Design leadership

Background

In April of 2022, I joined Garner Health as their Head of Design and first full time designer with the charge to build a high performing design team to create a usable, understandable, and trustworthy member experience.

I joined Garner at a really exciting time. The company was starting to get real traction in the market, signing larger clients, and growing rapidly. When I joined, member experience wasn’t at the forefront of the conversation. Stakeholders conceptually knew that have a good member experience was important, but there was no clear grasp of how members currently felt about the experience, if it was an issue, or what the business impact of that could be. Without that understanding, there wasn’t much appetite to invest in improving the member experience.

I set out on a mission to figure out what members really thought about Garner, understand how it was impacting the business, and make a case that investing in improving it would have a high ROI.

Approach

1. Evaluating the current experience

2. Building the business case

3. Defining an experience strategy

4. Measuring impact

Evaluating the current experience

When I joined, the company had very little understanding of our members, what they thought about Garner, or how that was impacting the business. I immediately set out to change this by conducting research interviews, building and running an NPS survey, and reviewing both client and member feedback our Account Management and Concierge teams had received. Together, these different sources built a relatively clear and consistent picture of what our members were saying about Garner.

Unfortunately, it wasn’t a pretty picture.

While many members had a great experience with Garner, many felt extremely frustrated by it, citing slow, opaque claims processes, not enough doctors, and confusion with how the program worked. In the initial surveys, our NPS score hovered around 0, meaning about there were roughly an equal number of people giving us a 9 or 10 as there were giving us a 0 - 6. Additionally, as you can see in the charts below, almost 15% of members gave us a 0.

We also collected a large amount of qualitative feedback - both from the surveys as well as from a series of interviews we conducted to dig deeper into member issues. This feedback helped us understand more nuance to the issues members were facing, as well as helped make their issues more concrete and motivating to the team. This quote particularly stood out to me as representative of a much broader theme we heard about:

“I am struggling to navigate it. I don’t have a lot of time to spend on it and it’s hard to figure out. I might love it, if I could figure it out.”

- NPS respondent

Putting it all together, three clear themes emerged:

Members had trouble finding providers that fit their needs.

We received consistent feedback that we offered too few options for doctors, and the options we did offer weren’t taking new patients or were too far away.

Members were frustrated by a slow and opaque claims process

Members felt like it took too long to reimburse claims, and were frustrated at how little visibility we gave into the process. Additionally, they felt like our claims policies were overly restrictive and that they had to jump through too many hoops to get reimbursed.

Members didn’t understand how Garner works

Members were generally just confused by Garner. They didn’t understand how it was related to their insurance or how to use it properly in order to get reimbursed. This lack of understanding exacerbated the issue with claims, as members would frequently not qualify for reimbursement because they lacked the understanding of how to correctly qualify.

Client feedback echoed these concerns, posing a retention risk.

In our client surveys and conversations, we heard many similar concerns, with the added gravity that they stemmed from employee escalations to our clients, posing renewal risks and threatening our retention targets for the year.

Defining an experience strategy

This analysis was enough to get meaningful buy-in from product and executive leadership that we needed to address member satisfaction. Over the next month, I led the development of our initial member experience strategy to protect client retention and improve member satisfaction and engagement. Here’s what we came up with:

Increase transparency and speed of claims and reimbursements

The first pillar was a major investment our payments and claims systems to improve time to payment and transparency into our claims process. Members at the time had very little window into what was happening with their claims. At the same time, time to reimbursement from the point of a visit was 8+ weeks, and the only way to get reimbursed was through checks. We knew that combined, these issues gave members a lot of anxiety about whether or not they’d get reimbursed, and when it was coming. We knew we needed to get time to increase transparency about what was happening in the claims process, while speeding up time to payment.

Improve trust in our recommendations

The second pillar of our strategy was to make a major investment in our directory data and ranking algorithms, as well as how we communicated about our recommendations. After hearing feedback from members, we conducted audits and determined that our provider directory data was too frequently inaccurate, creating a frustrating experience for members when they tried to call providers on our site only to find out it was a wrong number or that the provider wasn’t accepting new patients. But beyond the initial frustrations, these directory failures undermined members trust in our recommendations as a whole.

Getting this data accurate was so essential to people having a good experience, and I think is a great example of how so much more than just ‘design’ affects user experience and needs to be considered in UX strategies.

At the time same as the data issues, we saw that members didn’t understand our quality metrics or believe our recommendations were based on data. The combined effect being a lack of trust from members in our recommendations leading to lower engagement. We knew we needed to meaningfully improve our directory data while also improving how we communicated about our provider recommendations in order to rebuild this trust.

Improve program understandability

The third pillar was to make a meaningful investment into our marketing and app to help members understand it more. We knew members were confused by Garner. It was a unique offering, and worked differently than insurance with different and sometimes complex requirements. We knew we needed to make meaningful improvements to how we communicated and educated about Garner, as well as to make meaningful improvements to the app to facilitate that understanding and improve engagement in the program.

I worked together with our leadership team to integrate this strategy into our annual plan:

Within the second pillar, we planned several major initatives for the year across areas

These initiatives included a new team focused on improving directory data, direct deposit, a breakdown of benefit policy details in the app, a new routing flow to help answer common questions before sending them to a live agent, and more.

I also built out several systems to allow us to better monitor member experience over time

Monthly NPS and tagging

We moved our NPS survey frequency to monthly and began systematically tagging the responses to track changes across more nuanced categories, as well as hooking the data up to a looker dashboard for easier access.

Prescheduled research

We didn’t have a researcher on staff, and I saw that the designers on my team were frequently being forced to deprioritize research in order to hit deadlines because the overhead was too high.

I set up a new program to automatically recruit 8 members for live research sessions monthly that members of the team could sign up for in order to test whatever was most relevant.

It didn’t work

I worked with the executive team and product leadership to integrate this strategy into the company plan

Took multiple years, first year made a lot of progress on directory data, stuck doing claims table stakes in order to make enough progress on other initiatives at increasing sales. We didn’t do enough, and unfortunately underestimated the impact. Retention plummeted and engagement declined as we didn’t make enough progress fast enough. Refocused this year on engagement with plan to make major investment in member app to improve engagement and understanding.

Measuring impact

NPS has gone up

Engagement numbers this year TBD

Leading indicators in number of client escalations going down

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