Improving retention of health plan members during the renewal process
Led user research to identify opportunities to boost completion of Medi-Cal renewal applications.
ROLE
UX Researcher
DURATION
4 months
TOOLS
UserZoom, Figma
SKILLS
Survey design
Data analysis
Research reports
BACKGROUND
Health plans lose a patient and payer for every failed renewal.
Medi-Cal, California's Medicaid program, requires members to renew their coverage on an annual basis. Failure to complete renewal leads to losses for both patients and health plans:
For patients
When members fail to complete Medi-Cal renewal, they become unenrolled and lose their health insurance coverage.
For health plans
Californian health plans are paid roughly $400-$600~ per month per patient (from the Legislative Analyst's Office using the 2026 DHCS Rate Certification Report). When enrollment drops, this revenue drops immediately.
The losses are especially detrimental for nonprofit plans like Blue Shield of California, who operate on razor-thin operating margins and heavily rely on predictable enrollment volume to keep their care networks intact.
23% of eligible Medi-Cal members are unable to complete the renewal process.
(DHCS, August 2024)
Blue Shield of California Promise Health Plan approached our team to identify/define potential product solutions to address this large deficit and to map out long-term product strategy for such initiatives.
Reinforcing long-term product strategy with research evidence of success
In service of the Medi-Cal Redetermination team’s overarching ask to identify product solutions for BSC and define long-term product strategy, I led UX research to understand California members’ experience across existing renewal methods, and what the critical pain points/barriers to completion were.
RESULTS AT A GLANCE
164
Medi-Cal members surveyed
93%
In suggested online renewal usage
356%
In suggested online renewal usage by previous analog renewal users
$6,800~
per patient per year saved
For every member successfully re-enrolled
METHODOLOGY
Understanding where and why members were struggling with renewal
01.
What does the renewal experience look like today across existing methods (online, mail, phone, in-person)?
02.
Where and why do members struggle or drop off during renewal?
03.
What is the respondent perception of ongoing digital investments?
Screening for members who had undergone the renewal process before
Medi-Cal renewal comes in two forms: (1) auto-renewal, where coverage is automatically renewed and members are notified after the fact, and (2) manual renewal, where members must update their information and submit a renewal application themselves. The study screened specifically for people who had completed manual renewal before. To more accurately reflect Medi-Cal's ethnically diverse population, I added minimum screening quotas for race and ethnicity.
FIG 1. Study screening questions to target Medi-Cal members that had recently completed manual renewal
Counter-acting recall bias through strategic study design
Getting a comprehensive picture of member needs and pain points requires that I ask the right questions, but also that I ensure high accuracy of the accounts collected by setting up the study questions strategically.
To combat potential recall bias from the respondents in regards to asking about previous experiences, I structured the sections to jog the memory in sequential order with the renewal process. This ensured that respondents responded as holistically and accurately as possible.
The overarching survey asked respondents questions in the following structure: (1) recalling their most recent renewal experience (FIG 2); (2) renewal method preferences and why; (3) rating and ranking of a list of potential digital features and solutions that the company was already exploring through tangential initiatives (FIG 3).
FIG 2. Structuring for "Most recent renewal experience" section
FIG 3. Proposed digital feature list based on company initiatives
KEY FINDINGS
The study results pointed to online renewal and digital solutions as the clear path for an improved user experience.
Online channels, used by 47% of all respondents, were the most common renewal method driven by their ease of use, speed, and convenience.
Most respondents spent an hour on their renewal process regardless of the submission method; however, for specifically the application portion, online renewal was considered the fastest and the easiest by respondents.
Time spent and difficulty in the renewal process, according to respondents, was concentrated in the application form itself.
Online and mail renewal were rated similarly in terms of difficulty; however, pain points associated with manual processing for mail users highlight opportunities for new digital solutions to improve the application experience.
25% reported ever losing Medi-Cal coverage after a missed renewal deadline; among those who explained why, the reasons pointed to application completion and support.
Respondents preferring online renewal today (42%) rose to 81% when shown a digital solution with the proposed features (an improvement of 93%); the top cited features being pre-submission review, 24/7 chat support, application directions, a save button for progress, and pre-submission reminders.
Among respondents who didn't use online renewal, baseline interest of 18% rose to 82% likely to use a digital solution with the same features (an improvement of 356%).
OUTCOMES
My study findings served as guidance for the team’s long-term product strategy, with the potential to save $6,800 per year per member successfully re-enrolled.
I presented the findings and three strategic recommendations to the Medi-Cal Redetermination team. Though team priorities had shifted by then, the leads noted the findings clarified and reinforced several tangential strategic initiatives, helping de-risk ongoing investments in conversational AI and digital renewal tooling.
Because I could show directionally how many members would shift from analog to online renewal and keep their coverage, the team had early evidence of the financial upside of continuing to invest in digital solutioning.