Translating User Needs Into a Modern Software Product
Quantum Health offers concierge services to their customers’ employees, helping them navigate the complexities of health insurance benefits, claims, and billing. Their staff uses a variety of custom-built software tools to assist members.
Quantum came to PD to steer user-centered design as they were investing in modernizing their software suite. Through extensive user observation, prototyping, and evaluative testing, PD’s UX team helped ensure users’ needs were understood and met in the revamped software platform.
A Clear UX Problem
Quantum’s members call them when they need help with something regarding their health insurance policy, commonly questions about benefits, claims, or prior authorizations. Patient Support Representatives (PSRs) handle these calls, using multiple, proprietary software products to find needed information and track member correspondence.
With a growing member base and ever-increasing call volume, Quantum’s software had become a bottleneck. Navigating systems, especially while also on the phone, was cumbersome. Tasks were highly repetitive and manual. It was evident to Quantum that they needed to build the next generation of their software suite, but they needed help.
Immersing in Users' Work
Quantum didn’t need someone to just redesign their software. They needed someone to translate the needs of PSRs into an end result to ensure it was actually more usable, accurate, and efficient to use. To do this, PD’s process began with developing a rigorous understanding of PSRs’ roles, common tasks, mental models, and pain points via chair-side interviews.
The most significant revelation that came from research was how many applications PSRs had to manage and how poorly they worked together to complete member-related tasks. Despite the fact that PSRs thought about members as single entities for which benefits, claims, and personal information existed, member data was fragmented and workflows disjointed due to disparate software. PD recommended first solving this fundamental problem from which other pain points and inefficiencies stemmed.
Designing One Comprehensive System
Consolidating member-related content into one system first required defining the underlying structure for information and interactions. It was impossible to successfully display all member, benefits, and claims data on one page, so PD’s UX team created interactive prototypes that explored different approaches to hierarchy and navigation.
Through several iterations of prototyping and evaluative testing with PSRs, a foundational architecture was designed. It strategically grouped app information, taking cues from how often and in what order PSRs viewed content. The most frequently accessed member information was on the left half of the screen; adjacent content, including benefits and claims, was on the right. When needed, users could “pop out” sections into a secondary window for completing focused tasks.
To ensure users’ needs were successfully met, PD designed and tested comprehensive prototypes that walked through important task flows, evaluating the design’s ability to support efficient task completion and user’s ability to adapt to using it. The functional design was proved successful and ready to move into refinement.
Crafting a Transition to New Software
In developing a new, comprehensive system that would replace the various ones PSRs were used to, it was important to consider their transition to using the new tool. Similarly, it was important to help Quantum’s implementation team build the new software as efficiently as possible. To account for these needs, PD crafted a plan for incrementally transforming the current software layout and UI mechanics.
A crucial insight from user testing was that the visual appearance of a new UI had a direct impact on users’ ability to easily familiarize with it. With this in mind, PD adopted the aesthetic and interaction design of Quantum’s most recent software tool, evolving its components into a first generation enterprise design system. The design system would ensure greater implementation speed too.
Empowering Better Work Through Design
Though the new PSR software combined content from multiple of Quantum’s products, it was still one product among many made for various roles within Quantum’s operations. PD’s design system and the PSR UI laid the foundation for targeted improvements to other software with the goal of gradually bringing them into a cohesive family of products. One of these redesign efforts completely replaced a third-party tool, saving Quantum significant costs.
To date, the redesign effort has significantly improved usability, learnability, accuracy, and efficiency for the following core functions:
- Data presentation: How member, claim, and benefits data is organized and accessed
- Documentation: Logging call notes and activity used across many apps
- Claims: Viewing claim details and processing claims-related issues
- Task assignment: Assigning and managing tasks between teams
- Data quality: Managing Quantum’s database as it receives updates from third-party sources
- Authorizations: Processing prior authorization “cases” including documentation and clinical review
- Automation: Task automation and machine learning-generated member insights
