Care Manager Virtual Health System
Occasionally, projects that involve many different groups and as many different digital tools can become overwhelming and problematic. This project within Blue Cross and Blue Shield of Illinois (BCBSIL) has all of those ingredients but so far, my team has proved itself as an invaluable asset in organizing the project and supplying valuable observations from a number of user research sessions we had in the foundation phase of the project.
An older tool called Aerial is still being used by Care Managers (CM) to report field visits with BCBSIL members who require at-home visits. Utilization Managers (UM) handle the intake process for these members and dispatch needs to the CM group. The CMs meet with these members at their homes or facilities where they are living to find out how their care plan is working, what their primary care physician (PCP) has diagnosed them with and also whether they need additional resources. There are state mandated portions of the CM visit that need to be reported and the Aerial system helps to facilitate that. Virtual Health is a vendor provided tool being piloted in Texas for a health program there. My team is looking into whether this is a viable solution to replace Aerial, find out current pain points from both the Aerial and Virtual Health users and strategize on how these tools can be incorporated with other established systems within BCBSIL.
The request has been managed by the Development team and they reached out to our department to involve us. We are partnering with the teams who schedule and manage the CM and UM groups to organize field visits and observations. Eventually we will also utilize the CM/UM groups to perform usability tests on the solutions we devise.
I have been working with a coordinator on my team to organize notes from the various meetings and workshops we have attended for this project. Through this process, we have created a sitemap for how the different tools all integrate with the CM/UM process. From there, we were able to get a start observing the CM process. We connected with a CM manager to schedule field visits and office observations to see how they currently use the Aerial tool. These field visits have occurred in members' homes, assisted living facilities and at different BCBSIL office locations.
Early wires were built for the Member Dashboard portion of the project to simplify what the CM is seeing when they are reviewing a member's profile. Feedback from the CMs that we interviewed guided the design to include a specialized view that only shows conditions the member is currently eligible for (these are health conditions that the member currently has like Type 2 Diabetes or a mental health condition, for example). A new step was introduced to allow pre-populated information to display when the CM first accesses the member's profile. This also allows the CM to select any additional conditions the member has become eligible for.
After a series of field visits, we found that even though the CMs were provided with iPads and hotspots, they were not bringing these with to complete the information required on a member home visit. Some of the reasons included the CM wanting to have a more organic conversation with the member, safety concerns with bringing this type of equipment into an unfamiliar location and the system being too buggy to depend on it during a visit. The CMs would, instead, carry a notebook in with them , take notes and eventually compile the information on the iPad later in the day. This obviously creates a large room for information to be forgotten or left off entirely.
Where We Are Now
This project is still in the preliminary stage but based upon the insights we have provided, our team now holds a key place in the conversation. We are a key resource for information about how the end users are engaging with the tools and what our suggestions will be to improve the flow. Next steps include observing the intake process with individuals in the UM role and also with individuals who have transitioned from the UM role into the CM role.