Exchanges by Design: Building a Consumer-Friendly Interface

With two years remaining until the launch of state health insurance exchanges, state officials across the country are working diligently to design and implement their exchanges (for a recap of current state progress on exchanges, be sure to check out this recent State Refor(u)m blog post).  Of the many exchange components states are currently working on, one that is particularly important for eventual exchange users is the development of the user-interface or, in non-tech terms, the website or web portal. Specifically, through this interface, consumers should be able to apply for coverage programs, calculate expected tax credits and cost-sharing, and obtain standardized comparative information about available qualified health plans.
The look and “user-friendliness” of the web portal will be especially important in drawing consumers to an exchange and to make sure that they get the help they need to choose a plan, enroll, and stay covered.  Among the many design considerations, states will need to be especially aware of keeping information at appropriate literacy levels for consumers as well as how best to display relevant data to consumers.  To delve further into these design issues, 11 states are participating in the Enroll User Experience 2014 (UX2014).
UX2014 is a project charged with “developing a first-class user experience design for health insurance exchanges.” Distinct from other exchange development efforts, UX2014 is philanthropically funded and centers on the philosophy of what makes a good user experience inany context. I recently had the opportunity to interview Jim Jones, Senior Consultant, Sellers Dorsey, about his work with UX2014.  He shared some early lessons from the project:

• Be wary of the written word. In writing text for the exchange, developers should use clear and direct language written at an appropriate literacy level so that it can be easily read and understood by consumers.  Developers should also be aware of potential intonations and nuances that may impact consumer reaction to the exchange or skew responses needed for accurate eligibility determinations.  For example, instead of asking, “List your earned income’ it is more appropriate for an exchange to ask, “What do you get paid from your job?”
• Design for a varied audience. Exchange consumers will vary in the level of assistance or independence and the amount of detail they will desire or need as they navigate the web portal.  Designs should account for the variability of consumers and empower consumers to self-navigate through the enrollment process while also providing ample mechanisms for consumers to get assistance or explanations about available coverage options.
• Build environments that foster consumer trust. Consumers will be expected to share personal data with the exchange, and so exchanges must be designed in a way to build trust with consumers.  While serving different functions than the exchange, developers may want to look to popular websites for examples of successful personal data gathering, including banking websites, tax preparation websites (e.g. TurboTax®), travel sites (e.g. Kayak.com) and dating websites (e.g. Match.com®).
• Gauge consumer expectations on data sharing. Data sharing capabilities between federal and state hubs and the exchange will facilitate the process of data verification and eligibility determinations for consumers applying through the exchange.  However, Mr. Jones noted that users have conflicting reactions to these data capabilities.  Where some will be frustrated by sharing information they believe the government should already have access to, others will be deterred if an exchange seems to know too much. Developers should be sure to gauge the attitudes of intended audience so that they can build compromises to optimize data collection. In addition, the user interface will need to account for situations where the data sources aren’t available for that person at that time or contain dated information that no longer reflects the current status of the family (composition, income, etc.).
• Consider the needs of navigators. While consumers looking to obtain information about health insurance and subsidy options will be the primary users of the exchange, it is also important that exchanges work for the various entities designated to assist these consumers through the navigator program. Designers should consider embedding tools into the exchange portal so that these assistors can be more successful including account management capabilities.
• “You only have one right foot, and you need to get off on it.” Although, states face fast approaching deadlines to implement exchanges, it is important that states build-in adequate time to conduct testing and work out any programmatic kinks.  It will also be important to manage public and political expectations at the launch of the exchange.  According to Mr. Jones, “nothing is perfect at the beginning,” yet early design flaws may put the exchange at risk of building a negative reputation that will deter future users.  “Consumers will only embrace the system [once] it is proven to work for them.”

Free resources from UX2014, including a variety of deliverables and design guidance, will be publically available to states in 2012. For more information about the design principles of UX2014, as well updates about the project, be sure to check out their website: https://www.UX2014.org. For more information about state-specific activity related to creating a user-friendly exchange, be sure to check out resources posted on State Refor(u)m, and let us know about your state’s activities in the blog comments below or on your state’s milestone page.
Note: This blog post originally appeared on The SHAP DiaBlog run by the National Academy for State Health Policy, which shares lessons and best practices learned from the 13 states expanding access to coverage through participation in the State Health Access Program sponsored by theHealth Resources and Services Administration.