I've been fortunate that I have not had to make too many visits to the doctor over the years, at least for anything significant. But the dentist, that's a bit of a different story. I've had a pretty colorful history when it comes to tooth #9...that's the front tooth, the left one. I injured the tooth during a silly 16th birthday "hazing" gone awry, and years after the incident, I've had some pretty interesting visits to the dentist to repair, cosmetically alter, and in general, make fit for eating sandwiches. For the most part, the majority of the costs of these procedures were covered by my insurance plans...until recently.
Hoping to end emergency dentist visits and limited biting/chewing capability once and for all, I chose to go with an implant procedure. I was informed that my provider would cover only a small portion of the total cost, and like many medical procedures, was certainly not insignificant. Why would a procedure to limit "severe infection" from eating away at what was left of my root be covered so poorly? More than enough to get me questioning the process and the reality of the patient-doctor-insurance provider relationship, I sat down with my Periodontist, my assumptions were validated and the absurd reality of my experience reinforced what we all know and can attest to: Medical insurance certainly is not designed with a focus on the patient (user) but favorably skewed in the direction of the provider (A surprise to NO ONE.). So I asked myself:
What if insurance providers took a more user-centered approach to coverage?
Chatting with my doctor about the cost breakdown, it became apparent to me just how not user focused my insurance provider's policies are (NOTE: This is common for all major insurance providers.). As is standard process for medical procedures, my doctor broke down the implant procedure to its constituent sub-procedures, reported out to my provider and then the provider analyzed the sub-procedures independently (each having a unique medical code) reporting back to the doctor what the payout will be for each sub-procedure. What this translates to is that I could have 80% coverage for drilling the tooth canal and having the tooth extracted, but replacing the tooth - I'm on my own. To me the user, I see this entire process as one necessary procedure: Getting my tooth rid of infection and making it stable so that I can enjoy a comfortable life. From the insurer's perspective, the procedure is seen as a series of line items, multiple procedures, some considered "payable" and others not covered, a process aimed to minimize the payor's financial liability. My situation is not unique and my doctor proceeded to give me examples of other similar poor coverage user experiences from broken bones to elderly care. So I asked myself:
...If an insurance provider began to design an experience from the perspective of the user, leveraging the principles of design thinking to create an experience which is pleasant and useful for the user as well as profitable for the company?
Realizing that there is opportunity to differentiate an experience from that of competitors stuck in traditional top down policies, a provider could initiate a full service analysis identifying all consumer touchpoints (including the interactions of both companies purchasing insurance plans for their employees and patients themselves), spending time observing users, transforming this observation into insight, converging on the most impactful ideas, prototyping, piloting, iterating and implementing a transformative experience.
Of course, there must be some motivator, market pressure, business objective etc, etc... for a company to feel the need to differentiate itself in this manner, to truly stand out as a user-centered service provider.
I will argue that as the healthcare landscape drastically changes over the next, say 10 years, the individual healthcare service user will be presented with more CHOICE in regards to the healthcare plans we participate in. Businesses, in part to be attractive to employees, may purchase popular, user-centered healthcare plans to offer their employees. Providers will feel compelled to differentiate and stand out, to be attractive to both businesses and individual plan holders. A user-centric model will be just that differentiation that will new companies entering the market (of which we're starting to see an influx) attractive and help established companies survive in a new healthcare landscape.
Of course I'm riffing on a "happy path" of sorts as healthcare coverage is extremely complicated and convoluted as a result of many, many interests and motivations, but I can't help but think that there is room for a revolution which will ignite as companies leverage of user-centered design.
...And maybe, just maybe, the next tooth implant I need will be covered more reasonably, so that I don't look like a defaced subway ad if I can't pull together the money to cover putting a tooth back in.