Getting LTSS services in place faster.
For health plans, getting Medicaid LTSS members the services they need is a top priority. The goal is care in place by 10 days. In the past, care managers were tasked with contacting providers by any means necessary to solidify commitment.
Days to services in place:
40+ to <10
Reach all eligible providers with
1 Request
My Role
Lead UX Designer • Discovery • Facilitation • UX • Content Strategy • Testing •
Collaborators
Solutions Architect • Business/Health Plan Stakeholders • Business Analyst • Developers • Front End and Service Developers • Scrum Team
Domain
Availity Portal • Medicaid/LTSS • Atypical Providers
The challenge
LTSS care managers needed to connect Medicaid members with qualified service providers quickly, but the process was highly manual. Care managers contacted providers one at a time by phone, fax and email, often waiting for a response before moving on to the next provider.
The goal was to have services in place within 10 days, but the process was often taking 40 days or more.
Our goal
Create a faster, more scalable way for care managers to:
- Create a service request once and send it to all qualified providers in a geographic area.
- Give providers the information they needed to evaluate the opportunity.
- Allow providers to respond quickly without relying on back-and-forth phone calls, faxes or email.
The outcome
The approach
Discovery was a significant part of this project. I facilitated workshops with teams across the health plan to work through the referral process in detail, align around provider and business needs, and define how the new internal and provider-facing workflows would work together.
From there, we translated that process into a broadcast-and-response model that allowed care managers to reach qualified providers at once and gave providers a clear way to review and respond to opportunities.
DISCOVER & ALIGN
Facilitated workshops with the health plan to work through the referral process in detail, bringing perspectives, requirements and provider needs into a shared understanding.
MAP & DEFINE
Collaborated with the team designing the new case-management process to map how internal and provider workflows would work together, defining handoffs, data and requirements along the way.
DESIGN & ITERATE
Translated that process into the provider-facing experience, designing a clear workflow for reviewing and responding to service opportunities.
BUILD & DELIVER
Partnered with development through implementation to ensure the workflow, interactions and guidance carried through to the final product.
The solution
The new experience replaced one-at-a-time provider outreach with a broadcast-and-response model. Care managers could create a service request once and send it to all qualified providers in the geographic area, rather than contacting each provider individually.
Providers could then see available opportunities in one place, review the information needed to make a decision, and respond directly through the Availity Portal. They could accept, decline, request more information, accept pending recruitment, or respond to multiple referrals at once.
Because the experience was connected to the new internal case-management process, both sides of the workflow had to work together. We collaborated closely with the team developing that process to define the information, handoffs and statuses needed to move a referral from request to placement.
The result was a coordinated workflow that reduced manual outreach and helped get services in place in less than 10 days instead of 40 or more.
Track referrals
Status-based tabs helped providers follow referrals from initial response through confirmation, decline or closure.
Multiple referral selection
Providers could select one or more referrals at a time to respond to.
Comprehensive service information
Providers were given the details they needed to evaluate each referral, including care needs, preferences and preferred language. Additional details were available through Show More, keeping the initial view manageable, while a toggle above the list allowed providers to condense the view even further.
Badges show more granular status
Within each tab, referrals could be at different stages in the process. Status badges enabled providers to quickly see where each referral stood.
Response flow supports real-world scenarios
The flow supported several real-world scenarios, including Accept Pending Recruitment, which allowed providers to express interest in a referral while indicating they still needed to secure staff before taking on the service.
