As a cornerstone of Elephant Healthcare’s financial health, clinical billing profoundly influences the sustainability of our primary care network. This case study will show how we resolved two chronic pain points in the existing system: substantial unbilled care resulting in revenue loss, and the excessive workload placed upon our billing officers.
TOOLS
Figma, Slab, Miro
ROLE
Design Lead
We researched billing challenges at our facilities in Ghana and Kenya. Our goal was to confirm reported problems and find the exact needs of billing officers. We focused on three key areas:
The officer's billing workflow.
The patient's billing experience.
How price lists are set and managed.
Research Methodology
A contextual inquiry helped us to combine direct observation with interviews to intimately understand clinician workflow needs, behaviours and pain points.
What we found
Manual Concessions
5 – 7% of patients cannot afford full services, requiring officers to seek approvals for discounts.
Officer Risk
Officers often pay small patient deficits out of pocket because the system offers no alternative.
Heavy Workload
Billing officers manually track all care events and managing collections on every invoice.
“Yesterday, I saw three patients who were unable to fully pay for their medications. It would be nice if we had a way of making some exemptions for our patients”
Billing officer
Methodist Hospital, Aburaso
Mapping out the current user journey
We followed this by mapping the patient and billing officer journeys. This gave the team a shared, high-level understanding of the interactions between a patient, the clinicians and the billing officer, revealing key pain points and opportunities for improvement.
Working backwards with hard questions - PR/FAQ
To align the team and define final requirements, we used a PRFAQ framework. The PR framed the feature's hypothetical launch to secure stakeholder alignment, and the FAQ sessions that followed focused on customer questions and stakeholder concerns.
This process ensured the entire team and stakeholders were clearly aligned on the feature's scope, potential limitations and any other constraints.
Automation Strategies
We proposed two distinct approaches to stakeholders and billing officers:
Full Automation
Every care event (consultation, lab test, medication) automatically triggers and finalizes billing in real-time. No billing officer intervention required.
Hybrid Automation
Care events automatically populate draft invoices. Officers review, adjust for exceptions, and then finalize before payment collection.
Stress Testing Through FAQ Sessions
We facilitated structured FAQ sessions with key stakeholders; Business Development, Product and Engineering, Sales Coordinators, and Facility Managers etc. We tested each approach against real operational scenarios.
Critical Questions that surfaced
"What happens when prescribed medication is out of stock and we need to substitute?"
"How does the system select the correct insurer for patients enrolled in multiple health insurance schemes?"
"What about clinician documentation errors—wrong dosage, duplicate entries?"
"Can the system handle our three different price lists (national insurance, private insurance, cash)?"
Decision Framwork
Final Decision: Hybrid Model
We pivoted to a hybrid automation system. The PR/FAQ prevented us from building a brittle but fully-automated system that would have failed in production and required expensive rework.
Workload is significantly reduced because real time care events auto-populate draft invoices eliminates manual data entry for consultations standard labs and medications.
Human judgement is preserved when officers are able to modify invoices before they are finalized. Allowing them to handle:
Prescription updates based on stock availability.
Insurer assignment for patients with multiple insurance providers.
Price list selection (national vs. private vs. cash)
Correction of clinician errors.
Decision outcomes
By using PR/FAQ to validate our approach before prototyping or development, we:
Avoided weeks of wasted engineering effort on full automation
Secured unanimous stakeholder buy-in before the first line of code
Identified the specific edge cases to design for (informing our flows for exemptions, waivers, and manual invoice creation)
Established clear success metrics aligned with realistic expectations.
This flow depicts how an automated invoice behaves when triggered by real-time care events during a patient's visit.
We defined the solution by focusing on core user stories and high-impact features. Using our in-house component library, I skipped low-fidelity work and moved straight to high-fidelity mockups. All designs were optimised for our core device, the Tigi Tablet.
In the event a real-time care event is not triggered, the billing officer has the option of manually creating an invoice and populate it based on the care received by the patient at the facility.
Based on insights from our PRFAQ, we accounted for each scenario where the billing office updates the invoice by changing its attributes and finalizing it before collection begins.
This flow depicts how the billing officer takes payment once the invoice is finalised.
Billing officers are allowed to make payment exemptions based on the type of visiting patient.
The billing officer is afforded the option to waive a given amount off the transaction amount when payment is being taken.
In the event a patient is over-billed, this feature severs as a contingency to rectify the issue.
A Payment History was essential to resolve the lack of transparency by tracking all payments, timestamps, cashiers, and amounts for a given invoice.
We stress-tested the solution under real-world scenarios (e.g., pricing, processing time, insurance coverage) by conducting a soft launch at several facilities.
Users praised the Payment History for easy audits and appreciated the integration of Medical History with patient invoices
The new dispensing process did not fully solve pilferage. Moreover, users also reported confusion over specific financial terms.
We updated the final prototype based on research and soft launch feedback. While it was too early to measure overall success due to varied clinic processes, initial analytics (first two months post-launch) showed positive outcomes.
We discovered that:
Workload Reduction
Officers now spend 8 less minutes per invoice.
Finalized invoices
Across our territories this was almost doubled.
Revenue increase
We recorded an increase in revenue from collections alone.
