Garner Health

Role: Senior Product Designer

With the goal of transforming the healthcare economy, Garner uses a new approach to data science and novel financial incentives that help patients identify the highest-quality care and help doctors improve how they practice medicine. When patients see providers vetted by Garner, all of their out of pocket costs will be reimbursed.

 

Problems

Adjudication Tool

To reimburse patients Garner needs to intake, process, and adjudicate insurance claims. The tool they were using to process these claims was built by engineers in a low-code platform called Retool that did not scale with the companies needs. It was slow, cumbersome to use, and did not reflect the current adjudication practices of their auditing team. I was brought on board to study their existing systems, analyze their auditors process and usage patterns, and redesign the tool from the ground up.

Member App

Their member app was very bare bones, containing a bare minimum of features. I was responsible for building out their primary feature set that included providing visibility into the claims process, explanation of member benefits, payment options like direct deposit, and a clearer onboarding flow.

 

Building an adjudication tool

A sample of the initial analysis of Garners claims adjudication system and workflow. This was used to prove to leadership that significant optimizations could be made.

I always have two goals when redesigning tools that are complex and require users to process high volumes of data. Create an intuitive steam lined system that is also a quality of life improvement for its users. Often these tools are used for tedious tasks by understaffed teams and keeping those teams happy and feeling heard can have a huge impact on productivity.

For this project I followed the following process that I have honed for over a decade in the industry:

  1. Becoming a subject matter expert
    To build a more efficient tool from the ground up I needed to be intimately familiar with insurance claim processing and adjudication. I met with the department head and specialists to learn the ins and outs of their jobs, their pain points, and what they thought could improve the experience. I also regularly shadowed adjudicators to learn about their unique idiosyncrasies.

  2. Proof of concept in Retool
    Even though Retool proved to be inadequate at a production level it was integral in rapidly prototyping a large array of concepts. I could design the interface and hand it off to developers who would quickly hook it up to our production data and allow our auditing team to perform robust testing.

  3. Full redesign implemented in React
    Once we had a iterated and improved our prototype I translated the design into react components with Material as a base, creating custom components as needed.

The final design of the tool used several guided principles to ensure we were optimizing for efficiency while taking into account adjudicator quality of life.

  1. Show the adjudicator as much information as possible
    Usually I try to show exactly the data a user needs at the moments they need it and not overwhelm them with superfluous detail. In this case, our adjudicators were power users that were solving a myriad of complex issues. They needed an incredible amount of data and did not want to hunt for it on multiple tabs and pages. Their skillset allowed them easily parse information and they wanted as much of it front-and-center as possible. Tabs were only used to divide up large tables of data that would have otherwise caused the page length to be unmanageable.

  2. Keep track of every decision
    When solving claims issues it is helpful for adjudicators and claims processors to see what actions have previously been taken by other members of the team. Part of the claims team job was also providing information to members who had questions about their claims. Being able to easily report back to our customer service specialists helped minimize the impact of the requests on the adjudicator team.

 

Improving the member app

Payments

The number one concern for our users was getting paid. Insurance claims can be complicated on their own. Because Garner is separate from the patients insurance company it adds another system for the user to manage and understand. We wanted to make that as easy as possible for them by providing clarity into the adjudication process.

The Timeline

Once a patient sees a provider there is a long road before the claim will make it to Garner to be processed and eligible out of pocket costs are reimbursed.

Steps 1 and 2 we couldn’t offer any insight into. We had no visibility into the provider or the insurance companies process. Once the insurance company processed a claim it needed to be ingested into our system. Once it was transcribed it would appear in the patients app where they could get updates on its status.

 

Payment Details

Garner offers 2 ways for patients to receive their funds, by check or through direct deposit. There was an edge case that needed to be covered where patients could receive a payment by one method and then receive another patient by another method:

  1. Patient has checks chosen as a reimbursement method.

  2. A claim is partially paid due to some expenses being ineligible under their Garner policy.

  3. The patient changes their reimbursement method to direct deposit(this was most likely during the roll out of the direct deposit feature.

  4. The patient then disputes the partial approval and has the rest of their claim approved and paid through direct deposit.

Even though it was an unlikely case, we found that the engineering and design investment required to cover this case in the app was minimal (once implemented the cost to implement a fix like could potentially be quite large) so we decided to implement a multi-card system to be able to handle this and future cases that might arise.

A note on totals: To further complicate this case it is possible for multiple claims to be reimbursed in a single transaction which would mean that the deposit total and the amount being reimbursed for a single claim could be different. Thats why you will see the Amount on each card does not match the check or deposit total.