What is the S100 copayment initiative

The NSW Government Section 100 (s100) copayment initiative pays the cost of the patient copayment for some Pharmaceutical Benefits Scheme (PBS) s100 medicines for eligible NSW residents. The s100 copayment initiative provides medicines for potentially vulnerable patient groups. It is also a complex process that involves financial transactions and interacts with the National Health Act, underpinning the PBS, privacy legislation, and state legislation.

As part of SNSW, the Service for Business team were engaged by NSW Health to research and develop options for an effective and efficient approach to claims processing for the s100 initiative. This project only focused on how claims were currently processed. There was to be no changes to the eligibility criteria for the s100 initiative or the policy.

Our team consisted of a product manager, product designer (myself) and a service designer. I was the lead designer on the project.

As part of the discovery process, we were asked to -

• audit and assess the current solution used by NSW community pharmacies

• investigate the possibility of creating a single claims process that incorporated public hospitals and 3rd party pharmacies.

• look at a customer first claims approach

Stakeholder Management

The vulnerability and complexity of the various stakeholders, especially the patients using the medication made this project unique. It comprised:

• All patients who are prescribed s100 Highly Specialised Drugs, including their carers and families

• HIV / HepB patients

• Cancer patients

• Mentally ill (Schizophrenia) patients

  Interviewing these groups was difficult; some was very ill from side affects associated with their treatments, some were mentally challenged and some suffered from the stigma associated with their respective disease. In light of these vulnerabilities we were not given permission to speak to these patients. To overcome this problem we were given access to the people and organisations that support and care for them. In order for us to get a comprehensive understanding of these vulnerable patients and to be able to make a recommendation on their ability to claim their own medication we interviewed 25 participants across the groups and organisations listed below.

• Relevant patient support and representative groups:

  • ACON (Aids Council of NSW)

  • ASHM (Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine)

  • Positive Life NSW

  • Consumers Health Forum NSW

  • Mental Health Commission of NSW

  • SANE Australia

  • Mental Health in Multicultural Australia

  • Mental Health Carers Australia

• Pharmacists:

  • Community pharmacies

  • Hospital pharmacies

  • Third party providers (compounding and dispensing for public hospital pharmacies)

• Medical practitioners, specialist physicians, and other prescribers of s100 HSDs in NSW

• NSW Health senior staff across local health districts (LHDs)

Internal stakeholders: 

Due to the complexity and multiple considerations associated with this project, a Project Governance Group (PGG) made up from the 5 internal stakeholder groups were assembled to provide oversight and advice during the Discovery and Framing phase, as well as the subsequent development of a new claiming solution.

Our process

We started setting out our learning goals for the different stakeholder groups.

Based on our learning goals we created 11 different moderator guides and with the help of HIV and HepB support groups we created 2 surveys that were sent out to members. NSW Health provided us with participants to interview across the different stakeholder groups mentioned.

Interviews lasted one hour and were conducted online via Teams. We conducted 25 interviews over 2 weeks. Sessions were conducted by a facilitator and a note taker. Designers took turns to facilitate sessions to alleviate the pressure of note taking. Note taking was laborious and time consuming as we had to transcribe interviews in detail due to the complexity of the domain. Interview insights were added to Trello boards where we could sort and prioritise. With the help of two Support Groups we sent out a survey to HIV and HepB patients where we got more targeted feedback around the s100 co-payment program. Due to the volume of research it was not practical to synthesise the findings in Miro and we opted for affinity diagramming and white boarding in the office.

EMPATHY MAP

We started off created an ‘empathy map’ for patients to get an idea of their state of mind and ability to transact claims.

AFFINITY DIAGRAMMING

Once the interviews were done we started pulling insights from the interviews and grouping them per colour e.g. purple = medical practitioners, yellow = support groups, green = pharmacies etc. The next step was to started to grouping them and identify themes. Once we created the themes we sorted them into 6 main categories.

ARTEFACTS: Research

As part of our report out to stakeholders we had to deliver -

• a research document summarising our research with a recommendation on the focus of the project going forward

• a service blueprint

Recommendation

Based on the research findings, Service NSW recommended a Pharmacy-led S100 co-payment claims approach going forward. It’s the most patient centred approach.

Our Approach: Framing

We identified 6 top problems to solve during discovery and we focussed on this going into framing. Two of these problems were around policy and NSW Health had to address that within their department.

We focussed on the interface and through a white board session the PO and me created 4 main flows for our prototype.

• Search for and find the s100 program and onboarding

• Submitting my fist claim

• Recurring claims

• Criteria check (Proof of identity (POI))

At this stage of the process we had two developers join our team. We started having conversations with other development teams within the business profile platform, security and transaction teams, identifying potential blockers to different solutions.

ARTEFACTS

As part of the framing process, we were asked to deliver -

• a solution/s

• a conceptual prototype

• a usability report based on our prototype

Based on all these conversations I created an Axure prototype of our initial concept.

LINK: Prototype

We conducted 10 usability tests across Regional and Metro areas

• 3 Pharmacy Owners

• 3 Pharmacy Managers

• 1 Senior Pharmacist 

• 2 Pharmacist assistants 

• 1 Pharmacist from a third party pharmacy

We measured success by rating the ability of the users to complete each task without an issue. The average score was 17/20.

Next steps

NSW Health approved the initial concept and received a proposed cost estimate from Service NSW for the proposed product.