Context

Why direct payments matter

Pumpkin aims to differentiate itself by delivering a superior claims experience that not only delights customers but also strengthens our standing as the veterinary community's most-trusted and loved insurance provider.

A significant opportunity lies in supporting payments to veterinary clinics at the point of service. This is what customers are used to with human insurance, and what they expect from their pet insurance policy, too. This initiative has been a longstanding goal for Pumpkin, and achieving it would represent a major step forward in aligning with both customer and veterinary clinic needs.

How does a pet insurance claim work?

01

Discovery

Deepening our understanding of the vet visit journey

User Interviews

We conducted interviews with veterinary clinics to understand their processes around estimates, invoicing, and payments, gathering feedback to inform the design of our pilot system. I conducted 7, 45-minute interviews with practice managers & lead CSRs.

Findings

15 minutes feels like a good amount of time for us to process a claim while not putting excess burden on a clinic. There are also opportunities to frontload parts of the process before client gets to POS, depending on the clinic’s workflow.

In emergency situations, there is more time than we anticipated between stabilization and administration of treatment. This makes it much more likely that our claims team can successfully process an estimate during a visit.

In certain cases, SOAP notes will not be ready to share with our claims team during a visit. We will need to build in a process for getting a DVM’s verbal summary of the visit reason.

Research Outputs

In addition to those key findings, I was able to build a set of diagrams that synthesized what I’d learned about how estimates & invoices relate to the vet visit flow in order to create alignment within our team. This was particularly useful during our subsequent workshop.

Two of the diagrams I created, to help my team and stakeholders visualize and align on how we should be thinking about the evolution of an estimate and invoice over the course of a visit.

02

Workshopping

Brainstorming solutions anchored in the visit journey

Goals

As a group, we mapped out our understanding of different types of visits, to:

Understand where and how a direct payment solution fits in
Identify design considerations, including hospital & client needs/painpoints
Align on visit type(s) for which direct pay has greatest value

One of the outcomes of our workshop was a vet visit journey, organized by visit type. We used this to make sure the solutions we were proposing were anchored in the reality of bringing your pet to the vet for a potentially critical situation.

Outcome

In addition to building a journey map as a group that aligned our team behind, we were able to create a consensus that supporting critical care moments, despite being more challenging than wellness exams, was essential for Pumpkin Pay to succeed.

Why focus first on critical care moments?

These are the scenarios when hospitals and their clients face the extreme stress and patient outcomes are most at stake. It is also where Pumpkin has the most agency to provide support and solutions.

By focusing here, we will establish the credibility and trust to expand our hospital footprint and offerings.

This is how we become an entrenched, invaluable partner to the veterinary community.

03

Re-Framing

From insurance provider to pet health partner

Problem Statement

How might we provide the most efficient, trusted support to hospitals –and the least amount of work on staff–in order to support different visit and care scenarios, and go above and beyond when it matters most?

Guiding Principles

1

Act like a care partner, not an insurance provider

2

Design the service to flex to different care scenarios

3

Create as little work as possible on vet staff

4

Empower clients of vets to use and drive adoption

5

Provide transparency every step of the way

Considerations by Care Scenario Type

Preauthorization and direct pay are most valuable to Pumpkin customers when they are faced with an unexpected, expensive vet bill. We wanted to ensure our pilot service enabled care for the most critical scenarios:

Emergency Visit

Typically occurs at an emergency or urgent clinic, not their GP clinic
ER visits are urgent and unpredictable, preventing notification to Pumpkin until the pet is already at the clinic
Estimate is typically provided after pet is stabilized

Illness/Accident Visit

Typically occurs at their GP clinic
May be able to notify Pumpkin before visit depending on how far in advance it is scheduled
Unlikely to have an estimate available prior to visit, but can be provided to client during visit

Scheduled Procedure

May occur at GP clinic or at a specialist clinic
Typically have an estimate available ahead of the visit, which can be shared in advance with Pumpkin for preauthorization

Leveraging hospital clients to drive adoption and learning

During the preauthorization pilot, we discovered that clinics, despite finding it valuable, cannot or will not proactively inform Pumpkin-insured clients about preauthorization, leading to limited utilization.

We believe that promoting the service directly to clients of participating vet clinics and allowing them to initiate preauthorization and direct pay themselves will help us overcome this barrier.

04

Designing

Creating a workflow that facilitates care

Candidate flows

I designed these 4 candidate flows to get feedback on from stakeholders & vets.

Concept testing

I translated the flows into interactive flows, bookended by sketches to provide context.

Leveraging hospital clients to drive adoption and learning

During the preauthorization pilot, we discovered that clinics, despite finding it valuable, cannot or will not proactively inform Pumpkin-insured clients about preauthorization, leading to limited utilization.

We believe that promoting the service directly to clients of participating vet clinics and allowing them to initiate preauthorization and direct pay themselves will help us overcome this barrier.

05

Solution

Designing our pilot system

Final flow

Visual flow

Solution in action

Amy arrives at Paws & Claws Emergency Vet with her dog Leo, who is experiencing severe difficulty breathing. A technician brings Amy’s dog back to the treatment area. While she’s waiting, she checks in to let Pumpkin know she is currently at the emergency vet.

The CSR at Paws & Claws gets an email from Pumpkin, telling her that Amy has informed Pumpkin of her visit and requesting any records they might have on file for Leo.

Bill, a claims adjuster at Pumpkin, receives a notification that Amy has brought Leo to the vet for an emergency visit. He sees we have not yet completed a medical record review for Leo. He starts Leo’s medical record review, getting in touch with Amy and/or any vets Leo has been in to the past if any records are missing.

Once Leo is in stable condition, the vet reviews a diagnostic plan with Amy that will help them understand why Leo is having difficulty breathing. The vet emails it to Amy, and Amy sends it to Pumpkin.

Bill gets to work reviewing the estimate that Amy has sent over so that he can provide her and her vet with a pre-authorization decision within 15 minutes.

Amy receives a text from Bill explaining the pre-authorization decision and letting her know an EOB will be available in her member center shortly. Paws & Claws also receives an email with the EOB attached.

Towards the end of her visit, Amy receives a final invoice from her Paws & Claws. She wants Pumpkin to pay her vet directly for the covered portion of her invoice, so she fills out the direct pay form.

Bill reviews the invoice she’s sent over. Since all the services Leo received were already pre-authorized, he can quickly approve all covered line items in her invoice.

Bill texts Amy to let her know her direct pay claim has been processed, informing her of how much Pumpkin will cover & how much she will pay out of pocket. This information is also emailed to Paws & Claws.

Amy pays her covered portion and leaves the clinic with Leo. A few days later, Paws & Claws receives a check from Pumpkin for the rest.