Rightway Healthcare

Medical Concierge / PBM

Company

Rightway Healthcare

Product

PBM

Approach

Desktop

Framework

React/JS

Platform

Web

From Confusion to Clarity: A Guided Pharmacy Benefit Experience

Pain Points

  • Members faced confusion comparing complex drug pricing and plan options.
  • Lack of transparency made it hard to understand pharmacy vs. mail-order costs.
  • Switching to generics wasn’t obvious, leading to higher out-of-pocket costs.
  • Open enrollment support depended heavily on health guide expertise — inexperienced guides often had to reschedule calls, which meant:

      • Reopening the scheduling system

      • Finding a new slot on the member’s calendar

      • Creating a new support ticket

      • Delaying resolution and frustrating both member and guide

Key Features

  • AI-Assisted Plan Comparison: Automatically analyzes claims history and medication data to recommend the most cost-effective plan and pharmacy options.

  • Dual Experience Modes:

    • Fast Track — Quick, AI-driven recommendation for members who prefer immediate answers.

    • Guided Mode — Step-by-step walkthrough for members who want to explore details and compare options.

  • Generic Switch Visibility: Clear monthly savings displayed when switching to generics, improving cost transparency.

  • Pre-Filled Data: Pulls from historical claims to minimize manual entry and save member time.

  • Health Guide Support: AI tooltips and recommendations empower less experienced health guides to handle open enrollment calls without rescheduling.

  • Seamless Pharmacy Options: Side-by-side comparison of retail vs. mail order to maximize convenience and cost savings.

  • Plan Confirmation Flow: Clear, simple steps to review, confirm, and lock in a plan — reducing errors and decision fatigue.

New Design

I redesigned the experience into a guided, AI-assisted plan advisor that consolidates pharmacy benefit data, insurance options, and personal medication history into a single, member-friendly flow.

The new flow was simplified into 3 steps:

  • Review Current Plan & Medications (pre-filled with claims data).
  • Compare Recommended vs. Available Plans, with AI-driven cost projections and savings opportunities.
  • Confirm Plan Selection, with a transparent summary of why the recommendation was made.

The Impact

  • AI assistance reduced dependency on expert guides: Now, even less experienced health guides can use AI-powered plan recommendations during the same call, instead of rescheduling.

  • Faster resolution: Members get answers in one call, eliminating the need to juggle tickets, calendars, and multiple conversations.

  • Operational efficiency: Reduced rework freed up scheduling and ticketing resources, lowering overall support costs.

  • Better member satisfaction: No more waiting days for follow-up — decisions happen in real time.