PDP Check-in tool

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BACKGROUND
Medicare beneficiaries on Original Medicare, which often includes a Medicare Supplemental plan and a Prescription Drug Plan, will receive annual notifications about changes to their plans for the upcoming year. The most common change involves individual drug costs due to insurance carriers adjusting their coverage tiers or pricing structures. These changes often prompt consumers to switch their drug plans during the Annual Enrollment Period. We refer to this user persona as a "PDP switcher." They are typically familiar with the Medicare landscape and are four times more likely to switch plans and enroll entirely online.

Increasing digital enrollments would greatly benefit the business in several ways. It would lower customer acquisition costs, enabling more efficient resource allocation. Additionally, it would allow us to serve more customers during peak times, when agent capacity limits appointment availability. This digital shift would enable us to assist more customers with fewer insurance agents, leading to a leaner operation and a quicker path to scaling and profitability.

Despite receiving the lowest commission on drug plan sales, the high volume of customers switching annually makes it an ideal segment to serve digitally.

 

GOALS
The Medicare industry is primarily phone-based, with customers engaging brokers or insurance carriers through calls. Similarly, the FMS service model is high-touch and involves multiple engagements. On average, new Medicare sales require about 2 hours of phone time across 1.7 meetings for education, needs analysis, plan presentation, and enrollment. This model needs a call center with licensed Medicare agents.

The primary goal of the digital channel is to make tools and experiences to make sales calls more efficient. The north star goal is to drive more customers to shop entirely online. In the current market, less than 7% of Medicare plans are bought online. Customers prefer to do independent research online but validate their options with an expert. This preference for expert validation limits business scalability to the number of available sales agents.

PDP switchers are the most likely to utilize a digital only method to switch plans. How can we make the experience of comparing drug plans:


How might we create an online experience allowing for users to compare their current coverage's cost with alternative plans offered by Fidelity.

How might we make this a simple and trust-building experience that

How might we provide a differentiated experience in the market

 
Something here about differentiation / position as a "check-in" w/ target persona /

ROLE
UX team leader (design, research, content),
product strategy

STAKEHOLDERS
Fidelity Medicare Services, Health Care Group Leadership

TARGET AUDIENCE
Medicare eligible/first time enrollees

INHERENT CHALLENGES
Why do 93% of Medicare customers require assistance from a human in shopping for Medicare?

Too much choice: The average beneficiary in 2023 has 39 MA plans to choose from (up from 20 in 2018).

Lack of confidence: Customers report that a touchpoint with an expert (to validate their own research and choice) is critical to their confidence.

Lack of trust: CMS received almost 40,000 complaints about the marketing of plans last year (up from about 5,700 in 2017).

OPPORTUNITIES
65+ Customers are ready:

The population is comfortable with digital platforms & they want to embrace online tools (accelerated by pandemic).

In a poll of 2,500 current Medicare beneficiaries, 83% have no trust concerns when it comes to e-commerce.

Discouraged by traditional enrollment (phone calls, snail-mail, and pushy sales agents).

USE CASES
Medicare is a seasonal business, with the busiest time in Q4 when Annual Enrollment opens on October 15th and stretches through December 7th. During this time beneficiaries can make changes to their existing coverage. The rest of the year (and during AEP) New Enrollees are aging into Medicare and they can enroll within a 7 month period around their 65th Birthday. New enrollees have a higher barrier to entry for a fully digital enrollment — they typically require a baseline of Medicare education and have a higher level of anxiety about the transition to Medicare. A digital offering would need to do 3 things: educate, be personalized and build trust.  

Target Persona:
A New Enrollee is someone enrolling in Medicare coverage for the very first time. They will need to learn about Medicare, research the options available to them, and enroll in coverage that meets their health needs at a realistic expense.

Some variants of the New Enrollee might include:

  • The T-65er (someone who is turning 65 and enrolling during an initial enrollment period - IEP)

  • The late retiree (someone who has worked past 65 and leaving their group coverage during a special enrollment period - SEP)

  • The passive spouse (someone who doesn’t play an active role in making healthcare decisions)

PROTOYPING / PROCESS / TEST?
Enrolling in Medicare is complex and jargon filled process with a lot of parallels to filing income taxes. There are many personal considerations and edge cases that may come into play, and it can be overwhelming for many. Another parallel to taxes is that Medicare coverage should be reviewed annually to ensure it meets beneficiaries changing needs. TurboTax is a digital product that does a great job breaking down a complex process into a step-by-step question driven experience. What would that interaction model look like applied to Medicare enrollment? And would consumers use it for healthcare?

FOUNDATIONAL INSIGHTS: The origins of this business are in design strategy and deep qualitative research methods. These original insights hold true today:


People are disappointed in Medicare before their benefits even kick in.


The marketing ‘deluge’ overwhelms people, physically and emotionally, and serves to confuses an already complex choice.


Your relationship to me (as a broker) matters more than your relationship to Medicare.


Selecting Medicare coverage is an individual coverage decision that couples continue to make together.


Medicare is a healthcare decision that is ultimately made financially.

There are competitors who are pursuing this model as well, but they lack the brand resonance and trust of Fidelity. Some analogous  experiences include:

Chapter: askchapter.org
Peter Thiel is on the Chapter board, and they are apparently partnering with Palantir on data.

Fair Square Medicare: fairsquaremedicare.com
Fair Square Medicare raised a $15M Series A from Define Ventures, Y Combinator, and Slow Ventures.

To test the digital solution, we built a prototype that moved our existing point solutions into an end-to-end experience. This overall flow would test our simple decision framework:

When should I enroll in Medicare?
When do I enroll? Should I stay on my employer’s plan? Should I enroll in A+B now? Should I stay on my spouse’s coverage? Should I retire now, or keep working?

RIGHT TIME

What type of coverage is right for me?
Do I need extra coverage? Can I get vision coverage? Do I have to get referrals? What if I live in a different state half the year? Do I need a PDP if I am not on drugs now?

RIGHT TYPE

Which plan should I enroll in?
Are my drugs covered? Is my Doctor in network? Do I have to use the preferred pharmacy? Will I have to pay co-insurance?  What will my max out-of-pocket cost be?

RIGHT PLAN

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Strong Convictions: Don came into the session leaning towards a Medigap plan, and he seemed to confirm that preference as he read through the "Handy Chart" comparing MA v O++. However, the GT result was Medicare Advantage. After revisiting the chart, Don decided he'd rather override the tool and go with Medigap, but there was no place in the experience to confirm or change the recommendation. 

High Praise: Linda is a SHIIP volunteer, so she came into our test savvy on all things Medicare. Still, she had her high expectations met, lauding the simplicity and directness of the tool. She was a big fan of the "save your progress" feature, and felt that allowing visitors to continue as guests built further confidence in our intentions to help, not market.

Quotes for Context: Brian, who enrolled in Medicare the day before our interview, was anxious to get to our quotes for additional coverage. He remembered using concrete numbers as part of his decision-making process, and suggested we add offer that option even for those who are earlier in their shopping journeys. 

Basics Revisited: Warren was confident in his Medicare expertise, but could have benefited from a knowledge check. While he is not someone who would opt into education, he needs some assumptions corrected, and doing so as a part of the experience (for example, showing the full IEP) might be the only way to grab his attention. 

Setting Expectations: Susan wasn't clear on what the tool was building towards, and would have preferred to see some quotes, or even ballpark estimates, prior to engaging with the tools' questions. A quick look at our construct graphic (with ranges for MA and Gap) could be enough to add context for references to premiums.

Finance Friend: Lynette immediately saw the value in a Fidelity tool because her favorite Medicare resources have come from Thrivent Financial. Through Thrivent, she'd estimated her timeline would begin in Spring of 2023, something that our enrollment window tool confirmed. 

CNXR Crossover: Gordon found the transition from the FMS site to the CNXR experience abrupt, and was frustrated that it felt like two, non-related segments. He would have liked to see his recommended plans (Medigap) as the default on the Connecture side, and felt like he was having to answer similar questions afresh. 

Speed Clicker: Raphael was ready to shop! He blitzed through both tools and, given the choice, would have opted out of the tools to go straight to quotes. However, he compromised some needed education as he pushed pace.

Follow Up: Judy navigated through our tools at lightening speed, but paused on the Handy Chart (and revisited it after her recommendation). She went over to the CNXR side, but being a little ways out, wasn't ready to enroll. She would have liked to opt-in to a follow up engagement closer to her enrollment timeline. 

One-on-one moderated testing

INSIGHTS + LEARNINGS
Overall, our conception of a pre-enrollment digital experience landed with users as both intuitive and useful.

The 1-2-3 approach was able to serve users who were starting from scratch as well as those who had already answered one or more of those questions. A couple of users, who were more researched, could voiceover their answers to certain questions, but even they seemed happy to listen to our guidance and compare to their assumptions. It's well worth introducing this framework to users at the beginning of the experience to set proper expectations. 

It's important to provide educational moments throughout the experience, not just at the outset. This would allow users’ without a baseline level of Medicare knowledge to get contextual help along the way. This could be as simple as tool-tip definitions, or links to articles on related topics. We found that some users, who were very confident in their Medicare knowledge, could have also benefited from gentle reminders or knowledge-checks along the way. 

With one exception, users chose to "get started" and "continue without logging in" at the start of the experience. Most cited that they were looking to get information, not give it. Even those users with existing Fidelity accounts didn't see the value of connecting their financial accounts to Medicare at this early stage. However, many seemed open to the idea when prompted again after the guidance tools. At that point, they had gained confidence in the quality of the information and had been given data that they would have liked to save. One user remarked that including the option to "continue without logging in" (even at the later ask) increased her confidence in our intentions. 

Very few users turned to our 'Need Help?' panel, but the two that indicated they might reach out for assistance did so late in the experience (after seeing their results). They expressed that a chat feature would be helpful to submit some circumstantial information that might change the tool's recommendation. Our conclusion was that, if a user turns to chat as a resource during this flow, they expect to be connected to a live human who can answer their specific questions. Enabling a chat feature that would connect them to a member of the Sales and Service team could be a big help; connecting them to an AI bot that recommends resources could be frustrating.