Joanne Mendel

Client objective

Solution

A Kaiser Innovation Fund proposal aimed to identify opportunities to improve member experience and increase efficiency in pharmacy payment systems. Member experiences and staff workflows were mapped across channels to identify needs at points of service: pharmacies, phone, apps, online and in hospitals and medical centers.

Identified opportunities for mobile payment tools to improve member satisfaction and increase efficiencies within each channel. Identified where ongoing initiatives within Kaiser were addressing member needs, pharmacy workflows and billing/payment experiences revealed in the research. Identified new opportunities and solutions to be considered.

• Interviews with Staff and members: experience, financials, payment, attitudes towards mobile payment

• Member Journey mapping groups (6 groups)

• Staff journey mapping groups (4 groups)

• Secondary research—mobile payments; Pew, Forrester

• Gartner adjacent category research—mobile devices
  

Insight: Member and staff personas revealed that each group had different service priorities related to Rx cost, accuracy and delivery time.

Mitigation: Bringing these into alignment through greater transparency and communication could help create trust and increase satisfaction.

Journey maps provided a view into member activities, emotions and operations across stages of their experience. Three maps were created; one each for Rx refill centers, hospital discharge pharmacies and outpatient locations.

Opportunity areas were identified for each service delivery channel
Often pain points in the member experience are correlated with additional pain points on the operations side—for staff and/or systems.

The payment reconciliation knot —pain point example

• Drug pricing is not available to members so they must estimate the amount to charge their credit card or write a check for.

• Members may be asked to cover additional costs if there’s a gap between what they paid and what’s owed.

• Members must track the difference between what’s paid vs. owed or become confused upon being invoiced for the additional charges.

Solution thought starter…

• Eliminate the need for payment reconciliations by making drug pricing available members placing their order via phone or online for mail order Rx delivery.

Solution thought starters were generated to address the top opportunity areas and pain points for each channel.
They were framed as ‘How might we’ questions to address an opportunity

and mapped to stages of the member experience across channels. Thought starters were used as inputs to stakeholder solution ideation sessions to drive focused actions on company initiatives and unmet gaps.