UX/UI
UX Research
Product Design
This prototype was presented by Blue Shield of California's CEO at the 2024 HTLH US Conference.
Company: Blue Shield of California
Role: UX Designer
Team: Product Manager, Product Designer, internal SMEs, UX Researcher
Timeline: 4 weeks
Tools: Figma, Figjam
full case study
what is prior authorization?
The prior authorization (PA) process in the U.S. healthcare system affects both patients and healthcare providers. It is a time-sensitive process that requires providers to obtain approval from a patient’s insurer before providing certain treatments, medications, or services to ensure they are medically necessary and covered. While intended to control costs and prevent unnecessary care, the process is often criticized for causing treatment delays and administrative burdens. The large number of different health insurance companies and differences in their PA claim submission processes can easily become overwhelming and frustrating for providers, especially for those with a high volume of patients.
to combat these issues:
Our internal team needed to design a future-state prototype that communicates an efficient and user-friendly method for how PA can be managed digitally via an electronic medical record (EMR) system, which providers use to create and manage patient charts. The goal of this design is to showcase a streamlined workflow in which providers no longer need to use a separate system in order to submit a PA claim, which would reduce friction and also align with Blue Shield's goals in digital transformation in healthcare.
ux research:
User research for this project involved primarily secondary research from previous projects, including interviews with those involved in the claims process (e.g. providers, clinical reviewers, case managers, operations). The UX research team compiled a Figjam file to map out the current-state journey and highlighted friction and pain points.
From these research findings, the team was able to define success criteria for the prototype, which primarily focused on an integrated, easy-to-find, user-friendly PA claim submission form within an EMR.
EMR design:
Leveraging my previous experience working directly with EMRs as a medical scribe, I was able to design a high-fidelity prototype of a fictional EMR. Design elements were inspired by the EPIC EMR system.
modal:
We designed a modal to alert providers if part of the patient's treatment plan requires PA approval. Clicking the "Create Prior Authorization" CTA button would then prompt the EMR to autofill the PA claim form based on information from the patient's chart.
integrated documentation panel
To reduce screen-switching or multiple windows, we included a collapsible document viewer for attachments, such as the autofilled PA claim form, directly within the EMR.
real-time PA claim status updates
We designed visual status indicators within the PA submission form as well as a pop-up modal (not shown) that communicates real time approvals/denials, which would allow the provider to change the patient's treatment plan, if necessary.
BSC patient portal app
Patients also receive real-time notifications via their patient portal app when their provider submits a PA claim as well as when there are updates to the claim's status. Patients can also log in to see what treatments/medications were requested.
The final clickable prototype was presented by Blue Shield of California's CEO at HLTH 2024 to showcase the enterprise's digital health transformation efforts.
It was praised internally for helping stakeholders visualize a potential product for such a large-scale, operationally heavy effort.
The clickable prototype was later used as a reference model during product roadmap planning sessions for Blue Shield of California's digital health transformation initiatives.
The prototype was also featured on Blue Shield of California's YouTube channel, in a video promoting the enterprise's Prior Authorization Reimagined initiative (see below).
Working on a prototype of a future-state product with high visibility taught me the importance of balancing visionary design with realistic technical constraints.
I was onboarded onto this project towards the end of the timeline and felt that my designs were not as polished as I would've liked. There were some design elements that felt incomplete, such as a modal that prompted the provider that a PA claim needed to be submitted; I would've added a "cancel" button to allow easy dismissal by the user.
This project allowed me utilize my knowledge of physician workflows and experience in working with EMRs from my previous role as a medical scribe in order to create a user flow that aligned with user needs.