What's Working

Opening the Door
What a Big, Yellow Bird Can Teach Colorado's Exchange Portal

  What's Working - Winter 2012 - Opening the Door

By Rebecca Jones

Forty-nine-year-old Cheyenne knows she can change doctors if she wants to, but the hassle of doing so keeps her where she is. "I already have so much chaos in my life [that] it is easier to keep things like they are," she says.

Johnny, 59, fears enrolling in a health plan that asks too many personal questions. "They know more about me than I do," he says.

Tiffany, 29, likes to comparison shop to see what others' experiences with a product have been. "I'm a review queen," she says. "I look at reviews on anything."

Cheyenne, Johnny and Tiffany are among 15 people who top-level design engineers have studied intensively to develop a top-notch user experience for the state-based health insurance exchanges opening in 2014 under the Affordable Care Act. Individuals and small businesses will be able to shop online for coverage. The trio's comments are excerpted from the research for Enroll UX 2014.

Funded by a group of eight national and state health foundations, including the Colorado Health Foundation, Enroll UX 2014 will offer design standards for an online health insurance portal that will guide people to the best decisions for health insurance coverage. Teams from the federal government and 11 states are participating in the project. "UX" stands for "user experience."

The creative talent behind the project is IDEO, a global design and innovation consultant. The company's portfolio includes making accessible housing for disabled military veterans, designing Sesame Street-themed games for iPhones and coming up with a brand strategy and service model for Converse and its iconic Chuck Taylor sneakers.

"We're bringing the most creative Silicon Valley talent to the process to make it approachable," says Sam Karp, vice president of programs for the California HealthCare Foundation, which has taken the lead in overseeing the project. "Consumers should have a first-class user experience similar to the best retail website. This type of resource has never been brought to bear on this type of project before."

IDEO is well-known for its human factors research, a relatively young field that studies human abilities and characteristics and applies them to design projects. For UX 2014, IDEO researchers visited 15 people in three states – Ohio, Louisiana and California – to delve deeply into their relationships with their insurance carriers and to study what factors went into their health coverage decisions. The consumers chosen for the study represent a range of regional cultures, political persuasions and health care coverage experiences. Understanding their motivations and values gave designers ideas about how to make an ideal portal.

Karp hopes that by thinking like designers, the people who set up health care exchanges can combine what is desirable from a human point of view with what is technologically feasible and economically viable.

Once the design is complete, Enroll UX 2014 will be made available free for states to use or to customize while building their health exchanges. The design will support all manner of insurance programs, including Medicaid and the Children's Health Insurance Program. Karp hoped to make the design available about the time this issue of Health Elevations is published.

"This project really is driven by an understanding of consumer needs and desires, and how consumers would like to interact in enrolling in health insurance," Karp says. "We're trying to design based on what humans need to actually enroll efficiently. Some people need more support while some need less. How do we address those needs when 40 million Americans become eligible for coverage? That's a lot of people to get signed up, and most of it should be done online."