5 Lessons Learned in Redesigning America's First Health Insurance Exchange

November 21, 2011

By 2014 there may be 20 or more unique state health insurance exchanges selling plans directly to consumers who have never before purchased insurance. How can the user experience of a health insurance exchange be optimized for success? What is success?

A merely good state insurance exchange will meet its legal obligation and offer insurance policies directly to consumers. A great state insurance exchange will do much more - it'll guide consumers through the buying process like a health insurance sherpa. The result will be a consumer who will choose a plan fully confident in their decision.

Here are some tips we learned in the redesign of the Massachusetts Health Connector to help planners, designers, implementers and others involved in state exchanges aim for greatness.

1. No one wants to buy insurance: embrace that.

   It's an unfortunate reality, but honestly, no matter how cool, engaging, and painless we make the shopping experience, who in their right mind gets enthused about buying insurance? Rather than trying to make the shopping experience a pleasurable experience, avoiding frustration should be the goal.

   This means there should be nothing frivolous in the interface. Let them get in, learn a bit, make a confident purchase, and forget about it for the next 12 months.

2. Show all plans without bias.

   The Connector team was asked to use a Gold, Silver, and Bronze label system for grouping plans. With the metal system it's easy to think of Gold plans (no deductible, high monthly premium) as better than Bronze plans (high deductible, lower monthly premium) and design the interface that way. This leaves the consumer who purchased a Bronze plan feeling like they bought the cheapest car on the lot. Be objective and encourage the user to consider all options (see #5).

   

   Wireframe concept explaining Benefit Package tiers for Health Connector - Spring 2011

3. Take every opportunity to demystify insurance lingo.

   

   Assuming the consumer has a basic level of insurance familiarity is a big gamble. When a consumer doesn't understand the basic concepts of a product (that they are probably not even enthused about buying) this is the recipe for disappointment and resentment.

4. Let the consumer pick a plan by deduction.

   In an obligatory purchase like this, the consumer is going to narrow down their plan options to a short list of ones they find least painful, then choose the lesser of evils from that list.

   This is a deductive process. Giving consumers the ability to hide plans that they don't like is as important as letting them compare plans.

5. Encourage the consumer to think about total cost of ownership.

   

   On the surface, saving $150/month by choosing, for example, a Bronze Low plan over a Gold plan would save $1,800 over the course of the year. But since a Bronze Low plan carries an annual deductible of $2,000, all savings would go down the tubes if the consumer were to accumulate $2,000 worth of medical expenses that year.

   Getting a consumer to think in terms of a 'total cost of ownership' (premium + expected out of pocket expenses) is in their best interest. Consumers are comfortable considering a car's purchase price in combination with its fuel economy numbers...why can't we encourage the same behavior when shopping for insurance?

   Still, despite a UX designer's best efforts, some consumers will want to rush through, pick a plan they are familiar with, and get the heck out of there before the dust settles. Any educational content you try to put in front of them will be seen as an obstacle. Here lies the delicate balance between pulling off lesson #1 and lesson #5.

   A decision support wizard may be a potential solution for this one. The consumer would answer some simple questions about how much usage they think they will have, how comfortable they are with risk and unforeseen expenses, etc. The wizard's output would be a recommendation on what types of plans would best serve the consumer and why.