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 Problem
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 UI 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 existing flow forced users to interact with the automatic refill opt-in before checkout could progress. As a quick, heuristically sound solution, I collaborated with the checkout flow Product Owner to make the automatic refill opt-in optional during the checkout process. We also agreed to closely monitor the results.
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 below the business’s acceptable threshold.
So we arrived at the age-old question: How do we responsibly balance the needs of the business with the best-interests of our users?
The Hunch
Around this same time, product owners for the automatic refill service itself, prompted by the significant drop in performance, approached me with a strongly-phrased proposal: implement a new active choice opt-in during checkout to buoy the rate. I even got design options from their marketing team.
Their marketing team supplied several UI mockup options to support the proposal. It quickly became apparent that the term ‘active choice’ was inaccurate, and what was actually being suggested was either an implicit default or just a plain default. While these can be effective selling tools, they are also often dark patterns.
My assumption was that this proposal would swing the pendulum too far in the opposite direction. I felt certain this would negatively impact the experience for all of our users 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, including several of the proposed solutions. But the financial implications of this decision fueled a deep sense of urgency from business owners.
Time was short.
The Approach
Navigating Nebulous Goals
My first step was to establish a baseline of business goals. Unfortunately, the business lacked clear, quantifiable goals 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 usability study paired with open-ended questions. This lean, remote methodology was actually a paradigm shift at the time for our Fortune 10 business (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.
- Scalability: Testing remotely allowed for a wider participant pool compared to in-person sessions.
- Cost-Effectiveness: Remote testing is generally less expensive than in-person studies.
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. To my surprise, 17 of the 21 final participants favored the prototype with an implicit opt-in default, though this was only when accompanied with clear messaging and 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, multichannel 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 remaining auto refill experience on the digital platform to prioritize better visibility and more user control.