Millions of citizens rely upon The Healthcare Marketplace for medical coverage and benefits.
Citizens can also appeal coverage and benefit decisions they receive.
The CMS Marketplace Appeals Group (MAG) needed a better way for citizens to access, complete and submit their appeals.
The current process was confusing to users and often led to errors on the backend due to inaccuracies when using the paper form method.
MAG could reduce costs by diminishing the manual labor used in processing the intake of appeals and reducing dependency on the appeals call center and appeals mailroom staffing.
Estimated cost savings/avoidance of $1,881,600 per year following full implementation, beginning in FY 2024.
Modernize Healthcare.gov’s medical coverage and benefits
appeals process to create an easier and more accurate process for appellants.
Convert a confusing manual form experience into a seamless interactive conversation
between CMS and appellants.
We planned to synthesize data from our user research and discovery sessions with key
stakeholders to allow us to craft a vision for what a ‘digitized and streamlined’ appeals
experience should be.
Our vision was to replace a ‘conveyor belt’ user experience with a
‘friendly interactive conversation’ to make the appeals process more efficient and friendly
for users and CMS agents.
Research
Review CMS research
Insights
Personas
Analysis
User Journey Mapping
Ideate
User flow
Lo-fi designs
Wireframes
Design
Style guide
Design system
Wireframes
Hi-fi designs
Test
Consumer Feedback
User Acceptance Testing
Launch
Feedback loop
Continuous improvements
We reviewed early qualitative research from CMS and their findings.
CMS Marketplace Appeals Group User Questionnaire
Page-level survey - R3 Branded
Top pain points:
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First time appellants wary of complexity of an online option
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Appellants often do not have required information readily available
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Users did not like having to add dashes to their phone number inputs
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Active appeals should be available for the Appellants to review
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Expedited request option is not clear
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Calendar date picker does not work well for older Appellants
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Confusion was evident around signature sections
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Appellants would like the option to switch back and forth from English to Spanish during the form workflow
Top insights:
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Appellants have experienced a wave of emotions up to this point, so the onboarding needs to be easy
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Too many steps across multiple systems is confusing appellants
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Verbiage instruction needs to be more clear for each step to inspire confidence and minimize doubts
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Offer the ability to view all appeals: active or closed
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Display more information around authorized rep and signature sections
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Display a step tracker so appellants know where they are in the process
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Let appellants know when CMS requires more information/documents through the portal or email/SMS
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Provide an overall sense of efficiency when requesting or confirming receipt of documents
We designed 2 personas to help us understand and convey the story of the appellant portal design. Kristen helps us tell the journey, needs and expectations of a first time appeal submitter. David is our persona that has already submitted an appeal and has appeals in process.
We worked with CMS Marketplace Appeals Group (MAG) stakeholders to build the low fidelity wireframes.
Cool fact: CMS was using Sketch but was very open to seeing how Figma would work and this prototype was their first chance to experience the awesome collaboration benefits it offers. CMS quickly Fedramped and approved Figma use shortly after launch of the portal!
We used the CMS design system as a foundation and created a modern looking theme.
