Streamlining e2e management of Clinical Quality Measure for physicians & quality managers
Streamlining e2e management of Clinical Quality Measure for physicians & quality managers
Lead UXD @ Athenahealth, 2022
Lead UXD @ Athenahealth, 2022
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The Problem was that Quality managers and physicians were using broken experiences to manage Clinical Quality Measures (CQMs)*. Avoidable mistakes caused athenahealth to pay millions in penalties & workarounds on behalf of the practices. Meanwhile Walmart's entry into health clinics added to concerns of the scalability of our quality management.
*Clinical Quality Measures help monitor preventive/value-based care. Bundled measures make programs. Healthcare providers are required to enroll into these programs and submit satisfactory reports on time to the payers(Insurers & govt) to get paid. Unsatisfactory reporting often lead to penalties.
My role as Lead UX Designer
My role as Lead UX Designer
Over a period of 3 months I conducted contextual enquiries, surveys, and customer feedback analysis in collaboration with research ops, CSMs, SMEs (Product, Legal, Quality performance managers, Engineering) to uncover workflows, motivations, pain-points, anecdotes, and technical constraints.
Remapped complex journeys into Jobs to be done format and later into user stories
Designed, tested and iterated concepts.
Problems of efficiency, visibility, time and scale
Problems of efficiency, visibility, time and scale
In Setup & Enrolment
Quality analysts exist primarily due to the complexity of measures, error-prone excel docs to enrol providers, and the lack of DIY. Small practices can’t afford to hire them. Operations team from athenahealth spend a lot of time resolving enrolment errors, so they started doing the enrolment on behalf of some clients. Requests from 65 accounts from our Commercial Priorities Rank 99 - $185M revenue
User needs
In Care Delivery
Providers deal with:
- Unorganised, repetitive and outdated measures
- Inability to satisfy soon to be due measures
- QM tab isn’t print-friendly and many more
Quality managers deal with an experience purpose-built for providers which is very different from their needs, tasks and goals. Request from 247 accounts take this in our Commercial Priorities Rank 67 - $467M revenue
User needs
In Performance tracking
Quality analysts exist primarily due to the complexity of measures, error-prone excel docs to enrol providers, and the lack of DIY. Small practices can’t afford to hire them.
Operations team from athenahealth spend a lot of time resolving enrolment errors, so they started doing the enrolment on behalf of some clients.
Request from 65 accounts taken from our Commercial Priorities Rank 99 - $185M revenue
User needs
In Submission
Error prevention in reporting & enrolment could prevent majority of issues & delays during submission that lead to penalties! Resolving issues takes about a day of back and forth, including re-enrolments. This time consuming, expensive reactive approach during the submission window. As a workaround some clinics chose to hold off enrolment until the submission period, but reducing their overall score due to missed opportunities by providers.
User needs
Pre-existing high level JTBD map
It was too broad, and besides looking like the prophecy to COVID19 it was difficult to use in discussions and explaining the journey of a measure in relation to roles.
I re-mapped the journey into a traditional format that is useful in discussions
I re-mapped the journey into a traditional format that is useful in discussions
Design
Design
New Design Principles
New Design Principles
Self Service
- Program & measure selection and enrolment
- Creation of custom programs, configuration, and mgmt.
- Decide & configure practice/provider performance targets
- Contextual guides especially in known areas of doubt
Better Tools for Quality Managers
- Measure & Provider performance tracking & analysis.
- Actionable insights over quarterly assessments
- Support contextual investigation, drill-down, worklists
- Common sense efficiencies (de-duplicate tasks,
manual overrides, etc,)
Clinically insightful
- Closer integration with clinical workflows to surface
point-of-care insights
- Curated performance analytics & insights
- Integration of 3rd party data and clinical insights
- Management and payer reporting
Seamless reports
- Unified reports that answer questions and get jobs done.
- Drill down charts
- Presets & customisable views
- Provide comparisons wherever expected
Strategy
By preventing all errors in enrolments, and undocumented measures pre-submission, millions won't need to be paid in penalties. Performance tracking could infact have a significant positive impact.
Strategy
By preventing all errors in enrolments, and undocumented measures pre-submission, millions won't need to be paid in penalties. Performance tracking could infact have a significant positive impact.
New journey
New journey
E2E Quality Experience Vision & Scope
E2E Quality Experience Vision & Scope
I'll manage Setup & Enrolment, and Point of care, QM tab, as the key part of the strategy was to get enrolments and documentation right.We would hire more designers to work on the rest.
Scenarios managed in the new vision
Scenarios managed in the new vision
To convince leadership the need for more designers I wire-framed scenarios, which showcase the benefit the new vision as a whole, and not just enrolment and QM tab.
1. Avoid penalties in the MIPS Program (Merit-based Incentive Payment System)
1. Avoid penalties in the MIPS Program (Merit-based Incentive Payment System)
2. Meet performance targets for commercial contracts
2. Meet performance targets for commercial contracts
3. Maximise performance in the MIPS program
3. Maximise performance in the MIPS program
4. Streamline submission related activities
4. Streamline submission related activities
Setup & Enrolment
Before - Sending Excel docs without error prevention to the Ops team, to enrol providers into the best measures took 2 to 14days turnaround time! Unless the clinic had their own IT dept. who would generate regular report to improve enrolments.
After- A 2-step DIY - Instant Enrolments with built in guidance & error prevention. Providers can opt in to auto submit for certain programs.
Step 1 - activate programs and measures
Step 2 - Enrol providers into active measures. Copy & paste the measures between providers of the same specialty. Done!
Enrolment walkthrough video
Enrollment UI.mp4Concept test findings summarised
Concept test findings summarised
Point of Care - Quality Mgmt. tab
Before
Point of Care - Quality Mgmt. tab
Before
Before
1. Duplicate measures in the quality tab of the patient chart confuse providers. Quality mangers un-enrol and re-enrol providers so that they can check performance without confusing the provider.
2. Sorting: Cards sorted by measure ID aren’t apparent to providers. Measures that will become due at the end of the year are listed under Other Measures (alongwith Satisfied Measures).
3. Lookback algorithm & Measure Satisfaction: How a measure was satisfied or who performed dismissals like Manual Asserts or Exclusions is difficult. Also measures could only be acted upon when they are in the ”due” state. If the patient came in a day early the provider would not be able to satisfy the measure.
4. Print for pre-visit planning: Without the option to print selected measures to use in pre-visit planning medical assistants print the whole web page as is.
5. Out of date: Providers toggle between the Chart and QM tab in the hopes that the data will be reloaded. The last updated date shows up only if there is a data scrubbing issue
6. Supporting Docs: Not all satisfied measures have a summary tab that shows the clinical record or action which satisfied this measure.
After
After
Solution 1 was built into the existing Patient chart
Solution 1 was built into the existing Patient chart
Grouped similar measures into one card with input fields required into a single form.
Sorting: No more Other Measures tab, instead all measures are consolidated into a single list. Shows all measures that will be due this year to align with what is shown in the Quality Measure Reports. Sorts the combined list by due date and highlight measures that are overdue
Measure Satisfaction & Lookback algorithm: Changed the lookback algorithm to find the latest clinical record that satisfied a measure. Allows practices to satisfy measures before the due date if applicable to that measure. Has common assertion fields for related measures.
Print QM tab for pre-visit planning: Allows the user to select measures for print per patient.
Out of date: A Refresh button to re-scrubs clinical data
Supporting Docs: Shows the summary panel for all satisfied measures
QM Tab in Patient chart - Solution 1 Walkthrough video
Solution 1 was a highly-praised by every customer, but one strategic customer who had built a custom UI over ours in the patient chart.
Without the ability to serve clients with different experiences I had to come up with solution 2 below.
Solution 2. A dedicated configurator outside the pateint chart
Phase 1
1. Sortable columns to help understand impact to providers and which measure to hide.
2. Show/hide duplicates that serve the same clinical need outside of the Patient Chart. This can be done by speciality, region and department can also be configured to copy & paste the setup to other departments or specialities.
3. A Show All measures in the Patient chart would still allow the provider to view hidden measures.
This solution manages to solve some but not all problems, that Solution 1 resolved.
Phase 2
1. Prioritisation helps understand the impact to their scores against the program, as certain measures gain more points than others.
2. Quality Tab Preview helps the quality manager see measures performance in a speciality and be sure that the list is uncluttered for the providers of the speciality.
Impact & Bonus
Impact & Bonus
No more Million dollar penalties due to bad or late enrolments.
we actually make more money, as we are partners with some of our customers
Reduced costs to support enrolments as we no longer needed such a large ops team.
Bonus: Walmart Health closed all 51 health centers across five states and shut down the virtual care offering. Quote “...the challenging reimbursement* environment and escalating operating cost+ create a lack of profitability that make the care business unsustainable for us at this time…
Challenges & learnings
Challenges & learnings
US Healthcare is riddled with technical, ethical, monetary and policy issues, which need to be handled with diplomacy, and compromises are to be expected.
Jobs to be done trumps Personas when there are such a large number of dynamic personas. Creating empathy among stakeholders for personas you plan to eliminate will get in the way of the efficiency you are trying the build.
Notification overload for a healthcare provider has gone overboard. We need to rethink notifications and alerts outside of our product in harmony with the physical space and devices. Create an open standard, like the Federal Aviation Authority.
What's Next?
What's Next?
I've stated onboarding new UX designers in India into the Quality management domain to design the remaining journey.
Quality management was also added to engineering scope to break up the monolith, to enable customisable solutions for strategic clients.
To prevent being blindsided the Quality head of the strategic customer was hired.
United Healthcare one of the largest insurance network wants to change how we prioritise quality measures...that's going to be Solution number 3! :D
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