Searching for Doctors in the “Messy Middle”

By Madi Shultz

Choosing where to get medical care is one of the most important healthcare decisions consumers make. But in the age of information abundance, this decision is not simple. No matter the tools someone uses to navigate their search for care, they are faced with a tough task — how do I find the right doctor for me?

Investigating the factors that are important to members as they search for and select doctors has been an ongoing interest for Oscar. Like most research projects, this topic ultimately boils down to understanding how humans make decisions.

Thankfully, people have been studying human decision-making for quite some time. While there are many theoretical frameworks we could use as lenses, this scenario calls for a framework that accounts for high complexity. Specifically, how people make a very important decision (who gives them medical care) in the age of information overload.

Cue Google’s “Messy Middle” Model. Here’s the TLDR:

• Exposure is always happening — constantly informing the awareness a consumer has toward a specific search.
• There’s inevitably an event that kicks off the search for something. That’s called a trigger.
• After the trigger, consumers cycle through the messy middle — an exploration and evaluation cycle — until something eventually pulls them out of that loop.
• A purchase experience goes on to inform exposure and future search processes.

Let’s apply this to a relevant Oscar member experience.

• Exposure might look like a member learning a friend of theirs has been dealing with a skin issue. It can also look like a member growing their awareness of Oscar’s tools over time.
• Their trigger — the member develops their own skin issue and is concerned, so they need to find someone to check it out.
• At exploration, the member asks the friend which dermatologist she goes to and tries to gather some information about her experience.
• In evaluation, the member checks to see if that specific dermatologist is in-network with Oscar and accepting new patients. If either of those factors are not true, the member is likely thrown back into exploration.
• Finally, the member has confirmed this recommended doctor is in-network and taking new patients, so the member selects and “purchases” this doctor.

As we’ve conducted research with our members on this topic, the Messy Middle model has become more salient and reframed our thinking. For example -

• We see word-of-mouth recommendations — whether from a friend, family, or another doctor — as a key component of exploration. The recommendation functions as a shortcut to reduce time spent in the “messy middle.”
• Network status (“is this doctor covered by my insurance?”) and doctor availability (“are they accepting new patients?”) are primary evaluation factors. Primary factors are those that, if not satisfied, force a member to circle back to exploration.
• Reviews are used to explore factors that can’t be filtered or searched by but are still critical. They are a source for sussing out quality — things like bedside manner / knowledge, clinical quality, surgical track record, facility quality (i.e. wait times, cleanliness, if a facility does onsite labs). As members skim reviews, they aim to achieve a general consensus they can use to evaluate doctors.

Here’s the challenge: we’d love to support every moment of this journey, but we know we can’t necessarily address all aspects of the member’s search. We expect our members to leave the Oscar platform at some point as they search. They may explore reviews from third parties like Google (exploration) or call the doctor directly to confirm they have availability (evaluation). Aside from Oscar’s virtual care offerings, they will have to leave our platform to directly book an appointment (purchase).

Therefore, it is critical that we focus on Oscar’s role in this experience — where we can support exposure, exploration, and evaluation. For example -

• When a member is recommended a doctor by their family or friends, their exploration is mostly complete. They enter Oscar’s experience hoping to evaluate that specific doctor by certain factors like network status. Our system has to make evaluation seamless.
• Sometimes, they may have a specific doctor in mind, but in evaluation, find that the doctor is not covered by Oscar. In this scenario, we need to support the member as they circle back to exploration without overwhelming them with endless options.

As we zero in on our place in this journey, we sharpen investment opportunities and de-risk product decisions while still enhancing the overall search experience. The Messy Middle model (paired with lots of member research) is helping us do that.

Madi Shultz is a User Experience Researcher at Oscar, working on using empathy, rigor, and applied research methods to honor the needs of our end users and de-risk product decisions across member and provider experiences.