How Poor User Experience is Killing Obamacare

October 9, 2013

Buying insurance on the new health exchange should be as easy as booking a flight—both have your life at stake. Yet where the airline industry has arguably perfected this customer experience online, the health exchanges that went live last week all but ignore years of learning by UX practitioners. Todd Park, an advocate of applying the Agile method in building platforms[1] and U.S. Chief Technology Officer, said in USA Today, "These bugs were functions of volume […] Take away the volume and it works.”[2] In other words, blame the user, not the developer.

Park is severely mistaken here and is underlining the issue with the hubris of developers who seek lean approaches to large-scale projects. The Affordable Care Act (“Obamacare”) Health Exchange is a large-scale, high-stakes, high-profile initiative. The goal is not to build some start-up MVP (minimal viable product) where, like the technology company Uber, a pilot in one market is tested with the easiest usable interface. The way I see it, our government fell for the allure of Lean UX when it needed anything but. In going through the exchange myself, I found simple key errors in the overall user experience. As a UX practitioner who empathizes with people less technically literate, I found the experience trying, frustrating, and disappointing. (Updated: Many Lean UX fanboys on Twitter have argued that there's no proof that there was lean applied here, my assertion is purely subjective based on circumstantial evidence. Hence why this blog post is on my website.)

Remember at the beginning of AOL’s subscription service demise in 1997, when demand for the dial-up caused busy signals for hours? (Ironically, a problem rooted at AOL’s headquarters in the Washington, DC suburb of Vienna.) You would think those early-day problems would be antecedents in making sure you had more than enough bandwidth to meet demand and then scale down. Yet, under Park’s leadership, the government went lean with scalability in mind as a reactive measure rather than a proactive SDLC (software development lifecycle) with a proven, risk-averse approach. Rather than go through a scoping phase to tick off criteria that assess whether to go lean or not, from what I can tell in experiencing the website experience, Park & Co. went with a one-size-fits-all approach for User X instead of Users X,Y, and Z. It’s doubtful they went through personas as the design would indicate.

(Updated: I think it's fair to say that a Lean commandment is to go with the lowest minimal elements to meet the need and scale up to users. I argue that the number of servers you have available on a launch date is an aspect of the UX. Arguably, saying you planned for 50,000 visitors at once, is Lean thinking.

I'm a fan of Lean UX when you have a start-up or a small team that can be nimble and iterate. When dealing with large, global initiatives or big organizations that serve a diverse user base, private or public sector, I've yet to experience positive meaningful outcomes. I think Lean UX needs to evolve with a checklist to see if Lean is really the right way to go when planning a project, weighing it against the desired outcomes or knowing when the Lean approach may not be sustainable, something I cover in my Muscle UX book I'm writing now. Surely, we cannot approach everything by a one-method-fits-all myopia.)

Now, let's take a look at the homepage for healthcare.gov (snapshot on October 7):

1) Why not use self-segmentation? Why overwhelm a user with so many choices and the burden of having to sort out where to go? Imagine that you’ve never been on a computer, you’re sitting with a caregiver trying to figure this out, and have just been shown a bunch of directions to go in. We know from Columbia’s “Jams Study” that users are more apt to engage and have less confusion and frustration by having choices limited[3]. Like many pharmaceutical and health care sites, there should be a model window immediately prompting the user to choose between being an individual or family, or employer. Take a look at how Oscar Insurance does this elegantly (with an accessible, large font).

2) Log-in not accompanied by a “register” or “sign-up”? With such a complicated subject matter, going with what users know and expect is probably best. In fact, when President Clinton gave his pitch to the country during a chat with President Obama, he urged young people to get enrolled. Yet, studies show that millennials surf with temporal expectation bias (e.g. the search bar is perceived as always being on the upper right)[4].

3) Apply Now button has accessibility issues and is fighting to stand out. Someone with deuteranopia, colorblindness, would see this button as white in yellow with a very challenging contrast. Also, the button is designed to blend in with the picture in the background; hardly the standard 70% contrast level for a call-to-action. Making the button larger and starker makes this processing easier. Also, in the eye-tracking studies I’ve done, users almost always connect with a face that is breaking the “fourth wall” (looking right at you). (Updated: Should it be "Apply" or should it be "Enroll Now" given that the context to "apply" is that a user may feel like they could get rejected like credit cards or college admission. According to this report, 99.6% of healthcare.gov visitors do not enroll!) While the apply button is on the left, the face will be the first thing a user sees and connects with, so put this face on the left and the apply button right next to it. This button also competes with…

4) Start Here—this call-to-action button is not at the required 70% contrast level, and if I’m a user, which is it? Am I to Start Here or Apply Now?

5) Washed out FAQ section is hardly distinguishable within this design. What we have here is design without UX involvement. While, yes, this is visually pleasing, there is a gestalt effect blending these important FAQs, causing them to get lost. This site would be better off having a lot more white space with higher contrast, which would make it very usable for anyone visiting. Not to mention, if you look at the responsive site in mobile you’ll see an easier to read vertical list. (Easier because reading long horizontal menus takes users more time).

6) Urgency is buried. Tiny numbers appear beside even tinier print with extremely important information. To give the sense of urgency (and also a sense of confidence that users have time to sign up), these important numbers need to be pushed up to the top and clearly enlarged. (Do they really need to have the “Open Enrollment Began” date?)

7) Blog looks dated already. Either have daily updates or don’t promote it. The site looks abandoned, not to mention that it doesn’t even address the elephant in the room: there may be some issues signing up.

8) Connect with Us? Why? Without an example of a story, why would a user want to share one? A nicely embedded video with a call to action to share would have a bigger impact.

9) I’m following why? Give context…will following help users stay up-to-date and informed?

If this is the UX assessment of just the homepage, you can imagine what the sign-up experience is like. In the hour it took me to get through the New York health exchange, led there by HealthCare.gov, I saw filters resetting once the search was made, causing me to lose all the filters I had set without a contextual summary; an alphabetical dropdown menu of “medal” plans rather than in hierarchy—Bronze, Gold, Platinum, Silver (a terrible nomenclature that really doesn’t invoke the best feeling about signing up and confuses metal with medal. I mean who wants to be bronze? Well, if you can’t afford it, that’s the medal you get, yay!); no easy way to distinguish differences between plans (they would do better to have a chart similar to the booking of first, business, and economy classes on an airline); being told after I tried to search by doctor that the feature was unavailable at this time; etc.

To be fair, I’m not entirely sure I can hold the U.S. accountable for individual state exchange experiences, but certainly I can blame Park and our Federal Information Technology team for not setting an exemplary example.

(Updated: After I posted this, @Usertesting posted this tweet, which boasts a usability test for the site, giving it a 2 out of 10, highlighting some of my UX points and conducting a deep dive in the usability via actual user testing):

Great @Obamacare usability study by @ctomlin http://t.co/22eelb7E1T. Great holistic UX review by @Griffopolis http://t.co/9eZ5s9Nzxe
— UserTesting (@usertesting) October 10, 2013

Denis Griffith (@griffopolis) had led global UX initiatives for Emirates Airline, launching iteratively this year, while XCD/head of UX at Atmosphere Proximity. Denis also served as director of UX with Havas Life, helping to create one of the first presentation builder and sales aid iPad apps. He is currently working on a book about Muscle UX due out in spring 2014.

[1] http://strata.oreilly.com/2012/05/us-cto-seeks-to-scale-agile-te.html

[2] http://www.theatlanticwire.com/politics/2013/10/obama-administration-opens-about-exchange-glitches/70248/

[3] http://www.columbia.edu/~ss957/articles/Choice_is_Demotivating.pdf

[4] http://users.wpi.edu/~djamasbi/PDFS/2010%20djamasbi%20et%20al-%20IJHCS%20(journal%20version).pdf

How to Fix Motion Sickness with iOS7

September 27, 2013

Several people are complaining about motion sickness with iOS 7.

Regardless of what has been reported or rumored, there is a solution.

Apple has resolved this very easily and all you have to do to reduce motion in your new iPad or iPhone (or old one with iOS 7) is to do the following:

1. Go into Settings

2. Scroll to "General"

3. Tap "Accessibility"

4. Scroll to "Reduce Motion" and select "On"

This should resolve any issues around motion sickness.

Time for Insurance Companies to Step Up UX for Second Screen Viewing

July 9, 2013

The insurance industry, arguably, spends more money on television advertising in the U.S. than any other vertical, over $4 billion per year on average. They also have the biggest opportunity in a return on this investment, by embracing the emerging behavior of customers actively engaged through second screen experiences.

The second screen experience is when a tablet or smart phone is used as a companion to a first screen event. For example, I just watched an episode of “Under the Dome” with my TiVo, all the while looking up actors’ careers via my TiVo iPad app. Another type of second screen experience, even wider in audience, is conversing with others while a show is airing, such as tweeting during #MadMen or #GameofThrones. These second screen experiences--live chatter, trivia on stars (or players during a soccer match), background on production—offer richer and social engagement with content.

Television viewing is no longer the passive activity it once was, and your TV is not the only screen in your house. In fact, if you live in the common home today you’re likely to have many; from your smart phone, tablet, laptop, and desktop. Some day it may even be the elusive smart refrigerator, reminding you to get milk because you’re almost out. These screens are competing for your attention even as you have the television blasting auto insurance commercials as you run into the kitchen or check your Facebook timeline. The numbers show that consumers are no longer seeing this ecosystem at odds with itself as the age of “second screen” experiences has arrived.

A report in April pointed to the growing trend of households, nearly a third of households, having a tablet device (Double Encore). Of those users on Twitter, sixty-four percent (64%) are tweeting about the show they are watching, and seventy-one percent (71%) of in-home tablet use is while watching TV (Nielsen). Consider the insurance industry, which spend hundreds of millions of dollars in media to advertise to consumers every year, with Geico’s lead in spending with $1 billion in 2011. All those advertisements during an hour or two of watching television are, an opportunity to leverage second screen experiences to drive engagement with your brand.

Among Nationwide, State Farm, Geico, and Progressive, only Progressive offers a truly responsive site. The impact of not having a responsive site is that all the dollars spent on television advertising are only paying for half of the conversation with customers. A responsive site means that the content will fluidly change and respond to fit any screen or device size.

Getting a quote is one of the most important messages an insurance ad is asking users to do and, with second screen experiences, television is evolving into an active medium. Therefore, these advertisers and other brands should look to following these steps in customer engagement through this television-led ecosystem:

1) Plan for tablet use – This goes beyond responsive design, which is paramount for successful engagement given the range of screens out in the marketplace from iPads, Galaxy Tabs, Surface, and all the minis in between. Yes, the quote and account management callouts need to be prominent and quick to find in order to maintain attention of the multi-tasking consumer, but it is also key to make content tighter. Focus on concise and structured content rather than having the user sift through blobs of copy. Planning for tablet use means that your product offering isn’t hidden and the value propositions are clearly labeled.

2) Leverage your character – Flo, Gecko, Nationwide guy with microphone, these characters become the necessary emotional attachment for customers to trust and remember. We know that emotion and memory are chemically in the brain. The brand experience doesn’t end at the home page. Progressive does an excellent job of maintaining Flo throughout the experience and she is included in the upper left of the screen, allowing for her smile to be persistent through a fully responsive site. However, this aesthetic is key through the quote process. Could Flo be used to give positive reinforcement messaging through the quote process? Absolutely.

3) Design to brand throughout the quote process - In Designing for Emotion, Aarron Walter points out that brand contrast offers consumers a way to differentiate experiences. If brands design for emotional connection, they build the ability to recall that experience, and the association necessary to revisit the site and complete the transaction. So many sites look the same in the quote process; if a customer decides to comparison shop, it will be difficult to remember where each quote was obtained, even with follow up e-mails. If the price differential isn’t broad enough the recalled experience gets muddled.

4) Use Flat Design – Flat design is here to stay—Windows, iOS7, Google, Facebook, are leading the new wave in interaction design. Flat design makes content more accessible by doing away with wasted space dedicated for shadows and gradients. Typography shines through better in an HD world, making calls to action crisper for that target of 35-55 year olds.

5) Pair the social with the media plan – If you know when your ads are going to air and where, transact with your consumers where they are—Twitter and other second screen social interactions. Numbers are negligible with Zeebox and Fox Sync, but so were Twitter’s five years ago, so advertising within those platforms may be affordable. Regardless, you know highly rated shows are going to have a lot of chatter. Plan for your community manager to be online and responding to events in real time, particularly with insurance, which focuses on life-changing events. Audiences watching an episode of “Say Yes To The Dress” may be thinking about marriage, getting a house, or getting an additional car. Look to your media plan to guide customers to that second screen experience in getting a quote.

6) Plan for distraction – It might’ve been easier when consumers were at their desktop while the television was on, but time spent on traditional websites via desktop is steadily on the decline. Recognize that on a tablet, users will get push notifications, motivated by other ads on TV, tweets, instant messages, Facebook chat, and real world events like the baby crying or laundry being done. Cached data, follow-up notifications, extending sessions before timing out based on high-traffic times, or simple interfaces that don’t break with a clear persistent display of progress are just some ways you can build rapport with your consumer.

Taking these steps will create a handshake between brand and customer, particularly in an industry so driven on price and an ongoing need for trust—trust built around dynamic and relevant conversation with the implicit message of transparency and accessibility.

(Written for BBDO Digital Blog)