Problem Statement

Patients prescribed medical devices for home use often face significant delays and complications in claim approvals, leading to frustration and potential health risks. This issue arises from a lack of streamlined communication and coordination between patients, physicians, and claim processors, resulting in inefficiencies and misunderstandings.

A global leader in wound care products has set out to address these pain points as they pertained to its service offerings. I led the service design effort to help identify, assess, and align on a roadmap for service redesign through automation and other interventions to facilitate better communication and coordination among patients, physicians, and claim processors.

Service Analysis : User Research & Service Blueprint

I led comprehensive research and service blueprinting activities, collaborating with key stakeholders through workshops to map the current service landscape and identify transformation opportunities. The analysis revealed systemic challenges across three key stakeholder groups:

Patient Experience

• Critical delays in claim approvals create uncertainty and anxiety

• Complex paperwork and insurance procedures overwhelm patients during vulnerable times

• Lack of transparent status updates leaves patients feeling powerless and frustrated

• Financial concerns mount as approval timelines remain unclear

Healthcare Provider Challenges

• Valuable clinical time is diverted to administrative claim follow-ups

• Fragmented communication channels with insurers create persistent bottlenecks

• Provider-patient relationships suffer from approval-related delays and complications

• Inconsistent requirements across insurers multiply documentation workload

Claims Processing Inefficiencies

• Documentation gaps trigger time-consuming follow-up cycles

• High claim volumes create processing bottlenecks and backlogs

• Complex regulatory requirements add layers of verification

• Poor stakeholder coordination leads to duplicate efforts and errors

Through service blueprinting sessions, we mapped these interconnected pain points to reveal how breakdowns in one area cascade throughout the entire service ecosystem. This analysis formed the foundation for developing targeted intervention strategies.

Key Activities

• Discovery & Research In-depth domain analysis and user research uncovered systemic inefficiencies and opportunities for improvement. Conducted targeted interviews with stakeholders and subject matter experts to gain comprehensive insights into current challenges and aspirations.

• Process Analysis & Vision Alignment Through detailed workflow mapping and vision-gap analysis, identified critical breakpoints and areas for service enhancement. Working closely with stakeholders, aligned on priority areas for transformation and desired future-state capabilities.

• Service Blueprint Development Created detailed service blueprints mapping both current and future states, visualizing the complete service ecosystem and proposed improvements.

• Senior Leadership Engagement Presentations to senior leadership ensured strategic alignment and built momentum for transformation initiatives. These sessions secured buy-in for proposed changes and established clear implementation priorities.

Outcomes

The service design approach resonated strongly with stakeholders, generating enthusiasm for the proposed transformation vision. The work and insights achieved several key outcomes:

Strategic Alignment The service blueprinting process successfully aligned diverse stakeholders around a shared vision for service improvement. Senior leadership and subject matter experts validated both the identified pain points and proposed transformation approach.

Actionable Roadmap The detailed analysis and future-state blueprint provided clear direction for modernizing claim processing workflows. The proposed interventions were recognized as practical solutions to long-standing challenges.

Stakeholder Recognition The service design methodology was particularly well-received, with stakeholders acknowledging its effectiveness in:

• Revealing systemic inefficiencies in current processes

• Identifying high-impact opportunities for improvement

• Creating a cohesive vision for service transformation

• Building consensus around priority initiatives

The project established a strong foundation for transforming claim processing operations, with stakeholders embracing the proposed human-centered approach to service redesign.