Medicare Software for CMS Quality Measures
Overview
Project Summary
I led the UX design for Medicare compliance and quality reporting software that helped healthcare providers navigate the complexities of MACRA and MIPS reporting. Before this product, many providers struggled with compliance, manually tracking measures and billing codes across disparate systems. The goal of this project was to create an intuitive, automated solution that streamlined compliance, improved reporting accuracy, and increased provider reimbursements while reducing administrative burden.
My Role
- Lead UX Designer – Designed workflows, interfaces, and the rules engine UI.
- Healthcare Compliance Researcher – Worked closely with providers and subject matter experts to understand MACRA & MIPS regulations.
- Cross-Team Collaborator – Partnered with engineers and product managers to ensure regulatory accuracy and technical feasibility.
Impact
✔ Reduced time spent on MACRA/MIPS compliance through streamlined software.
✔ Improved reporting accuracy, ensuring providers maximized reimbursements.
✔ Increased adoption rates by simplifying a previously complex and frustrating process.
✔ Improved reporting accuracy, ensuring providers maximized reimbursements.
✔ Increased adoption rates by simplifying a previously complex and frustrating process.
The Problem
Challenges in Medicare Compliance & Reporting
Dr. Kahn, a practicing physician we interviewed, shared firsthand insights into the struggles of navigating CMS Quality Measures, reinforcing the critical pain points we aimed to solve. When I joined the project, providers faced significant pain points in MACRA and MIPS reporting:
- Complex & Manual Workflows – Many physicians, like Dr. Kahn, relied on spreadsheets, sticky notes, and even Google searches to track compliance, leading to inefficiencies and frequent errors.
- Unclear Regulatory Guidance – Physicians expressed frustration with frequently changing CMS rules, struggling to determine which quality measures were required or most beneficial to report.
- Lack of Integration with Existing Systems – Dr. Kahn noted that physicians often had to toggle between multiple systems to piece together compliance data, leading to gaps in reporting.
- Missed Revenue Opportunities – Without proper reporting, providers lost reimbursements they were eligible for.
Research & Insights
Understanding the Users & Regulatory Landscape
Given the tight timeline, I tapped into existing user insights while also conducting my own research:
- Worked with subject matter experts to translate MACRA/MIPS regulations into actionable UX workflows.
- Reviewed competitor solutions and identified usability gaps in existing reporting software.
- Leveraged past provider interviews to understand how they approached compliance and quality reporting.
Key Findings
✔ Providers wanted automation – They needed a tool that eliminated manual tracking and simplified reporting.
✔ Compliance needed to be intuitive – Users were overwhelmed by MACRA rules and required a clear, guided workflow.
✔ Integration was critical – The system needed to connect with EHRs to pull relevant data automatically.
✔ Compliance needed to be intuitive – Users were overwhelmed by MACRA rules and required a clear, guided workflow.
✔ Integration was critical – The system needed to connect with EHRs to pull relevant data automatically.
The Solution
1. Automated MACRA & MIPS Compliance Dashboard
- Real-time compliance tracking with visual indicators for completed and pending measures.
- Automated eligibility checks to help providers know exactly which measures applied to them.
- Smart notifications to alert users of deadlines and missing information.
💡 Impact: Reduced compliance tracking time allowing providers to focus on patient care.
2. Rules Engine for Billing & Reimbursement Optimization
One of Dr. Kahn’s key frustrations was that physicians often focused on easier-to-report measures instead of ones that maximized reimbursements. Our software addressed this issue directly.
- Designed a rules-based engine that guided providers to choose the most impactful quality measures, balancing ease of reporting with financial benefits.
- Provided real-time feedback on how providers could improve scores and maximize reimbursements.
💡 Impact: Ensured providers received the highest possible reimbursements while staying compliant.
3. Rapidly Built Compliance Dashboard to Meet Aggressive Deadlines
- Worked closely with engineers and the product manager to design and deliver a real-time compliance tracking dashboard under intense time constraints.
- The dashboard provided instant visibility into completed measures, outstanding requirements, and next steps, ensuring providers could stay on track.
- Prioritized fast iteration and seamless handoff, balancing UX improvements with the company’s urgent need to increase adoption and drive revenue growth.
💡 Impact: Delivered a fully functional dashboard fast, helping the company drive growth and improve compliance.
Process & Execution
High-Fidelity Design & Developer Handoff
- Created pixel-perfect, high-fidelity mockups from the outset, ensuring clarity for development.
- Developed detailed design documentation that preemptively answered engineering questions, streamlining implementation.
Feedback Loops & Real-World Validation
- Worked closely with compliance experts and providers to validate workflows and ensure accuracy.
- Applied insights from provider research to make the interface intuitive for non-technical users.
Cross-Team Collaboration
- Aligned with engineering teams to implement complex compliance logic.
- Ensured product management priorities balanced regulatory requirements and user needs.
Final Outcome & Results
✔ Faster Compliance Reporting – Automation dramatically reduced manual workload.
✔ Higher Reimbursements for Providers – Optimized reporting led to more accurate billing and increased revenue.
✔ Improved User Adoption – A previously frustrating process became streamlined and easy to use.
✔ Higher Reimbursements for Providers – Optimized reporting led to more accurate billing and increased revenue.
✔ Improved User Adoption – A previously frustrating process became streamlined and easy to use.
Lessons Learned & Next Steps
Key Takeaways
Dr. Kahn’s interview reinforced that the challenges of MACRA/MIPS compliance aren’t just about technical complexity—they directly impact physician revenue and daily workflows.
✅ Understanding physician workflows is key – The software had to fit seamlessly into a doctor’s limited administrative time, ensuring compliance was simple, fast, and unobtrusive. – Partnering with experts ensured compliance accuracy.
✅ Physicians prioritize revenue when selecting measures – By optimizing reimbursement opportunities, the software helped doctors report the measures that had the greatest financial and clinical impact – Eliminating manual work drove higher adoption and engagement.
✅ Seamless EHR integration is critical – Connecting with existing systems improved efficiency and accuracy.
✅ Understanding physician workflows is key – The software had to fit seamlessly into a doctor’s limited administrative time, ensuring compliance was simple, fast, and unobtrusive. – Partnering with experts ensured compliance accuracy.
✅ Physicians prioritize revenue when selecting measures – By optimizing reimbursement opportunities, the software helped doctors report the measures that had the greatest financial and clinical impact – Eliminating manual work drove higher adoption and engagement.
✅ Seamless EHR integration is critical – Connecting with existing systems improved efficiency and accuracy.
Next Steps
🔹 Expand predictive analytics to provide proactive compliance recommendations.
🔹 Improve mobile accessibility for providers managing compliance on the go.
🔹 Continue refining data visualization to make reporting even more intuitive.
🔹 Improve mobile accessibility for providers managing compliance on the go.
🔹 Continue refining data visualization to make reporting even more intuitive.
Visuals and Designs
