Joanne Mendel

Client objective

Solution

Kaiser’s Innovation Fund proposed an initiative to meet a systemic organizational need,  improving member experience and increased efficiency in pharmacy payment systems at points of service across channels: pharmacies, phone, apps, online and in hospitals and medical centers.

Member experiences and staff workflows were journey mapped to identify needs for each channel.

On-site research revealed opportunities to improve pharmacy workflows and billing/payment experiences impacting members, staff and the systems that support their work.

A solution framework mapped opportunities identified across all channels and stages of the experience to ongoing initiatives and inform those efforts. Additional new opportunities were prioritized.

Secondary research

• Pew, Forrester—mobile payments;

• Gartner adjacent category research—mobile devices

Ethnographies

• 30 Interviews with HMO staff and members in 2 cities: Denver, San Diego
  Topics: experience, financials, payment, attitudes towards mobile payment

• Member Journey mapping groups (6 groups)

• Staff journey mapping groups (4 groups)

Member and staff personas describe preferred technology and financial attitudes and practices.

Different aspects of the service experience was important to each persona — either cost, accuracy or time was most important to them.

Journey maps provided a view into member and staff activities, emotions and operations across stages of their experience.

Three maps were created:
• Rx refill centers
• Hospital discharge pharmacies and outpatient locations
• Phone, app and online channels

Opportunity areas were identified on journey maps at the stages where they occurred in the user and operational experience. A high-level summary of opportunities was generated for each channel.

Insights:

• Pain points in member & staff experiences often correlated with additional pain points on the operations side—for staff and/or systems.

• Pain points that happened early in the process often generated additional, avoidable pain points in later stages of the experience.

The payment reconciliation knot —pain point

• Because drug pricing isn’t available to members at time of a purchase, they must estimate the amount to charge or write a check for.

• Later, they may be asked to cover additional costs if there’s a gap between what they paid and what’s owed.

• When invoiced for additional charges, members must track the difference between what they paid vs. what’s owed, a source of confusion and frustration.

Solution thought starter — How Might We…

• Eliminate the need for payment reconciliations by making drug pricing available members placing their order via phone or online for mail order Rx delivery.

The solution framework is made of up opportunities and corresponding ‘Solution Thought Starters’ mapped to each channel and stage of the pharmacy experience.

Opportunities were mapped to company initiatives that were underway so that they could be incorporated into work-in-progress.
The remaining opportunities were prioritized as new initiatives.