A 14-month effort to answer one question: Can shopping for insurance be easy?
They met in the offices of a big design firm in San Francisco and in the living rooms of small houses in Ohio. They drew designs on 10-foot-tall sheets of paper and paced back and forth, again and again, reviewing their ideas. They worked 14 months straight meeting regularly in person, on the phone and in online webinars.
Their ranks included top health care officials from the Obama administration, states and some regular American citizens.And they all were all working furiously to answer just one question: How do you make shopping for health insurance really, really easy?
Right now, buying health insurance is anything but. Americans find it one of the most difficult things to purchase. Every year, branding firm Seigel + Gale ranks industries by “brand simplicity,” a measure of how easily consumers understand the product being sold. Every year, health insurance comes in at the very bottom.
Eight foundations came together about a year ago, aiming to fix that. It was April 20111 and the Affordable Care Act’s health insurance expansion was looming. Many of the 32 million Americans expected to gain coverage would likely to be shopping for the first time.
Together, the nonprofits committed $3 million to a project they titled Enroll UX 2014, meant to create a simple consumer tool to buy health coverage that would be made available to all states at no cost.
“Every state is going to have a health exchange in 2014,” says Mark Smith, president of the California Healthcare Foundation, which has lead the effort. “There’s no need to reinvent the wheel...at no cost to the public, we thought we might be able to put together the funding and policy expertise to inform a good design.”
Those health exchanges that Smith mentions are new marketplaces, required under the Affordable Care Act, where individuals will compare and shop for insurance plans. The goal of Enroll UX 2014 was to create a consumer enrollment interface that shoppers would find easy to use an intuitive.
“There will be one shot, at this level of effort, to make the health insurance exchanges successful,” says Richard Fiore, executive director of Alabama’s Health Insurance Exchange. “Whereever possible, we want to get the best resources as quickly as possible at value to the tax payers.”
The foundations brought in 17 states to work on the process including those that support Obamacare, alongside those who strongly oppose it. The federal government participated in all meetings. It also hired IDEO, a San Francisco-based design firm, to lead the process.
“We all know that health care is one of everybody’s biggest challenges,” says IDEO President Tim Brown. “If this could make people’s choices easier and better, we could have a hugely positive impact.”
IDEO started off with a round of focus groups, heading to Ohio,
California and Louisiana to talk to those likely to gain insurance under the Affordable Care Act. Again and again, the same complaints about shopping for insurance came up: “Health care coverage is complex and expensive.” “It takes a great deal of effort to feel heard, supported, and understood.” “The system is slow and unresponsive.”
The focus group started giving way to certain design principles hashed out between IDEO and representatives from both state and federal government.
Customers found the process too complex - so the Web site would never show more than three options at a time. To make the process less confusing, a utility bar would be anchored at the top of the site. A “help” drawer would always be present, where individuals could click for additional support. Two plans could be compared, side-by-side, with easy to read information about how much co-pays cost and the level of the deductible.
They went back and forth over whether individuals should be able to browse the site anonymously, checking out plans, or be required to register first (ultimately siding on the former option).
“One idea was to give the consumers smaller chunks at a time and let them use it in a way that was easiest to them,” says Judy Arnold, director of coverage and enrollment at the New York State Department of Health, who was involved in the project.
The Enroll UX 2014 collaborative began in April 2011. It wrapped up last week, when the group put out a toolkit for that any state could use to build the consumer interface that had been developed. You can play around with a prototype for the design here.
The aim isn’t to make buying health insurance as easy as any other purchase. “This is not the same as selecting a pair of shoes,” says Tracy Purcell, of TennCare, Tennessee’s Medicaid program, who also worked on the project.
Health insurance, by its nature, is a complex product. You’re buying a hedge against various diseases and injuries that might never happen. The idea here is to make that complex product, as Purcell puts it, “as intuitive and as welcoming as possible.”