Payer - Provider Experience
Redesign the payer (health insurance) and provider experience through new self-service digital and process touchpoints
MVP Health care works with 60,000+ different medical health professionals and 3,400+ facilities throughout NY and VT. These medical providers deliver care to members and work with MVP insurance for eligibility and coverage information, exchange of health data, claim submission and remittance.
However, the current experience and technology stack enabling these tasks is outdated and costing MVP hundreds of thousands of dollars in call center volume, delayed member care and opening up regulatory risk.
Improving the provider experience became a high priority for the business.
Role
Team
- 1 Product Manger
- 15 Internal Stakeholder Teams
- 1 UX Designer
Time
skills
Impact
- Secured funding and prioritization of digital overhaul; designed and shipped 30+ new web pages
- Estimated decrease in call volume of to provider call center >20% fewer calls related to claim status, >45% less on prior authorization and portal adoption increase from 1 in 5 to 4 in 5 healthcare providers
Discover
Objective: Align teams to a common language and process for the provider journey
Contribution: Established baseline journey and research through 20+ SME convos, 11 provider interviews and service blueprinting. Prioritized opportunities based on LOE and strategic value
Result: Co created a presentation deck highlighting current state, work-in-progress, opportunities and need for executive support
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Define
Objective: Align leadership on prioritized pain points and opportunities; receive executive support to implement changes
Contribution: Presented to VP+ level audience 50+ pain points, opportunities, 3 year roadmap and request for governance + funding
Result: Received funding and support to implement digital experience overhaul, communication strategy audit and assess vendors for backed processes (eg. Credentialing)
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Design
Objective: Audit the current digital ecosystem, map out vendor portal integration, understand tech limitations and build a delivery roadmap
Contribution: Performed competitive analysis, built a new IA and navigation, mapped digital user journey, and partnered with stakeholders to understand implementation timeline
Result: Delivered a phased delivery roadmap that aligned technical constraints with business priorities and informed future digital modernization efforts
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Synthesize
Objective: Build new digital and self service experience, integrating vendor features, while maintaining visual consistency with member facing product
Contribution:Worked within website CMS, collaborated new patterns for design system, partnered with marketing team for roll out and with communications for copy
Result: Worked with 15+ stakeholders from concept-to-design and enabled self-service by launching 30+ web pages, reducing reliance on support
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Deliver
Objective: Perform user testing with provider groups, measure impact against target metrics, and begin second round of phased delivery (in-progress)
Contribution: Worked with provider liaisons and call center to pull data, presented to leadership impact (in-progress) and began auditing PDF documents
Result: Provider call center estimated to receive >20% fewer calls related to claim status, >45% less on prior auth and portal adoption increase from 1 in 5 to 4 in 5 healthcare providers
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