Ginny will change healthcare.
And here’s why.
“The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery that he would perform unaided if he had the necessary strength, will or knowledge.”
Have you ever been stuck on the phone between your physician’s office and health insurance over a situation beyond your understanding?
Ah, the labyrinth of navigating health insurance coverage. If you don’t know, ignorance is bliss. But if you do know, like the population diagnosed with a pre-existing condition (PEC), it’s always long waits and the rules are always changing. Common snafus include getting misdirected to the wrong department, being asked questions you have no idea how to answer (because you as the patient don’t fill out the forms being processed), claims being processed wrong by human error, or the wild card disconnected call. There are several layers to hell, but we are going to focus on one thick layer: patient advocacy.
How can a patient have an advocate to navigate insurance when the current system doesn’t allow for clarity?
For some patients with PEC, doctors need to give prior authorization for a specialized treatment that needs to be covered by insurance. That can include medical treatments, such as infusion or chemotherapy, or pharmacy prescriptions, such as insulin. Either treatment route is often an unaffordable out-of-pocket cost, which adds another complex layer.
Some expensive treatments offer a third party co-pay assistance program to help patients pay up to a certain amount for their prescription costs per treatment, (for medical this excludes outpatient facility processing, that is billed separately). Co-pay assistance also requires registration and further benefits review with the insurance provider to ensure a patient’s plan is covered and for a certain number of treatments per year.
User Journey
Proposed Solution - Ginny
Start by answering a series of several questions. Think of it as “TurboTax for healthcare.”
In order to determine how to simplify a complicated experience for customers, I decided the best place to start was the common denominator: a pre-existing condition. I created a screening questionnaire for patients starting the app that would customize their experience based on their care needs and how they answer the questions. The app would also link communication directly to doctor’s and health insurance offices to ensure clarity and efficiency between all involved parties.
Some Project Hindsights…
Hospitals and medical practices will not want to adopt another software in their everyday work stream to input data. They are busy enough without it! This software proposal would work best as a Widget add-on that could filter data from the existing software and create a clear communication channel between doctor, patient, and insurance.
Would work best as “share info with patient/insurance” check box or filtering option within the existing software. Most medical softwares already have capability to share info with patients as part of 21st Century Cures Act, (things like lab results, visit notes, etc.) but does not share the status of pending referrals.
As pre-existing condition classifications have expanded to more inclusive and less terminal conditions in past 10 years, expect more users to be navigating the medical system and need to confirm coverage of their conditions.