WPS TRICARE portals: clear answers for military retirees, their families and their doctors

TRICARE For Life is the Department of Defense health benefit for military retirees and their families once they become eligible for Medicare: it pays after Medicare does. Most of the people who sign in are over 65; the rest are people with disabilities, spouses and caregivers, sometimes a son or daughter helping a parent. Our research found they are rarely happy when they arrive. They come stressed or worried, often about a bill that hasn’t been paid, with one question: did my claim go through, and do I owe anything? Many see the benefit as something they earned in uniform. For families living overseas, the doctor and the bill may also be in another language.

WPS Health Solutions processes TRICARE For Life claims for the whole United States and supports the TRICARE Overseas program, and it ran four portals: one for beneficiaries and one for providers in each program. In 2014 we spent three weeks on site in Madison assessing the portal platform. It worked, but it would not scale to the demand ahead, as more people reach 65 and a generation used to doing things online retires. Simple content updates needed the IT team, and people found the sites hard to navigate.

We started with the people

At the design kickoff in Madison we presented research on who uses the portals and why, and personas drawn from it: a retired soldier about to turn 65 and worried about what happens next, a widow whose daughter helps her with the account, a retiree who moved abroad, a young military spouse overseas filing a claim for care off base. Providers’ billing offices and WPS’s own customer service staff got personas too. The design principles came from there: the user owns the portal, design for mobile first, and put the effort into the features people rely on most.

Answers first: claims, bills and forms

We organized the beneficiary portals around the questions people bring: whether a claim was processed and what they owe, the Explanation of Benefits, deductibles and the out-of-pocket cap, the forms they need, and a secure way to send documents to WPS. The TRICARE For Life and TRICARE Overseas portals share one information architecture, and each gives its own audience a responsive experience with content in more than one language. We built them to Section 508, the federal accessibility standard.

Providers: claims without the phone call

For the provider portals we ran design sessions with WPS, reviewed the business requirements line by line and refined an interactive prototype that WPS approved in March 2016. Doctors’ offices and billing staff can register, see a dashboard, search claims and their status, submit claims, check a patient’s eligibility, message WPS securely and manage their own locations and users. The code search covers ICD code descriptions in Spanish and German for the overseas portal.

Off the mainframe, with content in WPS’s hands

We moved the TRICARE portals from the mainframe to IBM Digital Experience (WebSphere Portal and Web Content Manager) on new Linux servers, and built the web services that connect them to WPS’s claims systems and to the Department of Defense’s eligibility and sign-in services. Content, labels and translations live in Web Content Manager, so WPS’s business staff publish to beneficiaries themselves. We trained the authors and set up analytics.

The TRICARE For Life beneficiary portal went live in October 2015 and TRICARE Overseas followed in December; the two provider portals launched in late 2016. In November 2016, WPS received two eHealthcare Leadership Awards for the TRICARE For Life beneficiary portal: Gold for Best Patient Access and Convenience, and an Award of Distinction for Best Overall Internet Site (per WPS).

WPS’s business staff now create, update and target content for beneficiaries without waiting on IT.

Our part: the 2014 health check, then the research, design, build and deployment of the beneficiary portals, and the design and front end of the provider portals, with WPS’s IT team.