Brandy Shigemoto
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CalHEERS: Product Design

The California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) is jointly administered by Covered California and the California Department of Health Care Services. It’s a one-stop shop for Californians to apply and select health care. When CalHEERS approached Fjord to redesign the portal’s application, our team was tasked with the challenge of making the process of applying for health care easy (and dare I say, fun).

 
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just what the doctor ordered

The California Healthcare Eligibility, Enrollment, and Retention System (CalHEERS) is a customer-centric one-stop-shop for Californians to find affordable, high-quality health care. This application is jointly managed by two project sponsors: Covered California, who represents the marketplace, and the California Department of Health Care Services (DHCS), who offers free or low-cost health care.

When a single application determines 15 million Californians’ access to health care, it isn’t just imperative that it works - it has to be clear, simple, and fail-proof. To better serve its citizens, the state of California asked Fjord to redesign the CalHEERS online health care application from the UI to the foundational technology. 
 

 
 
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Key Facts

  • The CalHEERS portal determines 15+ million Californians’ access to health care
  • The project consists of two sponsor clients
    • California Department of Health Care Services (DHCS)
    • Covered California
  • The portal initially went live in 2013, and our work, starting in 2016, was its first major renovation to the front-end design and underlying technology
 

 
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Key Challenges

  • Two client partners with distinct business needs and regulating policies
  • The application has to play nice with two other interfaces
  • How do you design for everyone? The entire state of California makes for a very diverse customer base
  • A glacial pace of change with waterfall methodologies, risk aversion, and competing business priorities
  • Complex rules engines and business requirements
  • Legacy portal and application is not mobile friendly
 
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Design Pillars

We established three foundational design pillars for the redesign. 

 
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Humanize

Supplement content with visual aids, remove stigma by socializing the culture, provide hints and tips throughout the journey.

 
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Simplify

Define sections with simple, focused, and approachable content with clear wayfinding and progress indicators.

 
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Personalize

Adapt flows in response to user input, and provide flexible controls to refine content based on user needs.

 
 
 

Client Collaboration

In order to fully understand how the application mechanics worked, we hosted several interactive workshops with our clients. We met with them frequently throughout the redesign process to ensure our design supported all government mandates. 

To gain a deeper understanding of the existing CalHEERS portal we first held onsite stakeholder and subject matter expert interviews. I was able to meet with the marketing and technology teams to walk through their existing style guide and accessibility compliance standards in order to identify opportunities and constraints in the visual design. Afterwards, I worked with the visual design team to craft three distinct moodboards that paired well for both clients. Focusing on a friendly and vibrant direction, we created a design system that reinforced security and usability. Read more about the visual design evolution here. 🐻

 
 
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Application Sections

As part of our kick-off, we held a card sorting workshop with the sponsors where we looked at the application’s current questions and sorted them into relevant groups. Together we found that the current application felt unnecessarily lengthy and that there was a large opportunity to explore ways of making the questions feel more digestible and easier to answer. 

After synthesizing the workshop output, we broke up the application into four main sections:

  1. Introduction & Overview
  2. Household Information
  3. Individual Information
  4. Review & Submit

From there we crafted the CalHEERS ecosystem for a first-time user. This includes a holistic view of the application from signing up for an account to enrolling in a plan.

 
 
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Tackling the Hard Stuff

After breaking down the application into sections, our team chose to tackle with the most complicated piece first: income. Naturally, anything to do with money is a #trigger and people were routinely stressed out when it came to the confusing technical terms. We also learned that people often input fabricated amounts and adjusted the numbers to see if they could alter their eligibility results. These factors typically led to inaccurate information, preventing families from receiving health benefits. 

In order to capture accurate results, we created a step-by-step flow to guide the user through adding income and deductions. Consumers are walked through each income group page-by-page as the application surfaces content in bite-sized chunks. We also provide additional hints in tooltips to provide as much help as possible without overwhelming the user. 

After more than five rounds of testing and iteration, we created a flow that inspired more confidence and set the user at ease. Errors on the application have decreased 9% since the income section redesign was released in February 2017 (reported in early 2018).
 

 
 
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Motion:  Erich Reimers
 
 

Prescriptive and Progressive

Similar to going to the DMV, applying for health care is a dreaded and complicated task that no one looks forward to. The existing CalHEERS application came across as intimidating and used technical jargon that made it hard for users to digest and understand. 

Striving for a 6th-grade reading level, we worked to reduce and simplify the content. Our team repackaged the application’s federal and state rules engine to create a charming, empathy-driven user experience that eliminated gratuitous questions and emphasized security and reassurance. Users now spend less time searching for definitions or scrambling to answer unnecessarily complex questions and spend more time finding the right care for their family. 

To make the application less daunting, we knew we needed to keep the user focused on one task at a time. We set up a progress indicator in the application's menu that checked off each time a user completed a section. Our team created a step-by-step approach where the user could see exactly where they’re at within the process without jumping ahead and skipping imperative questions. 
 

 
 
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Motion:  Erich Reimers
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Group Questions

One challenge we faced coming out of our project workshops was that the sponsor’s thought the application felt long and monotonous, especially when a user had a rather large household. Since the majority of the questions are required by state mandates and could not be suppressed, we looked at how and when we could group certain questions in order to optimize the user’s experience.

We introduced a new way of asking questions. Our household section of the application now presents all questions at a group level, significantly reducing the perception of redundancy.

Instead of asking “Is this person pregnant?” seven times for all seven people in the household, we ask “Who is pregnant?” once at the household level and then capture any necessary follow-up information from there.
 

 
 
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Supporting Enrollment Periods

After we completed a massive overhaul of the intake application, the next step we took was to tackle the returning user flow. We needed an application for a returning user that could support two unique cases: Renewals and Report a Change (RAC). For Renewals, returning consumers needed the ability to review and update their application information quickly. For RAC, returning consumers needed the ability to easily report life changes to their application (e.g. giving birth or an adoption), and change their coverage, at any time during the year. 

By creating a custom returning user flow, we greatly reduced the number of pages a user has to navigate through. Instead of going through the intake application (like the previous CalHEERS portal), we spend the first half of the application asking follow up questions to ensure information was still accurate based on previous entry. Questions that appear include “Has your household changed?” allowing users to quickly add or remove members, which then informs the rest of the questions shown to the user. We also integrated helpful information throughout the flow; the application now asks the user to confirm tax and income information while surfacing life events that could affect each section, such as marriage or divorce.

After confirming updated household information, we then collect the majority of the individual information in one place. We found that returning users are typically there with a specific change in mind, however, they still want the opportunity to review all information without having to navigate through an entire intake flow. Once a returning user has completed the application, they can then proceed through the eligibility section to find out what subsidies or programs they qualify for, and then choose a plan. 
 

 
 
Motion:  Erich Reimers
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Application Results

By creating tailored and dynamic flows, we shifted the paradigm from concept-driven to human-led. The application is now personalized and intuitive, reducing the cognitive burden for the consumer.

  • Errors on the application decreased 9% since the income section redesign was released in February 2017.
  • Help center call volume decreased 10% in the same period.
  • Despite the current political climate, 88% of Covered California members are very likely to renew their coverage for 2018. 
  • With 10% of consumers dependent on a phone for internet access, the new adaptive portal experience meets people where they are–whether that’s on a desktop, tablet, or phone. 
  • The success of the single streamlined application has opened new streams of work, including other areas of the consumer and admin portals, as well as new modes of the application. 
 
 
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Lessons Learned

Designing for the entire state of California makes for a large user-base and challenges the notion of designing for everyone. Our team focused on designing for people who have a low-tech proficiency and lower education and income levels. I learned a tremendous amount about inclusive design, attempting to accommodate as many people's needs as possible, and striving to use simple and approachable language for complex and technical subject matter.  We ultimately increased the number of pages in the application, but greatly reduced the cognitive burden of the user by breaking up content into manageable chunks.
 

Design Results

  • 150+ users tested
  • 14+ rounds of user testing and refactoring
  • 7+ client workshops
  • An application that supports single-member households, multi-member households, returning users, and first-time users
  • A component based system to support onerous and growing legal/policy requirements
 
 

 
 

Date: 2016-2018
Company: Fjord
Project: CalHEERS
Role: Visual Design Lead

 

 

Core Design Team:
Kenzie Haynes (Design Director)
Anna Owens (Project Management)
Antonia Aglialoro (UX)
Ben Leffler (Content)
Brandy Shigemoto (Visual)
Philip Sullivan (Visual)