Washington HIX
Washington Healthplanfinder is the state's official online health insurance exchange (HIX) that connects individuals, families, and small businesses to affordable insurance plans and financial assistance under the Affordable Care Act ("Obamacare").
OVERVIEW
Timely, affordable coverage that adapts to life's changes
In 2014, over half a million residents enrolled in Washington's Affordable Care Act ("Obamacare") through the online health insurance marketplace, Healthplanfinder (HPF). HPF enables individuals, families, and small businesses to compare and purchase affordable insurance plans and access financial assistance. States were required to launch by October 2014 or opt into the federal healthcare application portal.
While open enrollment occurs annually, Special Enrollment Periods (SEPs) are available for "qualifying life events" like marriage, childbirth, or job loss that may occur during the year. In order to qualify, customers must submit valid proof of their qualifying life event to receive the right healthcare for their situation.
GOAL
Design and launch a process for customers upload documents online, have them verified by an account worker, and enroll in a healthcare plan. This helps more people get timely coverage faster, while freeing time for account workers to focus on other tasks.
MY RESPONSIBILITIES
• As product owner for account worker/admin, I managed full cycle development
• Performed impact analysis to determine scope and downstream impacts
• Developed functional requirements, task flows, use cases, wireframes
• Led UAT and post-launch performance measurement & reporting
COLLABORATORS
I partnered with client business owners, policy experts, compliance, and legal.
Internally, I partnered with subject matter experts, tech leads, and other product owners within the enrollment and payments domains of the system.
BUSINESS PROBLEM:
Customers needed a way to electronically submit required documents for healthcare application changes, so they can be approved to enroll in a plan. The manual document approval (via mail or in-person) and enrollment process for account workers was time-consuming and risked delays in health coverage up to 90 days.
00. SOLUTION PREVIEW
A process that allows customers to upload required documents for timely approval, so that they can enroll in a health plan during a special enrollment period
• Customers upload documents via the state's online healthcare portal
• Customers "conditionally pay and enroll" in a selected plan until documents are verified
• Account workers can review, flag, and approve documents
• Customers can track the status of a document on their dashboard
Constraints, Edge Cases, and Challenges
"Conditional" Enrollment
Scoping the feature revealed a key challenge: handling Special Enrollment post-verification. In the initial design, we required an account worker to approve documents before customer can enroll in a plan, causing potential bottlenecks and coverage delays. This led to the 'conditional enrollment' status, where documents, enrollments, and payments would be collected upfront. Coverage would automatically kick in when an account worker marks a document as "verified."
Edge cases
Other questions we asked ourselves was:
↗ How would system handle multiple qualifying events reported for one household?
↗ How would system handle multiple documents?
↗ What should the system do if a document isn't verified in X number of days?
↗ What happens if a document is rejected?
↗ How can the system be compliant with the latest policy rules and regulations?
↗ Should retroactive coverage start based on the doc submit date or verification date?
Design Patterns
We followed design patterns and guidelines established by usability.gov
More customers received timely coverage sooner
Enabled customers to enroll and pay for a healthcare plan upfront under a new "conditionally approved" enrollment status, pending document verification.
Coverage kicks in automatically (or at times, retroactively) upon document approval, avoiding delays in coverage
Streamlined document processing
Reduced document processing time from months to minutes for account workers
Zero high-impact defects
Careful testing, assessment of downstream impacts, and edge case planning delivered a stable system to over 500,000 state residents
• Customers "conditionally pay and enroll" in a selected plan until documents are verified
New "conditionally enrolled" status
• Depending on the circumstances, account workers can set retroactive start coverage dates based on policy and case-by-case exceptions
Support for retroactive coverage
Delivery Outcomes
• For visibility and reporting purposes, we created new document statuses to reflect processing status (e.g., "document uploaded", "verified")
Document processing status
For more information on this project, please reach out.
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