Designing Away Member Frustration

Dealing with insurance companies can be exhausting and frustrating, especially when it comes to billing issues. Fallon Health knew it could do a better job handling policyholder billing problems, but the company needed a better understanding of its member base to do so. Mad*Pow helped Fallon Health develop a deeper empathy for members frustrated with billing related concerns by creating a series of “ideal-state” journey maps to guide product and process development.

Project Highlights:

  • Inculcated customer/member-centric thinking among client team
  • Presented best-in-class solution and scaled down to a practical approach
  • Client internalized Mad*Pow approach for use in other areas

Lack of Understanding

Fallon Health had previously done some customer journey mapping work, but they wanted a deeper understanding of their member base to accurately depict the current member experience. The client felt this deeper understanding would enhance Fallon’s future vision brainstorms.

Member Perspective

Mad*Pow conducted internal stakeholder interviews to understand business objectives, current process and resources, and the success criteria used to measure current state member satisfaction. But we knew we also needed to hear from members themselves. So we listened in on call center conversations between Fallon Health customer service and members for background. Then, we conducted in-depth interviews with members to understand what they think is working well and what could be improved to make their experience better.

Journey Map Guide

Mad*Pow developed a journey map guide that combined a design process education and instructions on the various steps needed to infuse customer-centered thinking throughout the organization including:

  • Developing personas
  • Identifying use cases and scenarios
  • Creating touchpoint ecosystems
  • Developing journey maps
  • Crafting design and experience principles

Fallon Health was so pleased with our journey map guide for this project that they plan to apply it to scenarios outside of member billing.

An Ideal Experience

Our holistic, external approach allowed Mad*Pow to identify roadblocks in Fallon Health’s current infrastructure and provide a best-in-class solution that was easy to refine into a practical action plan. We created an Ideal Experience Narrative — an illustrated story demonstrating how to support members from the moment they determine they will be seeing a physician, through billing and resolution.


Based on the work done to identify the elements that would comprise an ideal billing experience, the team at Fallon recognized that while solutions could be devised to handle individual challenges as they occur, addressing challenges within the existing experience in this manner would be the equivalent of treating the symptoms of a health condition rather than the condition itself.

A more valuable and effective approach, the team decided, would be to treat the root causes as they’d been exposed by the work done  for the journey map. To that end, Fallon has begun to explore the design of a new Health Insurance product that would eliminate the challenges their current members experience, implement a new governance model for ensuring positive member experience, and establish a Digital Strategy Team to explore the options and solutions for creating and managing self service tools used by members.

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Designing Away Member Frustration


Adam Connor VP Organizational Design & Training   Contact Adam
Morgan St. Laurent VP, Visual Experience Design   Contact Morgan
Samantha Louras Experience Strategy Director

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