Navigating health ecosystems: A payer perspective

How a team of DIA Design apprentices helped to untangle a web of healthcare data and analytics, medical coding, and health risk adjustment systems

Navigating health ecosystems: A payer perspective
Photo by Carlos Muza / Unsplash
Simplistic entity relationship diagram showing how patient data in the form of codified medical records are submitted in claims sent to government agencies (to Center for Medicare and Medicaid Services and state agencies) for Medicare reimbursement by payers.

Situation: What was the situation we faced?

Health risk adjustment platforms, including the one created by our client, can be difficult to use and not designed with an overarching strategy in mind.

Over a 6-week assessment project, DIA Design worked with Episource to develop a current state journey map of Episource products.

Payer Healthcare Analytics & Technology Solutions - Episource
Episource is simplifying healthcare. From analytics to submissions, we are reinventing the risk adjustment and quality workflow for Medicare, Commercial, and Medicaid health insurance companies.

We developed recommendations for their platform by focusing on 4 of their products and services.

Tasks: What tasks were involved in that situation?

Our main tasks were to:

  • Create a journey map of their products
  • Identify their users
  • Define key user flows
  • Discover user needs

We needed to figure out:

  • Where products and services started and ended
  • Who and what systems were involved in each step and phase
  • How all Episource products fit together

Actions: What actions did you take?

Before the project started, we researched the domain space and created an ecosystem map to understand the domain of healthcare data and analytics, Medicare reimbursement, and risk adjustment.

We brought together a team of:

  • 2 designers, Jessi Shakarian and Justin Kim
  • 1 researcher, Priyanka Sanghavi
  • 1 data scientist, William Lage
  • 1 information architect, Grace Lau

to conduct the research and discovery sessions.

Over the course of 3 weeks, we met with product and engineering stakeholders to conduct product walkthroughs and demos.

Further activities included:

  • Stakeholder interviews
  • Gathered contextual information to ensure accuracy of proposed product models.
  • Discovery “homework”
  • Reviewed existing internal literature, diagrams, and product demos.
  • Created a comprehensive visual map of existing product space.
  • UX audits/Heuristic evaluation
  • Identified areas for improvement by tagging product screenshots on FigJam.
  • Generated findings and solutions using Nielsen Norman’s usability heuristics.
  • Competitive analysis
  • Compared competitors’ landing pages to the client’s products.
  • Journey mapping
  • Story-boarded an ideal future state for key users across each of the 4 products.

Result: What were the results of those actions?

As a team, we learned:

  • a LOT about healthcare data and analytics required by the US government
  • what it took to compile a thorough findings report
  • how to make design recommendations for various lengths of impact

Some of our biggest learnings and takeaways as apprentices were around:

  • Onboarding into an extremely complicated domain space
  • Learning to set expectations for document organization
  • Building confidence to ask questions
  • Accepting project ambiguity and uncertainties
  • Teamwork and collaboration

On the client side, Episource is bridging their product and engineering teams together to raise awareness and continue the work we started to cultivate customer-centric and research-driven culture in the organization.

Thank you and your team for the great case study work which established an important groundwork for us to start build a user focused and research driven design process in the organization!

~ Sungae Park, Head of Design, Episource LLC

Ecosystem Map