The challenges plaguing the launch of Health Insurance Exchanges across the United States to date are well publicized and have left many – justified or not – shaking their heads. Despite the challenges, the objectives of the plan are admirable and grand, and will provide great lessons about how large technology projects should be approached. One lesson that has become apparent early on is the lack of a customer-centric approach in the development of healthcare.gov. That same problem has been evident in the mHealth market.
A large block of the rapidly growing mHealth market is associated with extending the life cycle of the existing infrastructure of large-scale, legacy systems found in healthcare. These systems are critical for the daily operations of provider and payer institutions, yet cumbersome for users. They were built to process high volumes of transactions such as scheduling an appointment, admitting a patient, producing a bill or processing a claim. Adding an mHealth application into this environment typically means delivering mobile access or creating a mobile application that extends the existing, cumbersome capability of the legacy system. In either case, users suffer from desktop-based systems and mobile applications that lack customer-centricity – a high quality, efficient customer experience for the user.
The lack of customer-centricity is evident, too, in the Health Insurance Exchange efforts. Despite being new, many sites suffer poor enrollment counts because they were designed as transaction systems – taking an application, creating an account and processing data. The designers of these systems missed the point, which is to allow customers to shop for, and buy, health insurance. Instead of being customer-centric, many HIX designs focus on the transaction, not the user.
A similar tactic can be applied to developing mHealth applications. To wit, take the mobile-first approach – build for the customer in mind, and don’t try to build everything at once.
[See also: Doc's, devices and data: How to sort it all out.]
A mobile-first design strategy means designing an mHealth solution first and foremost from the perspective of a basic mobile user. Joshua Johnson described this well in his April 5, 2013 article "Mobile First Design: Why It’s Great and Why It Sucks." Johnson wrote: "You put your best foot forward on the mobile platform, providing the users with minimal screen real estate, processing power and third party plugins (for) an amazing experience that both looks great and functions perfectly." This is a customer-centric approach. The solution design intentionally controls screen views, interactions and data flow to give the customer a highly functional and pleasing omni-channel experience. The customer can use a smartphone, tablet, laptop or desktop with equal ease at any stage in the process. As for the negative aspects alluded to by Johnson – he readily admits they are just his own personal whims as a programmer.
Once the basic mobile user experience is created, ‘progressive enhancement’ – a concept coined by Steven Champeon – is systematically applied to the solution. Improvements and enhancements are added, progressing from the basic mobile user through increasingly sophisticated and powerful user environments.
With mobile-first, processes and steps are built in for the customer to engage and disengage, intentionally moving users off-line both to prevent marathon-long enrollment processes and a glut of online users clogging the system. The solution is built to deliver or collect key data as necessary with instructions to the customer when to log back in to take the next steps, a concept common to user-friendly online tax programs or lending sites.
Leveraging customer-centric mobile-first design, the health insurance exchanges could control content, interactions and data flow for a high quality and efficient customer experience. Doing so alleviates the potential to overburden an exchange system by delivering an intelligent shopping and buying experience and eliminates the black eye of enrollment bottlenecks.
Mobile first design is a simple and elegant customer-centric strategy to address the technology gaps like those experienced in the national health insurance exchange crisis.
As a principal in Pega Healthcare Solutions, Bill Marshall is a chief strategist and tactician for solutions in the rapidly changing U.S. healthcare market. He has specialized in the sector for more than 25 years, leading the launch of companies, divisions and products around such diverse solutions as decision support, data warehousing, ICD-10, care management, revenue cycle, total quality management, RAC and meaningful use.
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