Cigna: Scenario Modeling Tool

The competitive market share dashboard was used by the internal network analytics team, to gain a better understanding of Cigna’s competitive positioning and performance in relation to other top insurance providers within a particular geographic area. The report focused on the unit cost trends that Cigna negotiated with individual hospitals and systems, and was crucial to the on-going market planning process.

Project Goal

Build scenario modeling functionality into Web Application

The competitive market share dashboard had just been released to the web in a view only format. The next phase of this project was to convert the scenario modeling functionality from the Excel template into the new reporting dashboard.

Strategy

Stakeholder workshops for alignment and scoping
User discovery research
Rapid prototyping and usability testing
Iterative design and requirements refinements

Timeline

An overall timeline of 5 months (01/21 - 05/21).

User Needs

The network analytics team members could use the modeling functionality to project future year contract pricing to help save Cigna money and make them more competitive in a given area. The modeling functionality relied on complex calculations that were leveraged as future predictions for how to shape conversations with providers in up-coming negotiations.

“The labels and formulas need to be consistent and easy to understand to avoid confusion as we work on it.” - Pricing Analyst
“I need to see more than the top 10 facilities / fee schedules because sometimes I can’t do anything with them but will be able to manipulate the smaller contracts.” - Medical Cost Analyst
“I need to have more accurate data. I only get this report twice a year and that leaves a lot of room for unknown changes, given the healthcare industry today [related to COVID-19]. We need to get approved actions loaded in the database faster so the report is accurate.” - Regional Finance Lead

Results

The minimum viable product was released into production in May 2021 for usage by 125 users as a pilot for their market planning process. At the time of my departure, the product owner was working with production support to monitor any user feedback and requested enhancements as the pilot and additional users got on-boarded.

Unified process in a web application
Faster and more accurate data being leveraged
Ability to play around with ideas and see the impact

Before: January 2021, Excel

After: May 2021, web application

Design Process

User Research

Given the complexity of the legacy reporting tool, I spent 13 hours interviewing 13 users across the three main user groups — Medical Cost Analysts, Regional Finance Analysts, and Pricing Analysts — to understand the legacy functionality and the desires for the web-based modeling functionality.

My first step then was to understand the data flows, in both granularity and rolled up calculations, and what that would ultimately do to the reporting dashboard. I worked closely with the subject matter experts, users and product manager to understand the current functionality and requirements for the web version.

Rolled up data flow of existing legacy tool.

Individual system or fee schedule data flow of legacy tool.

Data flow for scenario impacts on the report.

Usability Testing

I conducted 22 hours qualitative and quantitative research via moderated interviews with a rotating number of Medical Cost Analysts (power users). The purpose of my user testing was to understand:

Example scenarios that might be leveraged to make sure I could accommodate the structural complexity between categories and scenario type.
- The organization and relationship of the data fields.
- The depth of knowledge in the current field calculations and how to provide clarity.
The categorization of scenarios and use of consistent language.
The flexibility of the search functionality for both fee schedules and provider systems.
- The amount of granularity in the data needed.

I put a special focus on my wireframes relating to the jobs to be done for the Medical Cost Analysts:

Job #1 - Create a new scenario to see the impact for both fee schedules and provider systems.
Job #2 - Edit an existing scenario based on input from my manager and matrix partners.
Job #3 - Review status of all scenarios modeled over time to see how the projection actually measured up to the real data being pulled in.

Usability Insights

Search functionality needed to be very flexible given the granular selection due based on the specificity of some of the actions within the models.
Calculations needed to be reviewed by the business stakeholders to align on the math, terms and consistency in expectations.
Modeling functionality seemed to follow a logical form flow and the designs evolved to include a multi-step wizard to help users create scenarios and see if their ideas would have valuable impact and help close cost gaps.
The ability to see real-time calculations of potential actions would be very beneficial.
Visualizations over the report would make it really easy to have conversations with managers and matrix partners to show the before and after and indicate the accountability that was lacking.