How BCBS of South Carolina lowered the digital learning curve for members

In the past, BCBSSC members were frustrated by the lack of transparency into the status of their PA requests. Rather than continuing to respond retroactively to these members complaints, BCBSSC created a new feature on their mobile app and web portal allowing members to check their PA status in close-to-real-time. The tracker works similarly to a pizza tracker—notifying members about updates in each step of the PA approval process.

Previously, members could go into their web portal to check basic information once a decision was made about their PA, but it wasn’t as robust or easy to use. BCBSSC wanted to make it easy for members to check the status of their PA requests, so they decided to take inspiration from a popular feature on pizza apps. However, instead of being notified when the pizza is in the oven, members receive alerts whenever the status of their PA is updated.

The three steps
BCBSSC created their live prior-authorization tracker using the following steps:

01. Use member feedback to guide portal ideation and investments

Members are often frustrated by the lack of transparency in the prior authorization process. While it's typically providers who submit prior authorization (PA) requests to the health plan, members are the ones waiting for those health care services and have a vested interest in knowing the status of their requests. If this information isn't easily accessible, members may resort to calling their health plans and/or provider for updates. BCBSSC saw this as an opportunity to improve member satisfaction and to help reduce the burden on call centers and providers by making it easy for members to track the status of their PA requests themselves.

In addition to high call volume, members who felt frustrated throughout the process were vocal in expressing their dissatisfaction through social media. BCBSSC responded quickly and decided to invest in a self-service solution for members waiting on PA approvals.

The key here is that although plans often invest in new features without conducting a thorough evaluation of whether the investment is worthwhile, BCBSSC completely relied on direct member feedback (through the call center, web survey responses and social media) to guide their new investment.

Once BCBSSC had decided to create a self-service PA feature, they worked with an internal consultant to conduct research on their existing processes. Then, BCBCSC gathered 22 leaders from departments across the organization for a two-day design sprint to craft a solution to their PA challenge. During the design sprint, they looked at voice of the customer feedback and research, and journey maps to help guide their designs. They then iterated on their design until they had two promising prototypes.

02. Take inspiration from best-in-class UXs that members are familiar with

During the design sprint, BCBSSC came up with the idea for a near real-time PA tracker on their online portal. Even though the ideation process was quick, user research and development took longer. It took 10 months to turn the protype into a minimum viable product (MVP) using an Agile process.

BCBSSC focused on making their tracker as easy-to-understand and user friendly as trackers that already exist in out-of-industry portals and apps. Similar to how popular pizza delivery trackers function, members are informed and notified throughout steps of the PA process proactively instead of the member having to call in for an update.

Domino’s Pizza Tracker

Health care innately carries a steep learning curve for members because it is a complex topic with lots of jargon. BCBSSC lowered the learning curve for their members by using a tool design that members are already familiar with and have used in their everyday lives.

BCBSSC launched their PA tracker on their mobile app in the beginning of 2020 so that they could release a Minimum Viable Product (MVP) first. They choose this approach so that they could get the tool in members’ hands as fast as possible and iterate on it. Once the PA request comes in to BCBSSC’s system from the provider, members will be able to see the services requested.

On the tracker, below, members can see an estimated time of arrival (ETA) for the PA approval or denial. BCBSSC created these estimated timelines based on the service, historical data on how long PAs for that service have taken, and promised timelines based on contractual commitments. Once a decision has been made on the authorization request, members can either access the authorization letter or are provided with reason for denials.

BCBSSC’s prior-authorization Tracker

To communicate updates with members, BCBSSC integrated their data systems to create a single data lake with the PA updates. The data refreshes every 15 minutes and is connected to their campaign management solution. Whenever a PA is submitted or there is a change with a member’s PA request, the member receives an email or text, prompting them to log into the portal or app to find more information.

03. Continuously iterate on tools

Although the tracker has launched, BlueCross BlueShield of South Carolina still considers this project a work in progress. They are continuously iterating on the tool based on member feedback. Below are some of the next steps that BCBSSC is considering:

• Expanding digital delivery: BCBSSC is working on extending digital communication to push notifications and reducing mail-delivery for members opted in to receiving paperless authorization updates.
• Strategically invest in future features: BCBSSC is considering extending the PA tracker to providers. Their current tracker is solely member-facing, but they believe providers could benefit from a tool like this as well. BCBSSC is also looking to create a similar tracker for claims. Claims are certainly another area where friction may exist for members, so providing more transparency throughout the whole process can help to alleviate any potential misunderstandings.
• Integration with benefits and find care: BCBSSC is considering how they can increase member transparency by connecting PA to member benefits information and the ability to find care for requested services.

After a two-day sprint with 22 plan leaders, BCBSSC developed a prototype for a mobile-first PA tracker. Members can now track the status of their PA requests in real-time, as BCBSSC pulls from their data lake to update the tracker every 15 minutes. BCBSSC has a 26% click-through rate for emails and texts about their new PA tracker, significantly higher than the industry average for health plan communications. Interestingly, although they traditionally see texts perform better for other communications, emails performed better for PA updates.

Additionally, BCBSSC hopes that they have alleviated anxiety for members who are waiting for PA approvals. These members will have a greater appreciation for BCBSSC and will be more comfortable with using self-service options in the future for other care needs.