Reimagining healthcare access for Anthem / Elevance Health members: from competitive response to integrated care platform

The Problem

Anthem BlueCross BlueShield’s Exponential Technologies division was watching the healthcare commerce space change. When Optum Health launched the Optum Store — a consumer portal for purchasing health products and managing services like prescriptions and virtual care — it represented a new kind of competitive pressure: one built on convenience and consolidated access rather than clinical depth.

The obvious response was to build a comparable product. But when the team began doing the research that would underpin that response, a more fundamental insight emerged: the fragmentation that made Optum Store useful was actually a symptom of a much larger problem. A person’s healthcare experience was not a series of discrete transactions. It was a web of interactions — with providers, insurers, pharmacies, transportation services, family members, and support systems — most of which were disconnected from each other and from the insurer sitting at the center of the financial relationship.

The strategic pivot Care Market’s purpose evolved from “respond to Optum Store” to “integrate the disparate systems and services that stand between members and the care they need.” That reframing changed everything downstream.

My Role and Constraints

I was embedded in the Exponential Technologies product team as a senior UX designer across the Care Market initiative, from competitive analysis through prototyping, user research, and limited release. Key areas of ownership included:

• Platform concept and early ideation: I produced the initial conceptual mockups and design prototypes that shaped the product direction, spanning homepage, care finder, product shop, prescription management, and services views.
• NEMT discovery and design: I led the design work for the Non-Emergency Medical Transportation integration, from partner ecosystem research and journey mapping through lo-fi and hi-fi prototyping and user testing.
• Caregiver archetype development: Flow mapping work I led surfaced the unmet needs of informal caregivers — a non-clinical population arranging care on behalf of patients — and established the Caregiver as a formal user archetype within the Care Market design system.
• User research and testing: I conducted and synthesized user surveys and usability testing across multiple stages of prototype development, validating direction and correcting assumptions before committing to high-fidelity design work.

The primary constraints were the complexity of the partner ecosystem (NEMT providers operated with independent, largely non-integrated systems), the sensitivity of healthcare data and member trust, and the need to demonstrate value across a member population with widely varying healthcare literacy and digital fluency.

Discovery: From Competitive Response to Platform Vision

Starting with the competition

The initial research phase included a structured competitive analysis of the Optum Store and adjacent healthcare commerce products. Early conceptual mockups explored what an Anthem-branded equivalent might look like, covering the core modules a member would need: finding care, shopping for health products, managing prescriptions, and accessing services.

That work was necessary, but it quickly surfaced its own limitation. Replicating a competitor’s surface produces a product that is, at best, equivalent. The team’s ambition was higher, and the user research confirmed there was room for it.

What users actually needed

User surveys with Anthem members revealed a consistent and more fundamental friction point than any individual feature could address: the experience of navigating healthcare was exhausting because the systems involved — insurance, providers, pharmacies, transport, family support — did not communicate with each other. Members were the integration layer for their own care.

This finding reoriented the product vision. Care Market would not be a store with health products. It would be a platform that reduced the coordination burden on members by integrating the services and systems surrounding their care.

NEMT: A High-Impact Integration Opportunity

Non-Emergency Medical Transportation emerged as one of the clearest early opportunities to validate the Care Market platform concept. NEMT covers specialized medical transport — wheelchair vans, litter vans, ambulance services — for patients whose condition makes standard transportation potentially harmful. Non-Medical Transport (NMT) covers rideshare and taxi services for appointments that do not require specialized vehicles.

The discovery research revealed a telling dynamic: NEMT was a widely available, often insurance-covered benefit that most members did not know existed. Even members within the healthcare industry were frequently unaware of it. Local NEMT providers existed in most cities but operated with independent scheduling systems, handled coordination manually via phone, and had no integration with insurance or provider systems.

The double opportunity NEMT represented both a genuine access gap for members who needed transportation assistance and an education gap for the large population who could benefit from the service but had never heard of it. Solving both within Care Market validated the platform’s integration thesis.

Process: flows before pixels

Before any UI work began for the NEMT feature, the team mapped user journeys in detail — drawing on both member research and data gathered from prospective NEMT provider partners. The goal was to expose assumptions about how patients, caregivers, care coordinators, and transport providers actually interacted in the existing fragmented system.

This exercise produced two important outcomes. First, it identified where the real coordination failures were happening — not in the transport itself, but in the scheduling, special needs communication, and payment handling that surrounded it. Second, it surfaced the Caregiver as a distinct and under-served user population.

An Unexpected Discovery: The Caregiver Archetype

Journey mapping for NEMT exposed a user population that prior research had not fully accounted for: the informal caregiver. This was not a professional care coordinator or a clinical role. It was a friend, family member, or neighbor who had taken on the practical work of healthcare logistics for a patient — arranging appointments, organizing transportation, picking up prescriptions, and navigating insurance on someone else’s behalf.

The Caregiver had needs that were distinct from the patient’s and distinct from a professional coordinator’s. They were operating without institutional support, often without health literacy resources, and frequently without the patient’s own credentials or account access. The existing systems — including Anthem’s — had no model for them.

The Caregiver was formally established as a user archetype within the Care Market design system, with dedicated persona documentation and journey maps. This was not a scope addition; it was a necessary correction to the product’s user model that improved the design of every feature the Caregiver would touch.

Prototyping and Validation

Once journey mapping had established a grounded understanding of the problem space, design work moved into rapid lo-fi prototyping. Early sketch-level wireframes for the NEMT scheduling flow were used in user testing before any visual design decisions were made, with testing questions focused on three core validations:

• Usefulness: Would users find this service relevant to their situation?
• Clarity: Did the interface make the process of arranging transport understandable without prior knowledge of how NEMT works?
• Fit: Did the proposed flow match how users actually thought about getting to and from medical appointments?

Testing at this stage corrected several assumptions — particularly around how much users understood about the difference between NEMT and standard rideshare, and how the Caregiver role would interact with the member’s account. Those corrections informed the hi-fi prototypes and the consent and registration flows that followed.

Later-stage prototypes expanded to cover the full Care Supporter registration and onboarding flow, including consent management, notification preferences, and multi-party coordination — the infrastructure needed to support the Caregiver archetype as a first-class user within the platform.

Key Design Decisions

Decision	Alternatives Considered	Rationale	Reflection
Reframe the product vision from commerce platform to integration platform	Build a feature-equivalent response to Optum Store	User research showed that the real pain was coordination fragmentation, not product availability. An integration platform addressed the root problem; a commerce clone addressed a symptom.	The pivot added complexity and stakeholder alignment work. A phased approach that launched commerce features earlier while building toward integration may have been more politically viable within the organization.
Map journeys before designing any UI for NEMT	Scope NEMT as a feature and begin UI design from requirements	The partner ecosystem research showed that the coordination failures were in the surrounding process, not in the transport itself. UI design without that understanding would have solved the wrong problem.	The flow mapping work took longer than stakeholders expected. Framing it explicitly as a risk-reduction step earlier would have made the timeline easier to defend.
Formalize the Caregiver as a distinct user archetype	Treat caregiver scenarios as edge cases within the member persona	Edge case treatment would have produced a product that technically accommodated caregivers but was not designed for them. The research was clear that this was a large, distinct population with needs that were not reducible to member needs.	Earlier recognition of the Caregiver during initial research planning would have surfaced this finding sooner and allowed more time to design the account delegation and consent models it required.

Outcomes

Care Market advanced to limited release, with the NEMT integration among the features delivered. At the design and process level, the engagement produced:

• A platform concept grounded in member research that reframed Care Market’s strategic purpose from competitive response to integrated care infrastructure
• An NEMT integration design that addressed both transportation access and member education about an underutilized benefit
• The Caregiver archetype: a formally documented user model with personas and journey maps, establishing a population that had no prior representation in Anthem’s design system
• A validated prototyping and testing process that corrected critical assumptions before high-fidelity design investment
• Care Supporter registration, consent, and onboarding flows supporting multi-party account access for the Caregiver use case

The broader organizational contribution was a demonstration that user research conducted before UI design — specifically journey mapping with partner ecosystem data — could surface product-shaping insights that requirements-based scoping would have missed entirely.

What I Would Do Differently

The Caregiver discovery was one of the most consequential findings of the project, and it came later in the process than it should have. Initial research planning focused on the primary member persona. A broader initial stakeholder mapping that included the informal care ecosystem would have surfaced the Caregiver at the start of discovery, not midway through NEMT journey mapping. On a project of this scope, that timing difference has significant downstream effects on the user model and the features built against it.

I would also have built a more explicit case for the platform’s integration thesis earlier in the stakeholder communication process. The pivot from commerce platform to integration platform was the right strategic move, but it required ongoing alignment work that a well-framed early artifact — a service blueprint, a platform vision document — could have anchored more efficiently.

Interested in how I approach complex healthcare service design and systems integration?

scott@scottopic.com