Scaling Medical Plan Creation at Collective Health

The company and the team

Collective Health is a health benefits platform that manages medical, dental, vision, and pharmacy coverage for large employers. The Plan Structure Launch and Design team, 27 ops specialists, is responsible for creating customized medical plans for over 60 clients, each managing an average of 4 to 5 plans.

Before the Plan Authoring Suite (PAS), creating a single medical plan meant opening a 20-tab Google Sheet, filling out 3 specific tabs by hand, opening Terminal, and running a custom script to output the JSON and CSV files the backend needed to process the plan. PSLD team members are operations specialists, not engineers. They were required to do both jobs.

A workflow that could not scale

The workflow worked when Collective Health had a small number of clients and plans. As the business grew, it did not scale. Errors were hard to catch and harder to trace. Troubleshooting consumed hours that should have gone to plan accuracy.

Training new PSLD team members was a lengthy process. Ops specialists had to learn a quasi-technical workflow that required running code they did not write and did not fully understand.

The company needed a purpose-built tool for medical plan creation. What existed instead was a patchwork of spreadsheets, terminal commands, and tribal knowledge.

End-to-end ownership across four years

I started on this project before my design manager was hired, contributing to early stakeholder calls with the VP of Product and senior subject matter experts to define what the tool could be. When my manager joined she took over running those calls and we collaborated on discovery, lo-fi mockups, and user testing. I built all prototypes and user flows throughout.

As her focus shifted to other initiatives, she handed full ownership of PAS to me. From that point I ran all working sessions, owned the UI end to end, and presented work directly to executive stakeholders including the CTO and COO.

Designing for the future, under pressure to ship now

The early work focused on understanding the PSLD workflow deeply before proposing solutions. I mapped the existing process, identified where errors occurred, and used that foundation to sketch an ideal future state before designing toward an MVP. This sequencing became a point of contention.

The PM and engineering leadership felt we were moving too slowly and designing too far ahead. Rather than abandoning the approach, we made the case directly to engineers: building toward a near-sighted MVP risked throwing away work within a year as the product iterated. We kept executing. When usability testing results were presented at a sprint review, the PM who had been most skeptical saw the value of what we were doing. That shifted the dynamic and the team aligned behind the process.

Designing under constraint: multi-tier plans

The most technically complex challenge came mid-project when a market requirement emerged for multi-tier medical plan support. There was no industry consensus on what multi-tier meant. Different insurers and networks defined it differently. We had to define it internally, then design a flow around that definition while working within significant technical constraints.

The solution required a new step in the flow built around provider groups, an internally invented concept that had no equivalent in the industry and could not be exposed to clients without causing confusion. Designing that step meant making three interconnected concepts legible to ops users, two of which existed only inside Collective Health and one of which meant something different outside it.

PAS moved medical plan creation from a fragile, person-dependent process to a structured, scalable system with built-in guardrails.

The PSLD team can now support plan configurations that were structurally impossible before. As Collective Health grows its client base and plan complexity, the tool grows with it.

What I would do differently