Making medical bills less terrifying with human-centered design

Imagine opening up a bill you just received and not being clear about what the charges are, when it’s due, or how much you need to pay. Sounds frustrating, right?

Unfocus your eyes and try to find how much is due. Not easy!

At the UVM Medical Center, we recently realized our medical bills were problematic for all of these reasons. They were confusing to read, and it wasn’t clear what to do if you needed help. So we set out on a journey to redesign our bills using a human-centered design process.

Research, Empathy, Insights

To kick off our project, our team of designers and writers did some usability testing with the existing bill. We wanted to confirm our hunches about what was wrong with our bill and build a greater understanding of the billing experience from the patient perspective. So we took the existing bill into the hospital, found some patients and visitors who had time to spare, and asked a set of open-ended questions to determine how much they understood about how much was due, when it was due, and other basics.

We found that the usability issues we’d recognized were widespread. For example, no one realized the bill was past due, and the total amount due and due date didn’t draw people’s attention. We also learned lots of new things: no one understood what the term ‘Contractual All’ meant, and the description of services was generally confusing. (For your enrichment: a ‘Contractual Allowance’ is the negotiated amount that the insurance company and the hospital agree to. This is usually less than what the hospital normally bills for a given service. Is that still confusing? Probably. The health payment system is a convoluted mess.)

Contractual, Y’all!

In addition to testing our existing bill, we spoke with the phone and in-person customer service representatives who help patients with billing questions. They had lots of feedback and insights about which aspects of the bill are most confusing and what patients’ most common questions are. They coached us to make it more clear that financial assistance and reduced payments are available, as this is something that patients often do not know.

One of the biggest problems customer service folks described is that patients often receive two bills for the same visit or service: one from the “Hospital” (for anything related to using the facilities, like lab work or costs related to staying at the hospital) and one from the “Physician” (charges from the specific physician(s) who treated the patient.) This 2-bill system is common in hospital systems, but it causes endless confusion for patients. They don’t understand why they’re getting another bill, when they just paid one. This confusion can cause patients to ignore bills and sometimes even be sent to collections.

Here are the two bills side-by-side — you can see why people get confused, especially if these bills arrive in the mail at different points in time:

After learning from testing the current bill and talking with the customer service folks, we gathered inspirational examples of bills we liked from both inside and outside of healthcare and posted them up on the walls of our studio. We also took a detailed look at the submissions to the ‘A bill you can understand’ design challenge that Mad*Pow put on last year.

Our inspiration board — anything but boring.

Out of this initial research, we distilled a set of key insights and problems to solve, and a strategy and principles to follow in the redesign process.

Key insights

• People assumed first page of the bill was a summary of charges, when it was actually the start of the detailed charges. Their eyes went straight to the detailed charge listing.
• Total amount due and due date were hard to see
• Phone number did not stand out
• No one noticed that the account was past due — it didn’t pop out
• Financial Assistance/reduced payment info was hard to find
• Font & contrast issues; our font was too small for low vision folks
• Language inconsistency & jargon; “Contractual All” was especially confusing

Design strategy

• Start with a summary of key numbers; follow with the details
• Use color and contrast to call out the most important elements
• Make the bill less terrifying

Patient Experience principles

As a patient:

• “It’s easy to see how much I owe and what the bill is for.”
• “It’s clear how I can get help with my payments or ask a question.”
• “My account status is clear.”
• “My payment options are clear.”
• “The bill is in language I understand.”
• “I can read it even without my glasses.”
• “It’s clear what type of bill this is.”
• “The layout is clean and calming.”
• “I’m not stressed about this bill.”

This work set us up well for the next phase.

Prototype & Test

Armed with our insights and design principles, we went back to our studio and started sketching up quick prototypes. We kicked off by running a two-day ‘design sprint,’ which is design jargon for a short, focused period of time in which we create a prototype, test it with real people, and learn from it. We spent a day brainstorming, sketching out concepts based on our prior research and insights.

Jeremy, Colleen and Julie mid-sketch and looking a little put off — angry even. Menacing even.

A few of the team’s initial sketches.

Interestingly, we initially gravitated toward graphical data representations like charts and graphs, but as we worked through the key problems to be solved we realized these were not as important as we’d originally thought.

After consolidating our favorite ideas, we created a prototype and tested it in the field, with great initial results. Since that time, we have cycled through many more versions of design and testing. Below shows the current bill on the left, and some sample redesigned front pages on the right.

Key features of the new design include:

• Strong use of color to identify ‘type’ of bill (blue is for Physician, green is for Facility)
• Amount and date due are strongly highlighted with color
• For accounts that are past due, this highlight turns to orange; for those nearing collections, it turns red and a warning message appears
• Phone number and how to get help are better highlighted
• ‘Ways to pay’ is clearer
• Font size and contrast were increased throughout

Feedback from the Patient & Family Advisory Council

We brought the bill to our awesome Patient and Family Advisory Council, a group of patients who volunteer their time to improve the hospital experience for other patients:

Here is one of our awesome advisors adding his notes about our bill.

We captured patient feedback and put it all on the wall so we could address it efficiently.

Their comments and questions led us to an innovative new ‘minimum payment’ option that we would not have thought of otherwise. Similar to a credit card bill, for people with higher balances, there is an option to make a reduced ‘minimum’ payment and pay the bill off over a longer amount of time.

People like it.

We’ve had very positive feedback from the people with whom we’ve tested the new bill design. The following quotes are from three different people:

SO much better! Not as daunting, more friendly.

It’s easier to read and understand.

I like the summary. It’s easy to see how much is due and when.

We’re happy they’re happy.

What’s next?

We’re currently in the process of working with our billing statement vendor to bring this new bill design to life. This is one of the most challenging parts of the process, because it depends on coordinating many diverse groups of people — in addition to our bill vendor who creates and mails our bills, we also need to work with the bank that processes the billing slips and our internal folks who work with our billing data systems. Fortunately, we have an excellent, enthusiastic project team that encompasses billing leadership, data science, design and communications.

We are keeping our eye on the ultimate goals of reducing confusion, making our bill less terrifying, increasing our rate of payment and reducing the number of folks we send to collections. We can’t wait to share the final design once it’s launched.