Antonia Aglialoro

Background

Covered California, the health insurance marketplace for the state of California, has been providing coverage to Californian’s since 2013. Starting in June of 2016, I have been working with a small team to redesign the online portal that nearly 15 million Californians use to apply for and manage their health care. The redesign for the intake application was launched in early 2017 and we are currently iterating on what has been released as well as rethinking other aspects of the online experience.

Healthcare is really complicated. Looking at the original Covered California online application, it was evident that the design was heavily driven by complex policy rather than user needs. It felt very much like a government website; impersonal, unintuitive, and dense with legalese. In redesigning the website, our challenge was to build a simple and approachable experience that empowers individuals to apply for and manage their healthcare while still ensuring that the application adheres to the complex ecosystem of policies that govern health insurance.

Team

• Design director
• Sr. Interaction designer
• Sr. Visual designer 
• Sr. Content designer 
• Visual designer 
• Product manager 

My role:

• Planning and conducting regular in-person user research and testing
• Facilitating client workshops to uncover business needs and align on priority
• Creating and presenting research and testing findings, wireframes, logic diagrams, and interactive prototypes
• Working closely with design team to define and iterate design concepts

User Research and Testing

We started out by simply observing end users (Californians) using the original application to apply for health insurance so we could understand existing pain points. The following are some insights from these observation sessions that had the largest impact on our approach for the redesign.

Main Insights:

The following sections take a look at how each of these insights informed our design decisions.

Where to Focus?

During testing, we saw that when people were faced with multiple inputs or actions on a page, they would generally feel less confident that they had properly completed the required tasks on that page. Through the redesign, we aimed to reduce the amount of actions on a page so that the user only needed to focus on one thing at a time. While this did ultimately create more pages for the user to click through, we observed in usability testing the users were able to get through the pages more quickly and with more confidence. 

Income is Extra Tricky

Everyone’s income situation is different. A lot of people have multiple sources of varying income and it can be difficult for the consumer to feel that they’ve reported it properly. Especially since so much of the eligibility determination rests on income amount, there is a lot of anxiety associated with this lack of confidence.

Before:

The old application provided very little guidance to the consumer on what income to report. In our redesign, we aimed to simplify the income reporting process by providing guidance to the consumer about exactly what they can report. We walk the consumer through all the different types of incomes they need to report and provide descriptions for each. While we may have broken the process out into more steps, we found that the specific prompts and guided steps helped the consumer feel more confident that they were including all of the possible income sources needed to determine eligibility. The guidance removed the mental burden placed on the consumer to figure what they needed to report and made the process feel simpler and more straightforward.

After:

People are Scanners

When people are faced with text-heavy pages, the majority of the time people do not read. The more common behavior is to scan the page for headers and obvious actions. We also heard that a big part of what made applying for health insurance so intimidating was the language. The old application communicated to the user using healthcare jargon that even some of our clients had a difficult time understanding. As part of the redesign, the content throughout the application is at a 6th grade reading level or lower. Additionally, we also reduced the amount of text on a page and only surfaced the most important information required in that moment.

Reflections

Designing for Everyone

As designers, we’ve all heard the phrase “if you design for everyone, you design for no one”. When creating most products, it is possible to identify a core group of users and create a design that specifically meets their needs. However, when designing a product that is inherently meant to be used by all, we must embrace the challenge. Our team decided that designing for everyone didn’t mean designing every imaginable use case. Instead, we decided to prioritize our MVPs, or “most vulnerable people”. We defined MVPs as users who might have a disability, lower tech proficiency, lower reading levels, etc.

Multiple Stakeholders

CalHEERS (California Healthcare Eligibility, Enrollment, and Retention System) is the convergence of two sponsors, Covered California (CC) and Department of Healthcare Services (DHCS). Covered California is a for-profit health insurance marketplace and DHCS is a state agency that covers low-income and disadvantaged Californians. Together, CC and DHCS have joined forces to create a single application that Californians use to apply for health insurance. This is the application that we have been redesigning. Answering to two clients is tough. While both have a passion and unwavering dedication to the same underlying cause, providing healthcare to all Californians, each still have unique business goals and requirements. For our team, the challenge was to incorporate each business’s unique requirements while creating a cohesive experience for the consumer. We found that the best way to align the two groups was to keep the consumer at the center of the conversation and always ask for the "why" behind a requirement.