Problem

CAQH, the Council of Affordable Quality Healthcare, for healthcare data, faced systemic friction within its legacy service model. Health plans were spending millions of dollars annually on redundant manual verification due to an automation gap in low-tech organizations and hidden API complexities in high-tech ones. This verification burden trapped analysts in a cycle of manual fixes, eroding trust between providers and plans while ultimately delaying patient care.

Research Results

Over 7 months month sprint, I integrated generative and evaluative research to uncover systemic issues:

• The Verification Burden: Mapped data flows to identify exactly where redundant manual checks occurred, finding that organizations were manually re-verifying rather than applying data.

• Analogous Insights: Investigated FinTech patterns to identify successful strategies for building trust in automated validation within highly regulated environments.

• Stakeholder Co-Creation: Led Service Ecosystem Mapping workshops to align on the problem space and turn clients into active collaborators from day one.

Impact

The project delivered a design strategy to secure CAQH’s position as a forward-thinking innovator:

• Smarter Attestation: Developed a system of lightweight, in-workflow "micro-attestations" to improve data freshness and reduce friction for providers.

• Primary Source Verification (PSV): Moved PSV upstream into CAQH to eliminate duplicated labor and software costs across the provider-plan ecosystem.

• LLM Integration: Integrated a Large Language Model (LLM) into the portal, allowing non-technical and power users alike to perform complex data analysis through natural language.