Increased healthcare literacy in the enrollment process, increases user confidence and satisfaction


Many of our clients often come to us with ‘transactional’ problems to solve. How do we get a higher number of completed registrations? How do we get users to engage sooner or for a more extended period? We also often hear the complaint that the process is too long, and the users’ experience will improve if we can shorten it”…Well, the answer is – yes and no. 

Our client, a healthcare insurance aggregator and open exchange facilitator, engaged Medullan’s research team to unravel their users’ registration experience during open enrollment. 

In our initial investigations, we watched as participants worked through the enrollment process to enroll in a healthcare plan online. We observed users stumbling in all the usual places – missing required fields, tripping over incorrect data formats, and pausing over confusing error messages. We also noted the pages where participants spent the most time, had the most questions, and sought help options most frequently. Invariably these were pages dense with ‘insurance language,’ or pages where users were required to answer complex questions about household and tax status, Medicaid eligibility, and exemptions.

Nearly all participants were able to complete the process, but what stood out in our conversations with them afterward was that they did not feel right or confident about the choices they made. We heard, “I just wanted to get through it” and “I’m not sure I chose the best one, but I had to pick something to get coverage“.

As we began to unravel the learnings from this first wave of research, we made a surprising discovery. What was most important to users was not how quickly they were able to complete the enrollment process, but how confident they felt about their choices made at the end. Which led us to consider a hypothesis: If users felt more confident in their choices, they may be more willing to complete the long and complicated enrollment process — and their perception of that process overall might be more positive.

To test our hypothesis we embarked on a second phase of user research. The participant profile for this research phase looked something like this (not inclusive of all criteria):

  • Total number of participants: 20
  • Average HHI: 15 participants made less than $50,000 / 5 made greater than $50,000
  • All participants < age 65 (non-Medicare eligible)
  • Range of household profile: Medicaid eligibility, multiple family members living out of state, multiple income sources 

Each participant completed the same tasks and processes for enrolling in a healthcare plan using their own ‘real world’ characteristics. As you can imagine, as the scenario’s complexity increased, user confidence decreased, regardless of how much time elapsed for a participant to complete the enrollment process.

Conversations with our participants revealed that overall familiarity with the healthcare landscape (understanding of health insurance, awareness, and use of healthcare services, knowledge of healthcare legislation, etc.) played a large role in how they felt going into the enrollment process.  Those participants who had a firm grasp of the healthcare landscape tended to approach the enrollment process more confidently. Those with a weaker understanding of the healthcare landscape approach the enrollment process with more anxiety. 

Below is an abbreviated visual example showing a portion of our research findings. It illustrates the relationship between healthcare literacy overall and the participants’ confidence going into the enrollment process. Participants with lower healthcare literacy reported lower confidence. No participants had high confidence in the enrollment process, where healthcare literacy was low.


Health Literacy Landscape – Pre -Enrollment


Figure 1: Pre-completion of enrollment process (subsample)


The most interesting observation was how the enrollment experience seemed to impact overall confidence — we discovered that most of our participants tended to report the same or lower confidence levels after completing the enrollment process. We found that even those who approached the enrollment process with confidence, felt less confident overall at the end of the enrollment submission.


Health Literacy Landscape – Post -Enrollment

Figure 2: Post completion of the enrollment process (subsample)


The findings allowed us to further hypothesize that if we could increase healthcare literacy as part of the enrollment redesign, we may increase overall user confidence in the process – resulting in users who felt better and more satisfied with the plan choices they made. 


Overview: Results from implementation

With increased literacy incorporated in the design of the enrollment process, completed enrollment applications increased by 9% overall in the following open enrollment period.  User satisfaction with the enrollment process increased, and users, in general, reported higher confidence with the redesigned process flow, regardless of the amount of time it took for them to complete enrollment. 

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