuitive, and dense with legalese. In redesigning the website, our challenge was to build a simple and approachable experience that empowered individuals to apply for and manage their healthcare while still ensuring that the application adhered to the complex ecosystem of policies that govern health insurance.

Multiple Stakeholders

CalHEERS (California Healthcare Eligibility, Enrollment, and Retention System) is the convergence of two sponsors, Covered California (CC) and Department of Healthcare Services (DHCS). Covered California is a for-profit health insurance marketplace and DHCS is a state agency that covers low-income and disadvantaged Californians. Together, CC and DHCS have joined forces to create a single application that Californians use to apply for health insurance. This is the application that we have been redesigning. Answering to two clients is tough. While both have a passion and unwavering dedication to the same underlying cause, providing healthcare to all Californians, each still have unique business goals and requirements. For our team, the challenge was to incorporate each business’s unique requirements while creating a cohesive experience for the consumer. We found that the best way to align the two groups was to keep the consumer at the center of the conversation and always ask for the "why" behind a requirement.

What We Did

The first step for every section that we redesigned was to understand the existing pain points. We observed consumers using the original online application and documented what worked and what didn't work. Generally speaking, we observed that the biggest user experience pain points consumers experienced with the application included: 

• Not knowing exactly what action was required of them on a page when there was a lot of content or multiple interaction points 
• Not understanding the language used to communicate healthcare topics 
• Not feeling confident that they provided their information properly (primarily with the reporting of income information) 

The pain points that we observed during these initial observation sessions served as the starting point for our redesign. Ultimately, these pain points were causing the consumers to feel a sense of frustration and a lack of confidence in the process. However, consumers are willing and determined to push through the application process because healthcare is a must have. Our goal for the redesign was to remove the barrier of entry for such an essential need and make the consumer feel empowered and confident that they are able to get the right healthcare for their family at the lowest cost. At a very high level, the main guiding principle that influenced all our design decisions was simplify. We believed that many of the pain points we observed could be solved by simplifying the language and interactions. Specifically, the main design decisions that we applied throughout include: 

• Reducing the amount of content on the page
• Using hierarchy to help communicate the most important content or action on a  page 
• Using plain english rather than healthcare jargon to communicate to the consumer
• Focusing on one thing at a time and breaking complicated flows into simple digestible chucks 
• Progressively disclosing information as it becomes relevant to the user so they are not overwhelmed with content or required inputs up front   

The redesign effort is quite large and still an ongoing process. We have touched almost every section of the application and continue to iterate. To demonstrate more in more concrete terms the way in which we applied these design decisions, I will focus on two sections of the redesign that I feel had the largest impact to the user experience. 

A New Way to Input Information 

The original application had a repetitive way of gathering information, often asking for the same information multiple times. For example, the application requires the consumer to indicate all the household members who wish to apply for health insurance. Previously, the application would ask this question to every applicant individually. As a result, we observed that consumers would often times become confused about which applicant they were providing information for and become frustrated because they felt that they had already provided the information. This pain point was especially noticeable for larger households. In the redesigned screenshot below, we ask the question of who is applying for health care and allow the consumer to select the applying individuals rather than asking the same question of every member. We applied this paradigm throughout for questions that could be asked in this format. As a result, we were able to reduce the amount of content on a page. Instead of answer the same question multiple times, they only needed to answer one question. 

A New Way to Report Income

Through user interviews and observations, we learned that reporting income was one of the most complicated aspects of applying for health insurance. Everyone’s income situation is different. A lot of people have multiple sources of varying income and it can be difficult for the consumer to feel that they’ve reported it properly. Especially since so much of the eligibility determination rests on income amount, there is a lot of anxiety associated with this lack of confidence. 

Previously, income section of the application was heavy on text. Income is complicated and the original design relied on text to explain the complexity. In user testing, we found that when faced with a wall of text, even if the content explicitly stated the required actions, consumers typically only scanned the information and would still become confused later in the flow when they were actually performing the actions. In our redesign, we aimed to reduce the amount of text up front and provide information contextually and upon request if the consumer was actively looking for it. For example, in the income introduction page shown directly below, we summarize the information that is important at this moment and provide a link for the consumers who wish to know more.  

When it came to actually reporting income, the old application provided minimal guidance to the consumer on what income to report or how to report income that varies in amount throughout the year. The instructions for reporting are written out in a lengthy paragraph and as we observed in usability testing, dense text is not very effective. In our redesign, we aimed to simplify the income reporting process by providing guidance to the consumer about exactly what they could report. We walked the consumer through all the different types of incomes they can report and provided descriptions for each. While we may have broken the process out into more steps, we found that the specific prompts and guided steps helped the consumer feel more confident that they were properly reporting their income. By explicating listing out the types of accepted income, we removed the mental burden that was previously placed on the consumer to figure out what they needed to report. 

The redesigned intake application was released at the beginning of 2017 and we are currently iterating on the released designs as well as redesigning the returning user experience.