Project Overview

Executive Summary

I was hired by SlicedHealth to create an interface that allows patients to find an estimate of their medical bill before agreeing to treatment. Sliced Health is a healthcare company that delivers AI-powered healthcare solutions to community hospitals. This product, Sliced Pricer, was created in response to the Health Care PRICE Transparency Act. The law requires hospitals to provide online access to pricing information for a variety of items and services they provide.

Challenges

  • Quickly learning about healthcare and insurance structures
  • Applying that information correctly to avoid legal penalties
  • Finding the balance between information overload and ambiguity regarding the information given to patients
  • Overcoming the communication barrier from the different mindsets of a designer and a businessman
  • Finishing the design and going live as soon as possible to get to the new market before competitors

Duration

October 28th, 2020 to December 4th, 2020
1 month and 7 days

My Role

I was hired to be the interaction designer on this project. This means that I was responsible for designing the appearance and behavior of the interactive product. I had to identify common user goals and design an experience that would satisfy these goals. My deliverable was a high fidelity prototype that was handed off to the development team.

Stakeholders

I reported to Reese Walker, Chief Product Officer and co-founder of SlicedHealth. He gave feedback throughout the entire design process and provided valuable clarification on healthcare concepts, developer limitations, and requirements from the price transparency law.

High-Fidelity Prototype & Live Product

The prototype button leads to the third version and most interactive interface that I developed in figma. However, I have five total iterations and go through them all in detail on this page.

The Live Product button leads to the finished Sliced Pricer tool based on my design. It is displaying real data from Stephens Memorial Hospital in Breckenridge, Texas. If you compare the finished product to my prototype, you will notice many changes from the development team. I discuss my opinions on their changes near the end of this page.

This page is still in progress

I completed this job in December 2020 and I'm working on this process page in my portfolio class. Please note that this page is incomplete and will be receiving multiple updates throughout spring semester.

What is Price Transparency?

Origin

The concept of price transparency legislation was introduced though an executive order on June 24, 2019. The mandates were codified in the PRICE Transparency Act on June 30th, 2020. The final ruling in support of the Price Transparency Initiative came on October 29th, 2020. This final rule went into effect on January 1st, 2021.

Explanation

The final rule established requirements for American hospitals to create, update, and publicize a list of the standard charges for services and items they provide. A public portal with this information must be easily accessible and usable. The publication of these charges is meant to give the public necessary information to make more informed decisions on their care. The publication of these standard charges will increase competition and drive down the cost of health care services.

Benefits

  • Since every hospital in the US is required to post their prices online, patients can shop for the service best suited to their financial and personal needs.
  • Patients will have an estimate of their bill before agreeing to the treatment, procedure, or prescription.
  • More people will decide to get medical care. According to a Harris Poll that was commissioned by Change Healthcare in July 2020, over half of consumers avoided care because they weren't sure what it would cost.
  • Hidden medical prices only serve special interest groups and do nothing to make healthcare more affordable for patients. By mandating the publication of all prices, patients will gain more leverage over hospitals and payers.

“An extra dose of transparency will bring more accountability and competition to the healthcare industry.”

-Sen. Chuck Grassley, R-Iowa. One of the bill’s co-sponsors

Objections to the Mandate

Despite the extensive patient benefits, hospitals and insurance companies have lobbied against price transparency. Hospital groups filed a lawsuit that challenged the Trump administration’s rule, but they lost the case in late June, 2020. Common objectives claim that:

  • The timeline and cost to find a price transparency product and integrate it into their charge master is unrealistic, especially during the COVID-19 pandemic. A charge master is an comprehensive list of items that can be charged to a hospital patient or the patient's health insurance provider.
  • The rule will not help patients become more knowledgeable consumers of healthcare because the field is too complicated.
  • Because patients don't understand the intricacies of healthcare pricing and treatment, they will become confused and angry if the estimate doesn't match their actual bill.
  • There are too many factors to provide an accurate estimate for most procedures. A doctor may order tests in the moment that patients cannot understand or remember.
  • The Centers Medicare & Medicaid Services does not have the legal authority to require the publication of a hospital's privately negotiated rates

My Methodology

Design Thinking

I chose to use the Design Thinking framework to guide my design process. Design thinking is great for a recognizing your location in the design timeline, but the specifics of each step are undefined. To supplement this framework, I used methods from Goal Directed Design.

Goal Directed Design

Due to the speed of this project and my other responsibilities, I was unable to use the entire Goal Directed Design process. To see that entire methodology in action, see my time management app project here.
For this project, I conducted research like how it is completed in Goal Directed Design.

Benefits

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Steps in Design Thinking

There are five distinct steps in this version of Design Thinking.

  • Empathize: 
  • Define: Research and
Empathize
Define
Ideate
Prototype
Test

Kickoff Meeting & 
Stakeholder Interview

A kickoff meeting is necessary to begin building rapport and establish a shared vision for the project. For this job, it was especially important because of the complexity of healthcare. I was able to meet with stakeholders and subject matter experts to get a high-level overview of the product's purpose.

To gather this information, I used a combination of the kickoff meeting and stakeholder interview topics from Goal Directed Design. My reference material is page 37-40 from the book About Face by Allen Cooper. I go through his comprehensive list of question with the stakeholders.

My primary stakeholder is Chief Product Officer and co-founder Reese Walker. I reported updates to him throughout the design process. Reese is a subject matter expert on how to best support patient access, billing, and collection operations of a hospital. The second stakeholder was my father, Chief Executive Officer and co-founder Reed Liggin. Despite our family connection, he was rarely involved in the process.

This kickoff meeting and subsequent feedback sessions were all conducted virtually due to COVID-19 restrictions.

What is the product?

The product is an online interface that anyone can use to look up a medical item or service and see the estimated price for a variety of payment methods.

Who will use it?

Reese predicted that family heads and young adults will be the primary user populations. Although price transparency would greatly benefit the elderly, it is difficult to explain the concept and show them where to find the patient portal.

What do your users need most?

Quick access to an accurate, understandable estimate of their upcoming medical procedure, item, or service bill.

Which customers and users are the most important to the business?

Community hospitals with more than 200 beds are some of the most important customers because that is the target market for SlicedHealth. Reese stated that all users are equally important.

"Patients may get angry if their estimate is wrong. But it's like going in for an oil change and finding out your car needs more work. Sometimes you go to the doctor for a check up but have to pay more than planned because they found something wrong."

-Reese Walker explaining the uncertainty of price estimates in healthcare

What challenges do the design team and business face?

The single biggest challenge is designing an interface that can simplify a complex charge master and display costs to users without overwhelming them with medical jargon.

What literature should I review to familiarize myself with the product & business domain?

I was told to review the final rule on price transparency along with a presentation from the Centers for Medicare and Medicaid Services

Budget & Schedule

Their cost was only my hourly wages. Regarding the schedule, I had to finish everything as quickly as possible. Price transparency tools are a relatively new market with limited competition. The quicker we could design and build a live product, the more hospitals we could sign before the legislation went into effect. Hospitals are supposed to
receive civil monetary penalties of up to $300 per day if they don't have a price transparency tool. This should motivate them to quickly purchasing a product like Sliced Pricer.

Technical Constraints & Opportunities

Reese claimed that the health informatics of standard charges is not complicated compared to other medical fields. So data retrieval would not be a constraint or challenge.

Business Drivers

Important business drivers include revenue, website traffic, and the size of the customer's charge master.

Stakeholder's Perception of their Users

Reese perceived the most common users as smart but easily frustrated. This is the common prediction of user behavior and required validation.

Notes from the Final Rule on
Hospital Price Transparency

final rule on price transparency along with a presentation from the Centers for Medicare and Medicaid Services. I had to personally review these documents along with several articles in order to familiarize myself with the concept of Price Transparency. These are my notes and derived requirements after reading the

Requirements for the interface

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"Patients may get angry if their estimate is wrong. But it's like going in for an oil change and finding out your car needs more work. Sometimes you go to the doctor for a check up but have to pay more than planned because they found something wrong."

-Reese Walker explaining the uncertainty of price estimates in healthcare

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Competitive Analysis

Introduction to the Competitor's Product

When I was designing the Sliced Pricer products, there weren't many competitors on the market yet. It was such a new law with vague requirements for the visual design, so there was no established design precedent. One of the only tools on the market at the time was made by Baptist Memorial Health Care. See their expense navigator tool here. I analyzed their interface to get a standard and see how they interpreted the requirements in the price transparency legislation.

I'll began by running through a common use case to understand the navigation and information architecture. First, I need to put myself in a patient's mindset so I have a purpose for using this interface. I developed the use case for an elderly man named John who suffers from dizziness throughout the day. His doctor said he needs come in for an impatient test for disequilibrium at the hospital in Memphis. (11 places called Memphis)

Heuristic Evaluation

Once I understood the steps in their form, I conducted a heuristic evaluation. This method is used for reviewing user interfaces and judging their usability based off of 10 heuristics. The heuristics are design rules of thumb developed by famous usability specialist Jakob Nielsen in 1994. Read his iconic article here. They are timeless principles that every website should observe.

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Begin Designing Version 1

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Prototype

The first prototype is available on figma through this link.

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Stakeholder Feedback

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Version 2 - Use Real Data

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Version 3 - Add Descriptions

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Version 4 - Insurance Form

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Comparing my Prototype
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Conclusion

What I learned

  • It's challenging to interpret design instructions from people not familiar with design principles.
  • I need to get better with information architecture. I was never able to take that class at KSU so I need to teach myself. That is probably my weakest skill.
  • Business people don't think of usability and have a vague understanding of the concept.
  • Healthcare is an incredibly complex field, but I love the challenge and want to have a career in that industry.

What I would have done differently

  • More user testing! I hate that I never had time to conduct tests with real users. I know it would have provided crucial insights on how to make the interface more intuitive.
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