Jenny Mikesell
User Experience Professional

Medicare Data Access

photo credit: JD Mason

Accessing Medicare Claims Data within Days, Not Weeks

I was the Senior UX Researcher and Human Centered Design Lead on this project. Together with healthcare innovators on a mission to transform the way Medicare data was accessed and utilized. Our vision: granting healthcare providers real-time access to critical Medicare claims data within 2-4 days, a game-changer in the realm of patient care coordination. Let me walk you through our remarkable journey.

The Dream Team

Our squad was a powerhouse of talent, consisting of a Program Manager, Project Manager, Technical Lead Developer, Two Senior Developers, Data Analyst, Subject Matter Expert, and yours truly - the Senior User Experience Researcher and Human-Centered Design Lead.

My Role: Bridging Insights and Innovation

As the Senior User Experience Researcher and Human-Centered Design Lead, I wove together a narrative that interconnected research, user insights, and the welfare of beneficiaries. I delved deep into user pain points, aspirations, and collaborated closely with Medicare developers to illuminate the problem and offer a revolutionary solution.

The Hurdles We Overcame

Our path was not without challenges. User access, client control over the user experience, and the time constraints of healthcare professionals were formidable barriers to surmount.

The Game-Changing Solution

Our answer? We developed a live data feed, drastically reducing access time from a staggering 25-30 days to a mere 2-4 days. This quantum leap in data accessibility was a shot in the arm for care coordination, especially for patients with chronic conditions.

Our Method: Research, Refinement, and Results

Our methodology was a carefully orchestrated symphony of researching data fields, dissecting raw data feeds within Medicare, understanding user workflows, and empathizing with their needs and pain points.

photo credit: Tweet by Irwan

Metrics of Triumph

Our research yielded metrics that painted a clear picture of success. We created a pilot product that proved invaluable to approximately 130 users in a specific Medicare payment model. Our groundbreaking work paved the way for Medicare to give the green light for production in May 2023.

photo credit: CDC

Empowering Medicare Providers expedite payments

Our mission was rooted in a simple but profound need - Medicare healthcare providers required current data about their patients. How could we give these users access to Medicare claims data sooner? What data fields were pivotal for their patient care success?

photo credit: Natanael Melchor

Shortening the Data Lag

Until recently, Medicare data was accessible only 3-4 weeks after a claim submission. We ventured to change this narrative.

Our users were Accountable Care Organizations (ACOs) from a variety of payment models within Medicare. We demonstrated to Medicare that access to claims could greatly improved care coordination and outcomes.

Our team created an enhancement to an existing Application Programming Interface (API) platform.

We answered these questions:

  1. What system do we use to give users access to claims data?

  2. What data fields do users need to make timely analysis about their customers?

photo credit: Richard Parej

The Benefits of Speed

Accessing data swiftly bestowed several gifts upon healthcare institutions:

  • Coordinate Beneficiary Care: Faster access to information allowed seamless care coordination.

  • Expedite Payments: Timely data meant quicker reimbursement for services.

  • Track Out-of-System Care: The ability to track external care enhanced patient safety.

  • Improve Clinical Context: Real-time data enriched the clinical context, leading to better-informed decisions.

  • Downstream Payment Cost Savings: Early data access translated to cost savings further downstream.

  • Claim Rejection Mitigation: Getting ahead of claim rejections reduced administrative hassles.

  • Track Financial Performance: A holistic view of financial performance became attainable.

photo credit: National Cancer Institute

Shaping Medicare's Future

Our research, analytical prowess, and engineering innovations changed the game for Accountable Care Organizations (ACOs) under various Medicare payment models. We demonstrated to Medicare the pivotal role of early access to claims data in enhancing care coordination and patient outcomes.

The Power of Enhancement

Our team amplified an existing Application Programming Interface (API) platform to achieve these remarkable results.

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Answering Critical Questions

We navigated complex questions:

  • The Right System: What system would give users access to claims data?

  • Data Fields for Analysis: What data fields were essential for timely customer analysis?

Part 2: Claims Phases Diagram (below)

I visualized intricate data from different phases of the Claims Adjudication Process, simplifying complexities for Medicare stakeholders. This visual aid was pivotal in conveying the significance of early data access.

Diagram credit: Jenny Mikesell

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Claims Phases Diagram

My colleague gave me an Excel file illustrating specific data that was populated in each Phases of the Claims Adjudication Process. I created a visual to explain it. This helped Medicare stakeholders understand what happened in each phase of the data and what user would see with early access to this data.

Diagram credit: Jenny Mikesell

Photo credit: Vlad Sargu

Research Goal #2

Field of Dreams

Our quest was twofold: identifying the data fields essential for Accountable Care Organizations and highlighting vital case studies aligned with their business objectives.

Photo credit: Accuray

In-Depth Insights

We dove deep into user interviews, contextual research, and surveys, unraveling the data fields crucial for patient care and provider communication.

photo credit: LinkedIn Sales Solutions

User Engagement: Fostering Community and Knowledge

I orchestrated surveys and designed webinars, fostering user engagement, and unearthing the data fields different users leveraged.

Onboarding and Participation

I created comprehensive onboarding documentation and a Participation Guide, ensuring a smooth transition into the new data enhancement.

Prototyping for Progress

Our team developed prototype dashboards for user testing and eventual standardization.

User-Centric Validation

At the end of our pilot, I interviewed users, gaining invaluable insights into their interactions with the data and the transformative impact on their workflows.

photo credit: National Cancer Institute

Quantifying Impact

We measured tangible outcomes:

  • Data Access Time Reduction: From 30 days to 2 days, a revolution in data accessibility.

  • User Adoption: A commendable 30% user adoption rate as of May 2023.

  • Provider Empowerment: Enhanced patient care coordination and outcomes.

  • Cost Savings: Downstream payment cost savings and reduced administrative burdens.

Use Case Illustrations

I created various illustrations for use case dashboards. Below is one example.

Illustration Credit: Jenny Mikesell

Diagram credit: Jenny Mikesell

Dashboard Prototypes

These prototype dashboards I created not only to illustrate a use case, but to use to test with users to eventually create a standard dashboard.

Our journey was a testament to the power of innovation, collaboration, and user-centric design. We transformed Medicare data access, leaving an indelible mark on the healthcare landscape.