Dan Prince

The Internet is quickly becoming the first touch point in the healthcare consumer’s experience. According to a recent national study we conducted, 56% of Americans turn to the Internet for health and wellness information. So if that’s the case, why are so many health plans missing an important opportunity to build their brands online by creating positive customer experiences?

My theory? It’s symptomatic of a larger problem. Health insurance as an industry had the lowest average score in Forrester’s Customer Experience Index, 2011. Bruce Temkin, who formerly led customer experience research at Forrester, now publishes an index similar to Forrester’s. Health plans’ scores put them one wrung up from the bottom in Temkin’s study, with the average customer experience rating for health plans sitting right on the line between ‘Very Poor’ and ‘Poor.’

Obviously, customer experience encompasses much more than website experience. But a quick trip to the sites of TriCare, the health plan for military personnel and their families that scored highest in Temkin’s study (with an ‘Okay’ rating) and Cigna, one of the lowest-rated health plans in his study, sheds some light on the customers’ point of view.

Before I share my findings with you, I would like to point out that one of my favorite writers on web user experience is Steve Krug, whose best-known book is “Don’t Make Me Think.” His premise is that if people come to your site and have to ask themselves questions like “What can I do here?” and “Where do I start?” you haven’t done your job right. TriCare, whose site has some classic usability flaws, nevertheless does a stellar job of answering the “Where do I start” question. You start by answering three questions.

After you answer them, you land on a fairly straightforward ‘Profile’ page. The fictitious answers I entered brought me to this page with five clear-cut plans.

I clicked on the first plan in the list, TriCare for Life, and came to a short digest description:

Clicking on ‘Learn More’ at the bottom of the page brought me to a longer description – but still not terribly long – with what appeared to be useful links for yet more detail if I were so inclined. Lots of clicking, but overall, it was a pretty intuitive experience.

Contrast this with Cigna’s home page.

The “Where do I start?” question is a lot harder to answer here. My first reaction was “Why did they clutter up the page with all these pictures?” The pictures create a friendly, approachable feeling – which is good in an industry that most customers see as unfriendly and unapproachable. But Cigna makes zeroing in on the little boxes that let you do something, like find out about their health plans, rather difficult.

My eye goes first to the vivid pink box that says “DEEP INSIDE YOU THERE’S A PERSON WHO REFUSES TO BE KEPT DEEP INSIDE YOU.” My reaction is “What in the heck does that have to do with health insurance?” Plus, Cigna has, in drawing my attention to something useless, wasted approximately 2 seconds of my time. Web users keep a tally as they go through your site, and they resent it if you don’t make an effort to get them to their goal efficiently.

Then Cigna compounds my frustration. The pictures aren’t just mood-setting visual clutter. If you click on them, they reveal that they are the gateways to presumably valuable content. For example, the bookshelf image (second row, first picture) is what you click to see “How to choose the right plan” and what plans are available in your state. If I came to the Cigna site with the sole purpose of picking out a plan, how many pictures am I likely to click on, hunting and pecking, until I figure out that it’s behind door number 7! (Of 30. The picture grid is 6 by 5.)

From an aesthetic and production values standpoint, the Cigna website is clearly superior to the TriCare site. But I kept thinking, considering all the money Cigna spent, did they spend any on user testing? If they had set just five users down and watched them interact with that home page, they surely would have seen the error of their ways.

Now, that’s one man’s opinion. The thing about user testing is that you don’t want one man’s opinion – especially one who thinks about things like usability on a regular basis. You want to assemble people who resemble your real users and ask them to do tasks real users would do on your site. Then sit back and watch them try to perform these tasks, preferably recording it so you can share the experience with the team who is creating the site.

The complication and the ‘shell game’ Cigna’s website presents fits all too well with the classic customer image of a health insurance company. Cigna obviously has the budget and the creativity to make the user experience of their website great. But they aren’t going to do it until they really get in touch with their users and create an online experience so intuitive that Cigna visitors don’t have to think!

Dan Prince

An increasingly important part of the healthcare customer experience takes place not just in the exam room or the waiting room, but online, where improvements are often easily and immediately measurable.

Usability testing can be a key ingredient in those improvements, as many healthcare companies have learned.

I recently saw an article on the Health IT Policy Committee and their efforts to improve the usability of EHRs – they are suggesting policymakers examine this issue more. To improve the usability of EHRs, the committee recommends defining a set of consistent icons and terminology that could be used across EHR systems. How can this be done? Usability testing with actual users of the system – clinicians to staff members – and incorporating their feedback into the EHR design.

Our version of usability testing at CHR is the uxLab®, our User Experience Lab. We have three approaches:

* The first is in a web-lab type setting where we have a group of six to eight participants in front of laptops. They are asked to do specific tasks and offer feedback – including content and design analysis, click patterns, user confusion or frustration, bottlenecks, time completing tasks, etc. The feedback is instant and the moderator can delve deeper into specific issues when necessary.

*The second approach is one-on-one testing with a participant and a moderator.

*And the third approach is remote testing with hundreds of participants, if needed. We can track click patterns, heat mapping, timed tasks and see exactly where the participant gets lost or off track. We can also get their emotional reaction to their online experience by recording their response through webcams.

A great example of ROI from our uxLab® is The Nashville Health Care Council’s project. After completely re-designing their website, they wanted feedback on the new design before they pushed it live. We did two groups of 7, totaling 14 people. The Council learned of some additional improvements that were incorporated into their final design, including several formatting changes to the homepage, such as navigation bar edits, events calendar formatting, and a more prominent link for membership application.

The success of The Health Care Council’s project was acknowledged by the Nashville chapter of the American Marketing Association with an Achievement in Marketing Award in the category of non-profit websites. For more on the project and analytics, read the case study.

Dan Prince

Seeing the world as others see it is an important ingredient in improving the customer experience in healthcare and every other industry … especially when it comes to the online experience! While you may believe you understand exactly what your customers need, it’s sometimes the little things we tend to overlook that can make all the difference.

We recently conducted usability testing for a health plan catering to seniors that wanted to make sure that its customers were having a comfortable, productive experience with its website. One of the site’s features was designed to make it easy for customers and prospective customers to compare different plan options, but as we learned through our test group, what seemed like a great idea would have been a big mistake.

The somewhat surprising reason? The comparison chart called for users to drag and drop the plan choices they were comparing into side-by-side columns. For seniors with arthritis, manipulating the mouse to drag and drop was frustrating and for some seniors, virtually impossible.

We suspect that a generation gap was at work. Programmers tend to be young and it probably did not occur to them that drag and drop was anything but simple and natural. Simply asking the user to “check” the plans they want to compare solved the problem.

Another surprising discovery: users were skeptical that the seniors pictured on the site were actual customers of the plan. This was concerning to the health plan because it placed a great deal of emphasis on using testimonials by peers of prospective customers to validate the value of the plan’s offerings.

The problem? There were no names associated with the pictures. So names were affixed along with the notation “Actual member.” Problem solved.

The lesson from this usability test? Take nothing for granted when assessing customer experience. Testing customer perceptions from a variety of perspectives is critical to success.