Developers: Matt Bankston, Lorelei Kravinsky, Dean Mayne, Guillermo del Fresno
QA Engineer: Rick Ponti
TL;DR
The prior authorization experience is highly complex and sometimes unpredictable. I simplified this workflow and increased monthly prior authorization submissions by 40%, conducted 20 hours of research and analysis, and restructured the design review process.
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Finding and Defining the Problem
User Interviews + Shadowing Sessions + Survey
Discovering the Problem
As a part of my work, I conducted weekly user shadowing sessions to track outcomes and observe product usage, gaining direct insights from users. During a weekly shadowing session with a pharmacy team member, I observed them processing prior authorizations for essential patient medications through insurance companies. Prior authorizations are vital for patients to access life-changing medications. Completing them involves providing comprehensive patient health information, including pre-existing conditions, current/past medications, and allergies. The user encountered challenges as they navigated through multiple pages to access crucial information, highlighting a lack of consistency across various prior authorization processes.
Verifying the problem
Through extensive discussions with the pharmacy team and designers, we identified three key inefficiencies:
Information required for prior authorizations was dispersed across 5 separate sections of the website, sometimes not even present in the software.
They had to manually edit PDFs to remove non-submittable content like patient photos.
Manual data entry for prior authorization submissions increased the risk of errors and added to their cognitive load.
These inefficiencies lead to fewer submitted prior authorizations, resulting in patients being unable to access life-changing medications. Armed with this information, I formulated a problem statement.
Problem Statement
How can we streamline the prior authorization submission process for pharmacy team members, ensuring faster access to vital, life-altering medication for more patients?
Designing a Solution
Workflow diagram + Wireframes + Mockups
Workflow Diagram
With data gathered from shadowing sessions, user interviews, and a survey, I constructed a swim lane diagram illustrating the current prior authorization submission process. This diagram highlights the various pages and sites users interact with to complete a single prior authorization request.
This mapping exercise underscored the necessity to centralize information and align it with the flow required by the submission forms within our product.
Mid-Fidelity Mockups
Utilizing the diagram I constructed, I organized the required information for the pharmacy team and generated mid-fidelity mockups to present to our developers. These mid-fidelity mockups intentionally deviate from our product's usual typography, adopting grayscale and a less pixel-perfect approach. This approach encourages discussion on layout, information placement, and functionality, allowing developers to identify potential technical issues before dedicating extensive effort to refining the solution.
Following the successful technical review, we engaged directly with the pharmacy team, verifying that the information order aligned with the prior authorization submission form. The subsequent phase involved refining the design and ensuring it adhered to our design system.
High-Fidelity Mockups
I developed high-fidelity mockups that precisely adhered to our design system and component library, allowing developers to seamlessly translate these mockups into production without the need for substantial modifications.
Key Improvements
I aimed to address observed inefficiencies from the research phase and create a streamlined user experience. Here are the key improvements I made:
All the information required for prior authorization submission is now consolidated onto a single page, in the order it will be entered into the form which reduces context switching.
PDFs for submission have been meticulously edited to remove photos and any disallowed information in prior authorization requests.
PDFs can now be downloaded with just one click, eliminating the need to manually edit PDFs.
All fields are copyable to the clipboard with a single click, simplifying the process of pasting information into the forms.
The request modal now mirrors the user's natural workflow when referencing notes, creating a request, and updating its status, with non-essential information initially collapsed by default. This allows the software to form to their natural workflow.
To visually illustrate the workflow enhancements, here's the initial swimlane diagram:
And here's the diagram reflecting the project's progress:
Design Review Process Improvements
Ensuring Design Excellence
Before this project, there was no formalized design review process in place. Recognizing that each design process is distinct and contingent on each team member's unique experience, I took the initiative to foster conversations and facilitate a meeting aimed at its creation. This type of process helps identify any discrepancies between mockups and the final product. Having a structured and documented design process ensures that final designs and mockups go beyond being mere guidelines or proposals and define the expected final outcome. With this in mind, We collectively agreed on four key steps to ensure my oversight and approval of the design before it's released.
We implemented a structured design review process with the following steps:
Tickets requiring design review are identified during sprint planning sessions, and marked with a 'needs design review' checklist item.
During QA testing, the QA engineer references the designs and Figma files, flagging inconsistencies in both visual design and workflows in a video.
I review the QA testing videos, provide feedback for any necessary fixes.
Once the ticket meets design requirements, the 'needs design review' checklist item is checked off.
The integration of this approach within the team yielded remarkably impactful outcomes. By leveraging the comprehensive design specifications I formulated, encompassing visual design, interactions, and overall workflow, our QA engineer adeptly identified deviations from the mockups, culminating in a seamless design review process.
Throughout my tenure at Alpha, we consistently employed this review method, transforming our releases from MVP versions of designs into meticulously polished, pixel-perfect implementations.
Impact
Revamping both the workflow and overall design of the prior authorization submission experience spanned three sprints, following an iterative approach to incorporate user interaction and feedback.
In conclusion, after the improvements implemented during the third iteration, prior authorization submissions increased from under 2,000 to over 3,300 per month, marking a significant 40% rise in monthly submissions. In light of our initial problem statement, "How can we streamline the prior authorization submission process for pharmacy team members, ensuring faster access to vital, life-altering medication for more patients?" It's evident that we've made substantial strides toward our goal. Our efforts have resulted in expedited access to essential medication for over 1,300 additional patients per month.
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