An email we received from a local elder services organization director (and regional director of SHINE, a Medicare counseling service) the day after COVID-19 was declared a pandemic.
What do you do when you’re working on a project that involves meeting with older adults during the age of social distancing and COVID-19?
What do you do when the local organizations serving these older adults become suddenly overwhelmed with priorities more pressing than helping with a school project?
This is the situation our team faced as we approached mid-March 2020, the midpoint of our project-based “Technology and Innovation in Government” class at the Harvard Kennedy School.
How Did We Get Here?
Two months ago, our team of Harvard students embarked on a project to improve the Medicare enrollment process for new enrollees in collaboration with the Centers for Medicare and Medicaid Services (CMS) and the Social Security Administration (SSA). Our first task was to find out why enrolling in Medicare is so complicated, a process that involves two federal agencies (SSA handles enrollment while CMS administers Medicare). After conducting 35 interviews with recent and prospective Medicare enrollees, relevant government agencies, and other stakeholders (e.g., nonprofits, private insurance brokers), we uncovered many different challenges. For instance, prospective Medicare enrollees don’t know which Medicare coverage options they should consider, nor do they know where to seek clarity. We were excited to start brainstorming ideas to address these challenges.
Then, on March 11, 2020, the World Health Organization officially declared COVID-19 a global pandemic. Harvard announced our classes would be online moving forward. State governors, including in Massachusetts (where we are based), began to issue stay-at-home orders.
As the world grappled with a new approach to daily life, we realized our approach to our project would need to change as well.
Our target population for research, older adults, is the group at highest risk for serious complications from contracting COVID-19. That made it ill-advised (and eventually impossible) for us to visit public places in-person to recruit research participants. Moving to a virtual world also made it harder for us to engage with our interview subjects, some of whom are not tech savvy. While we had previously envisioned meeting them in cafés and libraries and getting their feedback on paper versions of our proposed solutions, we now had to rely on computer-based tools.
While introducing new challenges, COVID-19 has also highlighted the need for improved online support tools for Medicare enrollment moving forward. All brick-and-mortar enrollment sites across the country have closed their doors and Medicare enrollment rates have spiked due to layoffs and general concerns about health.
Brainstorming Solutions
With these new challenges and opportunities in mind, our team got to work brainstorming ideas. Then, we grouped our ideas into broad categories and voted on them based on three criteria:
1. the salience of the challenge the idea addressed,
2. the feasibility of testing our ideas within the short timeframe of our class, and
3. the likelihood that our clients could implement them.
Starting with thirty ideas for potential solutions, our team used digital platforms to narrow them down to our three top ideas to pursue.
Our top three ideas (highlighted in yellow above) were–a web-based resource navigation tool (i.e., digital roadmap), automated chatbot, and “Get Help” search tool for locating telephone or in-person enrollment support. When we presented these to our clients, they suggested that we develop and test all three ideas with Medicare enrollees.
Prototyping Our Ideas
As we learned in class, an early model of a tool—a prototype—doesn’t have to be polished to test. According to guest lecturer and U.S. Digital Services cofounder Erie Meyer, volunteers may not want to criticize a polished (i.e. high-fidelity) product, but are often more likely to give feedback on low-fidelity prototypes. Keeping this in mind, our first prototype was made with just pen and paper, shared over video chat.
Christina Wu, one of our team members, holds up her low-fidelity prototype.
After initial feedback from CMS and SSA, we used prototyping tools such as Balsamiq to transform hand drawn prototypes into interactive tools for each of our three ideas:
Screenshot of Balsamiq prototype of the digital roadmap.
A digital roadmap that takes the overwhelming amount of information about Medicare and presents only what is relevant to the prospective Medicare enrollee in a plain language step-by-step guide and personalized checklist.
Screenshot of Balsamiq prototype of the automated chatbot (bottom right corner).
An automated chatbot that answers specific questions typed into a text box. This tool immediately directs the prospective Medicare enrollee to a website link with the relevant information, saving them time and avoiding confusion from navigating the Medicare.gov website on their own.
Screenshot of Balsamiq prototype of the “Get Help” search tool.
A “Get Help” search tool that identifies organizations offering Medicare enrollment assistance to prospective enrollees by geographic proximity.
Testing Our Tools
Before COVID-19 struck, we visited public locations favored by our target interviewees, such as bookstores and senior centers. We shifted to public online social networking sites, such as Nextdoor.com, LinkedIn, and Facebook, to find interviewees.
Because we conducted interviews over video chat, we experienced firsthand our interviewees’ comfort (and discomfort!) with technology. We subsequently redesigned our tools to meet the needs and requests of our least digitally savvy interviewees, such as adding a tutorial on how to use the digital roadmap website.
We were stuck on a dark screen for 15 minutes as one interviewee tried to join the video chat.
Technology can be challenging!
As we reacted to the unexpected challenge of testing with remote volunteers, we learned new ways to test a prototype. Our partners at CMS and SSA highlighted that the best practices we use in virtual testing today could help them in the future, especially when engaging populations that are traditionally hard to reach.
Let’s Fix it Together!
We are looking for individuals who have recently enrolled in Medicare or are enrolling soon to test our prototypes. If you or someone you know may be willing to participate in a virtual interview, please email innovategov.medicareenrollment@gmail.com. We would love to hear from you!
—Gwendolyn Lee, Melia Henderson, Christina Wu, Rob MacGregor, Mia Li