Explanation of Benefits (EOB)

Journey to a better health industry EOB.

More than a piece of paper

This document is known as the Explanation of Benefits in the health care industry. It’s typically shared after treatment or care that is completed by a provider. They’re hard to read and seem impossible to understand — often going straight to the garbage can. The EOB’s we were improving hadn’t been redesigned for over two decades.

Finding the Right Approach

The design, business, and technical teams worked together in an agile fashion. We started with a discovery phase that became a runway for the teams to follow. Agile allowed the team to iterate through problems and evolve the design over time.

Goals

1. Reduce member calls and increase self service
2. Reduce paper and mailing costs
3. Increase customer satisfaction

What was my role?

I lead discovery and design efforts. Helping lift the project off the ground, I completed a competitive analysis to understand where we stood in the health industry. I completed user research to understand where the gaps and pain points were. Once discovery efforts were complete, I designed the new EOB and took it through several iterations with the business and technology teams to ensure viability and feasibility.

The Problem

The original EOB was created in legacy systems and has rarely been touched since then. Creating a simple and easy-to-understand document is much more complicated than creating a typical print document like a poster or flyer. It’s more similar to web systems. We also had to deal with several mainframe systems.

Findings

The EOB labels, language, and structure are confusing for various reasons.

– Members do not always know what they owe

– Members do not always know what to do next

Members are likely to call when they receive an EOB with a rejected procedure.

The legal purpose of the EOB is about adjudication and transparency, specifically the member’s right to appeal.

Baseline Comparison

We completed two rounds of baseline testing where we compared our EOB to competitor EOBs. We found that we were, in fact, lagging behind our competitors, and it showed in the feedback we received from user testing.

A Better EOB

We completed concepts that were user-tested using usertesting.com. Our initial round of design showed significant jumps in net promoter scores and successful task completion. Not only were we designing internally, but we were also creating concepts for another subsidiary customer. Their specific requirements present additional challenges in their designs.

Designing an EOB

The new design displays summary-level information upfront: clear branding, marketing for paperless, the dentist visited, a definition of an EOB, claim details, cost details, and contact information for support. The following pages break down the specific claim details service by service and total costs by service. It shows additional details about overall member plans and benefits. 

The Final EOB

The EOB is an evolving product that will be improved and refined over time.