Case Study

Nava is supporting the Centers for Medicare & Medicaid Services (CMS) on an initiative to help Medicare beneficiaries understand the importance of preventive care and find a primary care provider in their area who can offer crucial preventive services. Preventive care such as annual check-ups, screenings, or immunizations, helps detect serious medical problems before they become life-threatening, leading to better health outcomes long-term. As Medicare provides health care for 65 million people, this initiative has the potential to improve health outcomes for a large slice of the public.

• Less than 50 percent of adults 65 and older are up-to-date with preventive care services
• 65 million Medicare beneficiaries can search for and compare healthcare providers using this tool

Approach

Preventive care is crucial because it can lead to less time spent in hospitals, nursing homes, and home health care. However, some research suggests that fewer than 50 percent of adults 65 and older are up-to-date with preventive care services. There are many reasons one might not receive preventive care, including but not limited to the lack of a primary care provider or an unawareness of recommended preventive services. 

That’s why we are supporting CMS on their initiative to help Medicare beneficiaries understand and connect with a primary care provider for preventive services covered by their plan. This work is part of a larger vision that aims to help millions of beneficiaries make informed decisions about their healthcare. 

At the center of this initiative is a tool on Medicare.gov, where 65 million Medicare beneficiaries can look for and compare healthcare providers of all kinds. With this tool, Medicare beneficiaries can find and compare providers in their area, assess quality of care, and understand financial considerations when picking their care. 

Our team has been tasked with helping CMS develop a more integrated experience across Medicare.gov. Long-term, our shared goal is to deliver the best experience for beneficiaries and caregivers to help them make informed decisions at every stage of their healthcare journey. 

Outcomes

In just six months, our team launched an early version of an improved customer service experience that helps beneficiaries understand preventive services covered by their plan, and then helps them find a provider who can give them that preventive care. 

This initiative helps meet beneficiary care needs by providing a seamless and personalized customer service experience. Specifically, Medicare.gov users can leverage the compare tool to search for primary care providers and receive all valid results in their area. 

Process

We began with a series of working sessions with CMS stakeholders to define the scope of this initiative. These working sessions unveiled what areas of the customer experience we might want to address, and ultimately informed our goal: encouraging beneficiaries to take advantage of preventive services. Once we defined our goal, we delivered a proposal to CMS that detailed four initiatives we believed would improve the Medicare.gov experience: 

• Enabling beneficiaries to search for primary care providers and preventive services using the compare tool

• Sending beneficiaries personalized messages that direct them toward preventive services through a primary care provider

• Adding a call-to-action to find a primary care provider and/or preventive services within beneficiaries’ Medicare.gov accounts

• Adding a call-to-action to find preventive services on Medicare.gov’s Preventive & screening services page

Next, we decided with our stakeholders that our team would focus on helping beneficiaries find and receive in-network preventive care. For the most vulnerable populations who may not have a primary care provider, encouragement to find one and take advantage of the preventive care they are eligible for may also help advance health equity and prevent the need for emergency services. We also wanted to make sure these new initiatives helped users with Medicare.gov accounts and those without. 

Next, we got to work on developing the initial build of the customer service improvement experience. We collaborated across teams working on Medicare.gov to create a more cohesive journey that highlights the importance of preventive and primary care. We did this through a series of design explorations and cross-functional collaboration sessions, which helped us align on the ideal user experience for Medicare beneficiaries. This process also revealed the technical requirements for making applications work together. 

For example, we wanted users to be able to click on a link from various pages across Medicare.gov and be directed to the compare tool, where their location and desired care type would auto populate in the search bar. To achieve this, we worked to understand how different parts of the site function. Next, we collaborated with each respective team to understand how we could transfer a beneficiary’s location from their Account Home to the compare tool. This would allow users to find relevant care in their area. 

We also added nearly 30 new search keyword terms to the tool. In order to add new search terms that fit people’s needs, we conducted extensive research to determine the appropriate mappings of preventive services to different provider types and specialties. For example, we wanted to make sure that someone who chose the “Diabetes screenings” preventive service was mapped to providers with this capability. We then verified that these mappings were accurate with clinical subject matter experts before adding the new search terms to the compare tool. 

This is especially important because one of the main reasons people go to the compare tool on Medicare.gov is to find primary care providers. However, until recently, people couldn’t search using the term “primary care provider.” Now, that search term yields providers in several specialties such as geriatric medicine, family practice, and internal medicine. People can conduct these searches in English and Spanish. 

To enhance the user experience, we added “Find a Provider” buttons to the My preventive services page. Each button maps to a specific preventive service type, and when beneficiaries click on one of the buttons, it auto-populates the name of that service into the search bar. This process allows beneficiaries to find a provider in their area who can support their particular health needs. 

We also added a link to the top of the Preventive & screening services page on Medicare.gov to help beneficiaries find a provider who can support the preventive service they need. Finally, we integrated a reminder of preventive service eligibility in personalized messages to beneficiaries. These messages guide beneficiaries to the compare tool, where they can find a provider if they don't already have one.

Closing summary

Now that CMS has achieved a more integrated provider search experience that promotes the importance of primary care access, we can look toward the future. We’ll continue to work toward our goal of making the compare tool more personalized, integrated, and supportive of beneficiaries and their caregivers at every stage of their health journey.