Individual Enrollment – Use Case

Navigating healthcare enrollment can be complex and overwhelming for seniors, requiring them to compare multiple plan options, understand provider networks, and evaluate supplemental benefits. Traditionally, many enrollments were broker-assisted, leaving seniors with limited self-service options. To address this, Alignment Healthcare developed the Individual Enrollment Portal, allowing users to independently search, compare, and enroll in health plans with clear, guided steps.

Despite its potential benefits, statistical analyses show that only 3% of seniors currently utilize self-service individual enrollment, with the vast majority still relying on broker-assisted enrollment. As a result, this tool has not yet been published to production but remains a viable solution for future expansion.

The Individual Enrollment Portal was designed to provide a seamless, transparent, and efficient enrollment experience, enabling seniors to confidently select the right healthcare plan based on their unique needs.

Key Features:

1. Plan Search by ZIP Code: Users can search available health plans based on their ZIP code, ensuring eligibility and localized plan options.
2. Plan Comparison Tool: Enables side-by-side comparison of plans, including:
3. Affiliated Providers & Medical Groups: Ensures seniors can see which doctors and groups accept each plan.
4. Benefit Categories & Services: Provides clear breakdowns of covered medical services.
5. Supplemental Benefit Options: Displays additional perks such as vision, dental, and wellness programs.
6. Guided, Step-by-Step Enrollment: A user-friendly interface guides seniors through each stage of the enrollment process, minimizing confusion and errors.

As a UI/UX leader, I played a key role in shaping the Individual Enrollment Portal, ensuring a seamless and accessible user experience for seniors. My contributions included:

• Conducting in-depth member call analysis by listening to real-time interactions with the call center to uncover key pain points and friction areas in the enrollment process.
• Leveraging CRM Call Reason Data Analysis to quantify the most common enrollment-related inquiries, identifying the highest-volume call drivers and assessing daily call patterns to guide data-driven design decisions.
• Simplifying the user journey by reducing cognitive load and ensuring a clear, step-by-step enrollment process tailored to address common member challenges.
• Designing intuitive plan comparison tools to help seniors make informed decisions by clearly presenting provider networks, benefits, and supplemental options.
• Ensuring WCAG accessibility compliance, making the platform user-friendly for seniors, including those with visual impairments.
• Optimizing mobile and desktop experiences, ensuring that enrollment was effortless across all devices.
• Collaborating with product and engineering teams to refine workflows and enhance system performance.
• Reducing enrollment friction by designing interactive elements that simplify complex healthcare choices.

1. Simplified and Accessible Enrollment

• Seniors can enroll in a plan with confidence using a clear, easy-to-navigate digital interface.
• Reduced reliance on paper applications and manual processes.

2. Increased Enrollment & Plan Selection Efficiency

• The tool provides real-time plan availability, allowing seniors to make informed choices without delays.
• Users spend less time searching and more time selecting the right coverage for their needs.

3. Improved Member Experience

• Greater transparency in plan details, provider networks, and supplemental benefits.
• Reduces confusion, leading to higher satisfaction and better plan retention.

4. Enhanced Broker Support & Hybrid Enrollment Model

• Brokers can guide seniors using the same platform, ensuring a consistent and efficient enrollment process.
• Enables both self-service and expert-assisted enrollments, expanding accessibility.

5. Limited Adoption & Production Readiness

• Only 3% of seniors currently use self-service enrollment, highlighting a continued preference for broker-assisted sign-ups.
• Due to this low adoption rate, the tool has not yet been launched in production but remains an innovative solution for future deployment.

User-Centric Design Enhances Clarity

• A simplified, step-by-step enrollment process significantly reduces cognitive load for seniors.
• Clear plan comparison tools help users make informed decisions.

Low Adoption Highlights the Need for Behavioral Shifts

• Only 3% of seniors currently utilize self-service enrollment, demonstrating a continued reliance on broker-assisted processes.
• Digital solutions require stronger incentives and trust-building strategies to encourage independent use.

Hybrid Support Models Are Crucial

• Brokers remain a critical component of the enrollment process.
• A blended approach—where self-service tools complement broker assistance—can drive adoption.

Accessibility Compliance Drives Inclusivity

• Ensuring WCAG compliance makes the platform usable for seniors with visual impairments and other accessibility needs.

Future Optimizations Can Improve Engagement

• Further refinement of messaging, user education, and interactive guidance could encourage more seniors to adopt digital enrollment.

 Technology Alone Doesn’t Guarantee Adoption

• Even a well-designed platform must address users' trust, comfort levels, and behavioral habits.
• Seniors may need additional education, live assistance, or incentives to transition from broker-assisted to self-service enrollment.

Data-Driven Design Is Key to Problem-Solving

• CRM call data analysis provided critical insights into user pain points, shaping an experience that directly addressed their needs.

Change Management and Stakeholder Buy-In Matter

• Adoption rates may improve with greater broker advocacy and structured onboarding efforts for seniors.
• Cross-functional collaboration between design, product, and customer support is essential to refining the solution.

Incremental Rollout Could Aid Adoption

• A phased launch with pilot groups, A/B testing, and targeted outreach may be more effective than a full-scale release.

Accessibility Should Be a Core Consideration, Not an Afterthought

• Ensuring WCAG compliance from the start provided a more inclusive experience.
• Mobile and desktop optimizations were necessary to accommodate diverse user needs.

The Individual Enrollment Portal has the potential to transform the way seniors select and enroll in healthcare plans. By offering plan search by ZIP code, comprehensive plan comparisons, and a guided enrollment process, this self-service tool enhances accessibility, efficiency, and member confidence. However, due to low adoption rates (3%), the tool has not yet been published to production. Moving forward, Alignment Healthcare may refine its approach to improve engagement and drive broader utilization of this streamlined, independent enrollment solution.