Role

Design Strategist and Researcher leading a cross-functional team of peers (Senior Managers and Directors). Data analysis performed by my team at my direction.

Methods

Diary Studies
Stakeholder Interviews
Analytics
Document Analysis
Journey Maps
Service Blueprints
Workshop Facilitation

Result

Designed new journeys in four key areas and received approval for pilots.
Reframed the "unsolvable" problem of access to include tangible, impactful plans of action for multiple teams.
Created an engaged, informed, cross-functional task force as champions for the initiatives.

Summary

Driving Customer Experience Through Innovation and Collaboration

A California insurer had achieved consistent improvements in customer experience, as measured by both internal and external surveys. However, internal analysis of call data, grievances, and NPS survey responses revealed that Access to Care remained a persistent challenge.

Access is considered a “Wicked Problem” because its root cause—an overall shortage of doctors—is one that most operational teams consider to be out of their hands. Yet, as the Customer Experience Lead, I took on the challenge to improve member experience with the resources we had while building a sense of agency and ownership among team leaders. I was tasked with leading a team to identify levers that would help us accomplish two critical goals:

Achieve a weighted NPS score of 25 by the end of the year, with a target of improving access-related scores by 3.5 points.
Reduce grievances related to Access to Care by 5%.

Over an intensive 12-week period, I conducted in-depth research, analyzed and mapped findings, and facilitated multiple workshops with a dedicated cross-functional team composed of Directors and operational leads. Through this collaborative effort, we uncovered innovative opportunities to improve access—ranging from operational adjustments to enhancing communication with members and providers.

Our work culminated in actionable recommendations that reshaped how we approached the issue of access, proving that even in the face of systemic challenges, meaningful improvements are possible.

Insights

Developing a shared understanding of the experience and operational barriers

We were fortunate to have access to dScout, which allowed us to stand up diary studies and interviews quickly and have results in just a few weeks. We also mined our repository of related research on topics like provider search usability and attitudes towards alternative sites of care. Additionally, we conducted various internal reviews including:

Analysis of NPS open-ended responses
Coding the text of grievance reports
Review of relevant external regulations and internal processes
Review relevant of member communications and digital tools related
Stakeholder interviews

We discovered that dissatisfaction with “access to care” from the perspective of the members includes more than just the ability to see a doctor in a timely manner. Some of these factors included:

Convenience and flexibility of scheduling an appointment (e.g., online scheduling, the ability to access an alternative like telehealth)
Clarity around when and how to get a referral or authorization and expectations around timing for the same
Dependability of our patient transportation vendor

From the provider and internal process perspective, we learned that providers might be available, but they are suppressed in search due to a regulatory restriction. We also identified issues in the pre-authorization process.

The Research

I presented the research through stories, pictures, and quotes to give the team a better understanding of the experience and emotions of members.

"[The payer] takes too long to approve treatments when you need them asap or the clinics contracted under them don’t take you at priority."

“We keep losing our primary care docs. Wait time is ridiculous to get an appointment and even worse for specialists.”

"I’ve been referred to two different practices so far that don’t even take your insurance. The whole process has taken so much time."

Analysis and Synthesis

I led workshops to collaboratively build out an empathy map and a context canvas to synthesize the learnings from the human and operational perspectives. This activity also helped team members empathize with the experience and barriers.

Empathy Map

*Fidelity lowered to protect IP

Context Canvas

*Fidelity lowered to protect IP

Co-Creation

Mapping the experience from the provider and patient view

Once we established a shared understanding of the patient experience, we used that insight to collaboratively map the journey of a patient seeking care. Conducting this exercise in a workshop setting allowed us to draw on the subject matter expertise of participants, creating a holistic view of the process that avoided finger-pointing and fostered cross-team collaboration. This approach helped us pinpoint pain points and opportunities while providing a structured framework to organize our data and research.

The outcome was a comprehensive service blueprint with dozens of actionable opportunities. We divided into groups, each focusing on a specific part of the process, to brainstorm solutions. When we consolidated and refined the ideas—removing duplicates—we ended up with 183 tangible actions, spanning short-, mid-, and long-term initiatives aimed at improving both the patient experience and operational efficiency. After evaluating these ideas for feasibility and impact, we identified key themes to guide our strategy moving forward.

Blueprint and Ideation

We collectively built a service blueprint based on the findings, with each team member contributing their domain knowledge to help us understand the steps. We called out the pain points and opportunities (in red) and used these as a starting point for our ideation session. We generated over 180 ideas.

*Fidelity lowered to protect IP

*Fidelity lowered to protect IP

Result

Empowering teams to make meaningful improvements

We ultimately mapped new future-state journeys in key areas and received approval to implement pilots and process improvements. These included:

Created multi-channel communication strategy for authorization status updates, implementing automated notifications at critical touchpoints.
Redesigned provider directory maintenance process to reduce suppressed listings while enabling urgent care access through expanded associate permissions.
Launched guaranteed same-day appointment program through specialized call center team, including out-of-network coverage for urgent needs.
Expanded virtual care adoption through integrated marketing, enhanced provider search capabilities, and accelerated implementation of econsults.
Restructured vendor contracts to align with experience metrics, introducing accountability measures for transportation reliability and authorization processing.

Through this and other customer experience improvement projects I led while at the company, we were able to drive a 35-point increase in NPS over three years, and move from #16 to #6 in Forrester's CX Index.