ACO Program Mgmt Tool
In 2017, new federal legislation introduced value-based reimbursement models which fundamentally changed the way healthcare organizations are reimbursed. I worked on a software team that was tasked with building a cloud-based, SaaS application to support these new payment models for our ACO clients. Below is a snapshot of our journey.
The Challenge
Building Value In A Value-based Reimbursement World
Building Value In A Value-based Reimbursement World
Considering the range and scope of job roles needed to support a successful CMS-compliant value-based reimbursement program, the challenge was to build an app that allowed an array of user groups across an Accountable Care Organization (ACO) to effectively manage + monitor clinical, financial, and claims data of their patient populations in order to accomplish organizational goals and lower cost. The tool had to be robust – affording our users a way to maintain disparate data sources, identify at-risk patients, administer patient care management activities, and provide actionable insights through a reporting dashboard. Finally, the tool had to answer an important question for health care organizations:
"Which performance opportunities will yield the most impact + value for my efforts?"
My role
I led the user experience and product design from June 2016 to April 2017 working with an agile team that comprised of a product manager, delivery manager, and dev team. I stopped working on the app after it was sold in May of 2017.
Discovery
Understanding the problem
Understanding the problem
First off, my team researched the ACO healthcare environment and its participating actors so that we could better understand our user's current state workflows and associated challenges. We observed healthcare professionals working day-to-day, performing clinical and administrative tasks both in the front-office and back-office settings. We also conducted comprehensive discovery interviews to better understand goals & impediments and to test our initial assumptions around what it’s like to be a healthcare professional.
One pervasive problem that we identified early in the discovery process was that time and resources are extremely limited as a healthcare organization. Understanding this was critical to crystallizing some basic universal questions our tool had to answer from an ACO’s perspective:
- Which low-effort / high-impact activities bring the most value?
- Which patients should we focus care management resources on?
- How is our staff using the tool so that we can be more efficient?
- Have we received the data that we expected to receive and can we trust it?
- Overall, how are we performing in the major categories of cost, utilization, and risk?
Understanding the user through personas
In order to maintain deep user empathy and identify commonly desired end-states, we utilized personas. Below is a snapshot of the personas we developed through a series of on-site observations, client discovery calls, and user interview sessions.