Case Study
Clinical Quality Feedback, rebuilt so providers could help themselves
Clinical Quality Feedback, CQF, is how healthcare providers send Highmark the supplemental clinical data that standard claims miss. The legacy tool was so hard to navigate that doctors and hospitals leaned on Highmark staff for almost every submission. I led the redesign.
The redesigned CQF. One interface for providers and internal admins, built in Highmark's Digital Design System.
The Problem
A tool that needed a human guide
Providers submit supplemental clinical data through portals such as NaviNet and Quality Blue to close the gaps that claims data does not capture. In the legacy CQF, submissions stalled, payments were delayed, and internal staff spent their days walking providers through screens that should have explained themselves.
The legacy CQF home page. Dense, dated, and dependent on training.
Usability
Providers could not finish a submission correctly without guidance or prior training. The task flow was unintuitive from the first click.
Functionality
Status was hard to see and document handling was weak, which produced errors, resubmissions, and administrative delays.
Appearance
The interface looked outdated next to Highmark Health digital standards, and that quietly eroded provider confidence in the system.
The goal was a self guided system that cut submission errors, took the load off internal staff, and stayed compliant and accessible at every step.
Research
What the research actually showed
I started with analytics, past research, and customer feedback, then ran interviews with providers and admins. Every artifact below changed a decision. Select any image to see it full size.
Key insights
Providers wanted a straightforward system, and one thing above all else: confidence that a submission went in correctly.
Personas
Personas from the interviews kept two very different audiences, providers and internal admins, in view for every design call.
Journey map
The map put the pain in one place, document submission, and gave the whole team a shared target to design against.
The findings became a prioritization sheet built with the product owners, so the redesign started where the pain was worst instead of where opinions were loudest.
Key Moves
Three decisions that shaped the redesign
Move One
Design in the system, skip the wireframe stage
With a code freeze coming in December, there was no time for a long wireframe round. I designed high fidelity screens directly in Highmark's Digital Design System. Every screen stayed on brand and accessible, and realistic designs reached user testing weeks earlier than planned.
Finding: the deadline punished process for its own sake. Decision: let the design system carry consistency so my time went to flows and testing.
Move Two
One interface for providers and admins
Providers and internal admins worked in parallel tools, and admins relied on an Impersonation Mode to act on a provider's behalf. I designed one interface that serves both audiences. Admins lost the workaround, developers built and maintained one product instead of two, and forms moved faster for everyone.
Finding: two audiences were doing one job in two places. Decision: unify the interface and retire Impersonation Mode for good.
Move Three
Settle it with prototypes, not opinions
The external development team pushed back on removing Impersonation Mode. So I built two prototypes with the same look and feel, one on the legacy mode and one on my streamlined flow, and demoed both to executives, product owners, and the development director. Watching the difference side by side ended the debate, and the streamlined approach was approved for rollout.
Finding: arguments about risk went in circles. Decision: make both options visible and let stakeholders judge the work, not the worry.
Challenges
Working under real constraints
External dev authority
An outsourced team dictated technical decisions because their company, not Highmark, would be fined for a HIPAA violation. Every design had to survive their review.
HIPAA constraints
Patient data protection came first, and it ruled out several convenient features. Compliance had to be designed in from the start, not inspected in at the end.
Two audiences, one product
Providers filing submissions and admins processing them needed the same tool to behave in very different ways, without doubling the build.
Code freeze deadline
A December freeze meant approval had to land early. Prioritization was ruthless, and anything that did not serve the core submission flow waited.
Outcome
What changed
The redesign also retired Impersonation Mode entirely and sped up form processing for the admin teams. Executives who watched the prototype demos brought the UX team back for further engagements, which is the review that matters most.
Lessons learned
- Prototype advocacy wins. A working demo settled in one meeting what weeks of discussion could not.
- Design compliance in from the start. Building HIPAA in early preserved design freedom instead of losing it at review.
- One interface can serve two audiences. It cut build time almost in half and made the product easier to scale.