Digital Health Platform: Member Portal

CX Transformation to simplify access to a member’s benefits information.


The Challenge
The client aimed to provide a personalized, unique, and seamless member experience to assist members in navigating through various business lines.

The Solution
Create a next-generation digital front door in conjunction with a third-party vendor to streamline fragmented member services, get to market quickly, drive sustained and continuous engagement, and help them make their vision of an interconnected care experience a reality.

The Results
• Client launched first release of joint solution approximately one year from project launch.

• The client experienced growth within months, including winning new business, expanding relationships, and re-engaging past accounts.

• Achieved significant annual revenue increase and gained thousands of new members for enhanced engagement and improved health outcomes.

• West Monroe achieved a NPS score of 10 out of 10.


This project is protected by a Non-Disclosure Agreement (NDA) and was conducted simultaneously with the Digital Health Platform Managing Care project.

The Company
The Client is a nonprofit healthcare organization and integrated delivery network with 44,000 employees and serving approximately 7 million members across four states.

My Role
Design Lead

Key Deliverables
Information Architecture
Design Backlog
Alpha Release

12 months

Project Overview


The Approach

The project was a three-year, $28 million engagement that brought together several integrated teams within the client’s organization.

Several teams were integrated into the client’s organization to accelerate the project and drive a cultural shift toward digital. These teams included members with experience in product development, engineering, healthcare payer SMEs, and operations.

Planned rollouts secured an effective roadmap despite red tape in the  digital product organization. The product team addressed client and industry-specific regulations, regulatory filing dates, and sales deadlines. The rollout strategy systematically introduced features while ensuring compliance.

Conducted a two-month discovery phase with the client research team, analyzing recent research including, usability tests, user interviews, and call-center transcripts.

According to call center data from 2021, 80% of the call volume is driven by Claims and Benefits alone, and 51% of that volume represents questions about benefits and coverage. There is an opportunity to greatly reduce the number of calls the center receives about coverage / benefits questions by making benefits information more accessible and offering an avenue to ask specific questions without calling.

Archetypes: The research team developed an archetype matrix to map out more nuanced behaviors, needs and preferences depending on the member’s demographics and medical condition(s). These archetypes served as a constant reference point throughout our design process, ensuring our solutions remained aligned with user needs.

Journey Map: We created a journey map for a customer enrolled in coverage who wants to review how their coverage has changed year over year. They are looking to receive care based on their new or existing coverage.


Pain Points
• The absence of clear cost estimation transparency for medical services entails failing to offer patients comparisons between different plan levels, leading to a lack of trust in the plan.

Lack of clarity regarding the location and availability of the medical benefits booklet, causing uncertainty and frustration among members.

• Absence of clear, concise, and contextually relevant help and documentation hinder users in achieving proficiency in understanding the system.

• Find a balance between comprehensive details and using simplified language. Prior research indicates that many members are confused by some of the basic terminology.

• In relation to healthcare  terminology and concepts, providing users with easily accessible and contextual support resources to aid in understanding and navigating the system.

• Increase comprehension and transparency by improving the visuals in plan progress - Current format is not always the most effective way to communicate where members are in their plan financially.


Problem Statement
How might we deliver the ability for members to view their personal coverage details, intuitive and easy access to benefits booklet information (such as prescription coverage). Help customers view and understand preventative services as well as plan progress, displaying and interacting with client’s Coverage Plan Tiers or other custom setups for health plan structures.

We believe that by providing benefits and claims information in a simple and clear manner, customers will be able to clearly understand what has been covered by insurance, what they might owe after insurance, and have more confidence that the information presented has been processed accurately.This may result in decreased customer support calls to explain coverage, reduced customer suppor tneeded from a claim dispute, faster time to payment and increased customer confidence.


The process of implementing third-party vendor-provided concepts for the Member Portal involved several key steps to ensure alignment with client requirements:

Early stage sketch ideation aims to quickly generate and explore a wide range of concepts and solutions, to address fundamental user pain points and problems. Learnings were taken into vendor concept evaluation.

We thoroughly reviewed third-party vendor concepts to ensure they aligned with client requirements and objectives for the Member Portal, analyzing features, functionalities, and design elements for improvements.  Identified issues were iteratively addressed to refine the interface design, navigation flow, and overall user experience.

Conflicting priorities from leadership often led to delays and necessitated alignment sessions to manage risk and balance priorities.

In the project’s early phase, the third-party vendor viewed our team as a potential obstructor to their project deliverables and were hesitant to share design assets or product roadmaps. Weekly internal design reviews scheduled to foster trust and collaboration.


Design Decisions
The designs are intended to provide members with the context and tools to understand their benefits and plan progress accumulations by offering clearer and more human explanations of key benefits, terminology, and processes.

Benefits Lander
1. A status chip was implemented to clearly denote whether benefits are active, providing users with a quick and easily recognizable visual indicator to enhance their understanding of their benefit status.
2. Smaller benefits card controls were designed to minimize screen real estate usage, providing a cleaner interface.
3. Policy information content is placed into an expansion panel to minimize screen real estate usage, allowing the more frequently accessed Plan Progress content to be positioned higher on the screen for enhanced visibility and quicker access.
4. Clearly inform users of their coverage period ensures they know how long their benefits are valid.
5. Content was organized according to members' perceptions of relatedness, grouping items together based on their intuitive associations.

Plan Progress
1 Tooltips offer users contextual help by delivering relevant information precisely when and where it's needed.
2. Plan progress is centered on the remaining deductible and the percentage paid, not the total amount spent. Research testing showed users found this approach more comprehensible and intuitive.
3. Reorienting plan progress bar visualizations simplifies the comparison of coverage tiers, thereby enhancing users' understanding and aiding in their decision-making process.
4. Implementation of a secondary button allows users to access detailed accumulations, optimizing space on the main page by consolidating information into a separate view and preventing clutter.
5. Enhanced tooltip modal explanations help members better understand their benefits in relation to coverage tiers,

Cost & Coverage
1. Grouped content facilitates easier comparison of insurance coverage tiers, enhancing user comprehension and decision-making.
2. Common medical procedures and office visits are grouped to enable the member to compare  insurance coverage tiers, enhancing user comprehension and decision-making.

Health Spending Accounts
1. Allow member to know account balance and how long they have to use it, and prepare them even before they hit an error screen.
2. Status chip to denote current state of benefits information
3. View my applicable spending account(s) plan year start and end dates, so that I know which of my accounts is currently active.
4. Notification to inform member of impending deadlines to submit claims.
5. System data to inform member of last day to use funds and submit claims

Benefits Booklet Notice
1. Allow users to know why they don’t have a booklet, and prepare them even before they hit an error screen. The placement of the action doesn’t change, which can help in making them remember where to look for it, once available.
2. Meeting people where they are, providing the info they need without alarming unnecessarily.

What I Learned
Considering the unusual project structure and the task of leading two distinct design teams could have been daunting, yet by communicating early and often with design leadership, we successfully managed the process and stayed aligned with our product roadmap, ensuring project success.

Client Testimonial
“I will forever deeply appreciate the contributions from these individuals (West Monroe), and believe they are the keystone to achieving milestones in 2022. With admitted bias, I personally believe the Gold team exemplified a standard of flexibility, strategy, and progress within the org in 2022, and I attribute that success entirely to these individuals. In the highest regard possible, I praise their contributions to our effort. These are fantastically talented people, and I consider myself very lucky to have worked with them.”

- Client Design Director

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