Making health insurance easily accessible online

Photo: IDEO

Photo: IDEO

What was the problem?

Forty million Americans will become newly eligible for health coverage when the Patient Protection and Affordable Care Act (ACA) is fully implemented in 2014. Some will be enrolling in health insurance for the first time, while others will experience changes that provide increased access to affordable health coverage.

In anticipation of this transition, the law requires the development of electronic enrollment options for health insurance plans operated by state and federal governments under the ACA. To assist public and private agencies in meeting these requirements, a coalition of nine national and state-based foundations, led by the California HealthCare Foundation (CHCF) worked on a project to develop a digital enrollment prototype for Americans seeking health coverage.

The goal of the project was to create a detailed reference design of an easy-to-use consumer health insurance enrolment experience. Design agency IDEO was selected to lead the consumer research and design effort. After a yearlong collaborative process, the resulting 300-page design specifications manual and design reference prototype illustrates a customisable and human-centered approach to public and private health insurance enrollment.

The core challenge was to create a flexible set of design standards that could make it easier for Americans to enroll online for health care coverage. The scope and complexity of this design challenge required a multi-part design solution that was inclusive, responsive, and respectful of state-to-state variation and resource constraints.

What did they do?

The project began with extensive research into the needs of Americans. First, the design researchers interviewed dozens of health care workers, insurance experts, potential applicants, public employees, and policymakers. In-person interviews were conducted by the team in three states. In addition to demographic, situational, and language diversity, interviewees represented different perspectives and experiences with commercial and public health insurance enrollment and coverage. Synthesis of these findings informed the development of interaction frameworks and design principles, which in turn led to the creation of potential design directions. Rapid iterations of review and feedback led to the final design specifications manual and digital reference prototype.

Fifteen states participated in the project via three large in-person workshops and numerous digital meetings held to discuss project updates, customization options, and implementation requirements. Throughout the design process, design review and information sessions were held with state and federal staff members, healthcare industry experts, IT experts, and Americans from a range of socioeconomic backgrounds.

What was the result?

One result is the ACA’s Affordable Insurance Exchange concept, “a new transparent and competitive insurance marketplace where individuals can buy affordable and qualified health benefit plans.” Each Exchange offers a choice of health plans that meet certain benefits and cost standards, as well as information about eligibility for health programs and tax credits that make coverage more affordable. The Exchange concept was implemented in all 50 states starting from October 2013, at which point each state was required by law to have its own State Health Exchange or default to the federal Exchange. Various state-level offices are engaged in exchange planning, development, and execution.

Presented as a customizable toolkit, the final design specifications manual is divided into 11 chapters aimed at enabling federal and state government agencies to help millions of Americans engage successfully with the online health insurance enrollment process. The companion design reference prototype shows how the core design standards interact during the enrolment experience.

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