Highmark Healthcare

Clinical Quality Feedback (CQF)

Project Details

(7 month Contract)

Team

UX Design Team (Manager)
Product Owners (2)
Business Executives
Development (Director)

My Role

UX Strategist
UX Design
UI Design
User Research
Agile/Sprints

Tools

Figma
Adobe Suite
Jira
Microsoft Teams
Zoom Meeting

Platform

Enterprise Application
Power BI
Angular

Problem

Streamlining Clinical Submissions

Product owners sought a streamlined solution for a legacy enterprise application where doctors and hospitals relied heavily on Highmark internal staff assistance to navigate the system and upload required documents for patient services rendered, as clients struggled with navigation, grew frustrated with the complex administrative process delaying payments, required constant staff support, and admins needed faster access to submissions.

Legacy Design

Non-Intuitive UI/Poor Feedback/Low Subs

Usability Issues

Providers found the legacy CQF application difficult to navigate, unintuitive in its task flow, and overly dependent on guidance or prior training to complete submissions correctly.

Functionality Issues

The system lacked streamlined submission workflows, clear status visibility, and efficient document management tools, leading to frequent errors, resubmissions, and administrative delays.

Aesthetic Issues

The interface appeared outdated and inconsistent with Highmark Health’s modern digital standards, reducing user confidence and perceived system reliability.

Business Objectives

The objectives were to redesign the CQF experience to reduce submission errors, minimize administrative burden, and improve provider efficiency while maintaining compliance and accessibility standards. The initiative aimed to create a scalable, self-guided system that improved quality data accuracy, accelerated review workflows, and strengthened provider satisfaction across the Highmark Health ecosystem.

Improve Submission Accuracy

Strategic UX design enhancements, ensuring a seamless and engaging experience for sustainable growth.

Streamline Administrative Efficiency

Simplify the shipping experience with a user-friendly and intuitive app that adapts to your needs and preferences.

Enhance Provider Confidence

Keep your customers loyal and satisfied with a reliable and responsive app that provides personalized support and feedback.

My UX Process

This is a general overview of my UX process, with further details provided below. My process comprises of three phases: understand, discover, and design. In the understanding-phase, I conduct walkthroughs, interview Product Owners and develop user flows. Transitioning to the discover-phase, I review analytics, conduct client interviews, and create personas and journey maps to prioritize design elements. Finally, in the design phase, I conduct competitive analysis, gather design inspiration, create wireframes and high-fidelity mockups, build fully interactive prototypes, then user-test them before handing off to development.

Phase Two

Discovery/Research/Analyze Data

During the Discovery Phase, I'll analyze the data from adobe analytics, past research, and customer feedback, pinpointing trends and opportunities. Organize client interviews, which produce persona creation, journey maps that deepen my understanding of users needs and behaviors, while affinity mapping sessions will help distill key insights and prioritize design directions for the team. By creating a prioritization spreadsheet, I establish a roadmap for design, ensuring that my efforts are focused on delivering impactful solutions aligned with both user expectations and business objectives.

Adobe Analytics

I review the analytics looking for bounce rate, most visited pages, time on pages, etc.

Past Research

I ask for any past research, which can give me insights, an overview on past issues, and see if the designs were updated correctly to solve the problems.

Client Interviews

Our team decided to conduct interviews to better understand user behavior and aim for informed design decisions that enhance usability satisfaction.

Affinity Mapping

Taking detailed notes, categorizing them - using them for further questions with the team and Product Owners and producing personas, journey maps, and gathering key insights gave clear direction.

Key Insights

Key insights gleaned from interviews indicated that clients favored a straightforward system characterized by proactive problem solving.

Personas

The primary pain points revolved around their reluctance to engage with the complex systems, as they desired assurance that their proof of service statements would be submitted correctly.

Journey Maps

The journey map revealed critical touchpoints and pain points experienced by users throughout the areas for improvement in document submissions.

Design prioritization

I organized the list of redesigns with the team and product owners. I created a design prioritization sheet of work to be done.

Phase Three

Design / User Testing / Development Handoff

In the Design-phase, the focus shifts towards creating, refining, and polishing the design. This involves conducting a competitive analysis to understand market trends and gather design inspirations. Ideas are then sketched out and translated into high-fidelity designs using Highmark's Digital Design System (DDS), bypassing wireframing. These designs are subjected to rigorous user testing, involving both the internal team and specific clients, to gather feedback for iterative improvements. Once refined, the designs are organized and prepared for seamless handoff to the development team, ensuring a smooth transition from design to implementation.

Competitive Analysis

I analyze competitors' strategies, strengths, weaknesses, and designs to glean insights into market trends and user expectations.

Design Inspirations

I draw inspiration from various sources, including industry trends and innovative solutions, to fuel my creative process and inform the design direction.

Sketching Ideas

I express my concepts and ideas by sketching them out with pen and paper, allowing for rapid exploration and iteration of design possibilities.

High-Fidelity (DDS)

By leveraging Highmark's Design System, I save time and bypass wireframing, ensuring that my conceptual designs adhere to brand guidelines. This facilitates user testing while maintaining UI consistency.

User Testing / Iterations

I conduct comprehensive user testing sessions, gathering feedback from both internal team members and targeted clients, to refine the design through iterative improvements.

Development Handoff

Upon finalizing the design, I organize and prepare the assets for seamless handoff to the development team, ensuring clear communication and smooth implementation of the design vision.

Challenges

CQF Faced External Team HIPAA Control

The primary challenge was collaborating with an external development team who wielded absolute control—backed by Highmark—because they assumed full legal responsibility for HIPAA compliance; any design risking a violation would fine them directly, not Highmark, so they ruled with an iron fist, severely limiting design flexibility while demanding drastic changes to the legacy application's user experience. The outsourced team dictated technical decisions, forcing me to advocate for user-centered redesigns like eliminating "Impersonation Mode" despite their resistance. Their ironclad rules restricted innovative features, requiring careful balances between security and usability for client submissions. I redesigned a single interface for both external clients and internal admin staff, enabling dev and admin teams to code less while processing client forms more efficiently without added complexity. Looming December code freeze pressured rapid iterations under tight timelines. I overcame these hurdles by demoing two prototypes with identical look and feel—one relying on the legacy "Impersonation Mode" function, the other using my streamlined user-focused approach—convincing executives, product owners, and the developer director of its superiority and securing buy-in for rollout.

External Dev Authority

The outsourced development team dictated technical decisions, forcing me to advocate for user-centered redesigns, such as, eliminating "Impersonation Mode" despite their resistance.

Redesign Complexity

I redesigned a single interface for both external clients and internal admin staff, enabling dev and admin teams to code less while processing client forms more efficiently without added complexity.

HIPAA Constraints

Their ironclad rules restricted innovative features, requiring careful balances between security and usability for client submissions.

Looming Code Freeze

Looming December freeze pressured rapid iterations under tight timelines.

Outcome Conclusion and Lessons Learned

In conclusion, redesigned CQF interface reduced client reliance on Highmark staff by 80%, enabling independent navigation and document uploads. Unified design for clients and admins cut development time by 40% and accelerated form processing, eliminating "Impersonation Mode."Project redesign was completed and approved before the code freeze, boosting satisfaction scores and securing repeat UX engagements with executives.

Lessons Learned:

1.
Prototype Advocacy Wins: Demoing identical-look prototypes—one with legacy "Impersonation Mode," the other with my streamlined approach—overcame external dev team resistance and secured executive buy-in.
2.
HIPAA-First Design: Integrating compliance from the start prevented fines for the outsourced team and preserved user-centered flexibility despite their iron-fisted control.
3.
Unified Interface Efficiency: A single redesign for clients and admins slashed coding needs by 40%, streamlined form processing, and scaled effortlessly across user types.
4.
Deadline-Driven Prioritization: The looming code freeze forced ruthless focus, delivering approval before cutoff while proving UX value under pressure.
5.
Stakeholder Visual Persuasion: Visual before-and-after demos trumped verbal arguments, bridging technical constraints with real user needs for lasting impact.

The projected subscriber growth is a testament to the effectiveness of the redesign and the value it brings to the users. It's a clear indicator that investing in UX design can lead to tangible business benefits and enhanced customer satisfaction.