Starting January 1, 2021, the Hospital Price Transparency rule was introduced in the United States. Under this rule, all U.S. hospitals (with some exceptions) are required to provide clear, accessible pricing information online about the items and services they provide in two ways:
- As a comprehensive machine-readable file with all items and services.
- As a display of services in a consumer-friendly format.
At this time, the Centers for Medicare and Medicaid Services (CMS) also began to audit hospitals across the United States for compliance with this rule. CMS is also the agency responsible for investigating non-compliance complaints and reviewing analyses of non-compliance. A group at CMS is leading the charge to make costs available by enforcing the HPT ruling to ensure those who need care the most can understand their options among providers. To keep up with the number of cases being handled by this group, CMS needed a case management system to support the unique needs and processes of the investigative group and the complexity of Health Price Transparency cases.
Our human experience design team got to work on creating such a case management system. Prior to developing this system, though, they needed to get a better understanding of the needs of their users. Softrams champions the shift left approach, which prioritizes understanding the needs of users before beginning to code a system. Our human experience design team conducted stakeholder interviews to understand users and their realities, activities, and drivers, as well as formalized goals and objectives. From these findings, the team created personas to help guide decisions. Participatory design techniques were also employed to bring users into the design space and allow them to directly contribute to the design process. The human experience team created custom-built mural boards to help focus conversations and to build clarity and alignment as well as an enjoyable stakeholder experience.
The development of the HPT system also involved practicing continuous research throughout all stages of development after developing the team’s initial understanding of the users’ needs. The team used an iterative and agile approach to quickly create designs to put them in front of users during short regular touch points. They also conducted usability tests to validate features as they were deployed and gathered fresh perspectives by consulting users outside of the initial stakeholders that were consulted prior to development.
Using human centered design throughout this process culminated with the release of the minimum viable product of the Hospital Price Transparency Management System (HPT-MS) in August 2022.
With the new HPT-MS, CMS users are able to address complaints about hospitals not complying with the Hospital Price Transparency rule and investigate those complaints directly within the system. It is a consolidated location where documents can be stored and analyzed, and that incorporates automation to reduce manual labor for specific tasks such as sending a communication to a hospital or creating a report. 21 spreadsheets that were previously used to investigate and document cases were consolidated into the HPT-MS system. Several letters, case investigation reports, and an executive level report – tasks that could take hours to complete – were also automated. Case documentation storage and workflows are also contained within HPT-MS.
HPT-MS is an excellent example of how human centered design can be used to effectively build a system that meets the needs of its users. By working closely with users throughout the development process, our human experience team was able to fully understand what features HPT-MS needed. Thanks to this work, Hospital Price Transparency compliance cases can be more quickly and efficiently investigated, ensuring that U.S. citizens seeking healthcare are empowered to understand their care options.