Protected: OptumRx Automatic Refills

OptumRx operates a massive prescription service, supported heavily by its digital consumer-facing platforms and automatic refills of home delivery medications. As the lead designer for the web-based consumer application, it was my job to ensure ease-of-use and clarity for customers across user groups, touchpoints, private labels, and scrum teams.

If I did my job right, people could lead healthier lives with less stress about forgetting to refill their medications. This in turn drives adoption and continued use of the service.

Everyone’s happy, right?

The Opportunity

The year started with a concerning dip in checkout NPS (Net Promoter Score). Digging deeper, consistent VOC (voice of customer) feedback from the live product revealed user frustration and confusion surrounding a specific opt-in element during checkout.

Automatic Refills Opt-In

Automatic refills are a cornerstone of OptumRx’s business model, predating the digital platform entirely. However, this core user benefit — and revenue driver — was relegated to a single, unintuitive touchpoint in the web platform: a mandatory opt-in checkbox nestled within the checkout flow. This unfriendly approach was further hampered by an enterprise-mandated form input pattern that didn’t guide users when they missed required inputs.

The critical nature of automatic refills, coupled with limited visibility on the digital platform, placed immense pressure on this singular UI element. It’s no surprise, then, that previous design decisions prioritized business needs over users’ experience.

“It’s Fixed”

The pre-existing flow forced users to interact with the automatic refill opt-in section before checkout could progress, without adaquate signals or affordance. As a quick, heuristically sound solution, I collaborated with the checkout flow Product Owner to increase visual emphasis of the automatic refill opt-in and make it optional during the checkout process. We agreed to closely monitor the results over the coming weeks.

Freed from this opt-in bottleneck, the results for checkout were as-predicted: improved NPS, reduced VOC complaints, less confusion, and — unsurprisingly — fewer opt-ins. However, as months passed, analytics revealed the opt-in rate had sunk to a rate the business found unacceptable. What was ‘acceptable’? More on that shortly.

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Thus, we arrived at the age-old question: How can we responsibly balance the needs of the business with the best-interests of our users?

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The Hunch

Prompted by the significant drop in performance, product leaders for the automatic refill service itself, approached me directly with a strongly-phrased proposal: implement a new “active choice” opt-in pattern during checkout, complete with wireframe designs from their marketing team, to buoy the opt-in rate.

Reviewing the supplied UI options, it was apparent the term “active choice” was being used loosely. The options being suggested ranged from an implicit default to an explicit default. While these tactics are effective selling tools, they can also be dark patterns.

My assumption was that this proposal had a high chance of swinging the pendulum too far in the opposite direction. I felt this would negatively impact the experience for our users, tank our NPS and VOC feedback, and put us right back where we started.

Selling Stakeholders on the Need for Validation

With some effort, I secured buy-in across the matrix of stakeholders to validate a path forward by testing several designs, intentionally including the proposed ‘dark pattern’ solutions. But time was limited as the financial pressures of this decision fueled a deep sense of urgency from all affected business owners.

The Approach

Navigating Nebulous Goals

My first step was to found my work in the business goals and establish clear expectations. Unfortunately, the business didn’t have (and was unable to provide) a tangible goal for opt-in rates, making it a challenge to strike a pragmatic balance between immediate business needs and a user-centric design.

A Lean(er) Research Plan

Given these limitations and sense of urgency, I recommended a remote, unmoderated think-aloud study paired with open-ended questions. This lean, remote methodology was a paradigm shift at the time for our multi-million dollar OptumRx organization, complete with an on-site usability lab. But my approach offered several advantages:

• Fast, Formative Feedback: We could gather qualitative insights from a broad range of participants in a short timeframe. In-lab studies took 4-5 weeks from initial request to completion, where my approach would take less than 2 weeks.
• Scalability: Testing remotely allowed for a wider participant pool compared to in-person sessions. I was able to pull from a national audience more easily, and be picky about my screener to fully align participants to our target user types.
• Cost-Effectiveness: Remote testing is generally less expensive than in-person studies. My approach costed ≤10% vs our average on-site study of this size.

Collaborating with the full matrix of product and business owners, I came up with three (3) viable interface solutions for the study that included recommendations from the marketing-produced proposals.

Having previous experience across the research process, I wrote the research plan for a usability(-ish) test leaning on talk-aloud protocol and qualitative feedback. I designed the interactive test prototypes, and constructed the remote framework and unmoderated prompts using usertesting.com. For test rigor, I organized at least 6 participants per prototype, with a randomized presentation order to minimize question order bias.

Participants completed tasks within each prototype, narrated their thought processes, and self-evaluated their progress. Additionally, a predetermined set of open-ended questions delved deeper into user behavior and motivations, providing valuable qualitative context.

The Outcome

Research Results: A Nuanced Picture

The usability test yielded positive results: participants readily navigated and grasped all three prototypes. In a surprise result, 17 of the 21 final participants favored the prototype with an implicit opt-in default coupled with additional, clearer visual signals and more heuristically user-friendly controls.

Automatic Refills: A Double-Edged Sword

Automatic refills are a double-edged sword in prescription management. They offer undeniable value to patients who prioritize convenience; forget the hassle of reordering — new medications arrive automatically when needed.

However, real-world usage paints a more complex picture, as evidenced by consistent VOC feedback. A common customer complaint is receiving unnecessary refills, and it’s easy to understand why. Managing multiple daily medications, changing addresses, and taking vacations that shouldn’t revolve around medication deliveries — these all contribute to the issue. Additionally, a patient’s medication needs can evolve, with some meds becoming unnecessary altogether (the ideal outcome!).

In these scenarios, anything less than meticulous oversight by the customer can lead to wasted shipments and unwanted charges. These particular customers simply don’t find value in automatic refills as the service currently exists.

Understanding customer needs should lead to solutions that objectively meet them. However, competing priorities often muddy the waters. Automatic refills contribute to a steady revenue stream, making enrollment a natural business focus. And this is where the crux of the problem ultimately lay.

A Balance Between User Needs & Business Goals

In this case, answer to our problem was a balance of clear visibility and adequate user control that would support business goals without encumbering uninterested users.

After educating stakeholders on the limitations and benefits of the qualitative methodology used, I presented the “winning” prototype as a viable solution. My final recommendation was to implement this winning opt-in interface pattern, measure its performance over a month (we had thousands of weekly checkouts), then determine the next steps. More importantly, I emphasized that the long-term goal should be shifting focus away from this single bottleneck by establishing a holistic, omnichannel awareness strategy to educate and attract suitable users. One that prioritizes visibility, control and freedom while avoiding unnecessary friction for patients who don’t find value in the automatic refill service.

Immediate Action & Long Term Change

I worked with the checkout development team to implement my recommendation the following sprint. Later that year, senior product leaders directed funding to overhaul the auto refill experience across the digital platform, heeding my omnichannel recommendation to raise awareness through intentional prompts across touchpoints and prioritize better visibility and more control for users.