Mapping a Concept onto a Verbal List

Tasks confronting users are sometimes more complex than can be represented by simple words or phrases. In such a case, the user has an even more difficult challenge trying to make what appear to be simple selections.

“Do you want claim status, coverage and benefits, or billing information?”

Here we have a set of formal categories—by and large not words that we use every day. This is because the task itself is not one that we pursue every day. The health-care application that asks such a question is an abstraction that derives from the complexity of our economy and the modern society that it has spawned. There is no “natural” or “evolutionary” model that makes this interaction even remotely basic or simple. So callers have to perform mental calisthenics to get through the question.

In this case, you are listening to words from the IVR and concurrently thinking about and making internal comparisons with your need or goal. This activity is similar to the previous essay, in which you are “deciding” which flavor of ice cream you want. But in this case, the task is even more difficult, because you must devote some additional brain power to figuring out the precise meaning of the words that stand for the tasks.

What is “Claim status?” What does it mean? Well, in isolation, with plenty of time to think about it, one could arrive at a definition—a “claim” must be a request for the insurance company to pay. And the following phrase, “coverage and benefits,” must be information about what the insurance company is willing to pay for. So you ask for claim status if you have already made a claim for a medical procedure in the past, and want to find out its status. But you ask for coverage and benefits if the medical procedure is in the future—you are in effect asking for permission to seek the procedure under coverage.

In other words, seeking payment in the past versus payment in the future is what you’re asked to decide. Now hold those concepts in mind as you hear the third choice—billing information. Well that’s a kind of payment as well, isn’t it?

What we have here is an exclusivity problem. As shown in the Venn diagram, the three classes have overlapping semantic implications—even though the words are all different. Each choice in the list is not fully exclusive of other choices, so you must hold all of these elements in mind at once—a challenge for short-term memory—and you must think—a challenge for both short-term memory and cognition. These challenges cause interference that limits the number of choices that can be processed at one time.

Now imagine that you’re calling for your Dad, who goes in tomorrow for his fifth outpatient visit to adjust a leg brace following his knee and hip surgery a few weeks ago. You seem to remember that those co-pays that you make every time you take him have some kind of cap. That after a certain level, you have to pay less—or maybe it was more, it’s so hard to remember these things. So you listen and must decide:

“Do you want claim status, coverage and benefits, or billing information?”

Although at first glance it is a “simple” question, you’ve actually got some real thinking to do here, don’t you?

The interference is a version of cognitive dissonance, and is a key explanation for why healthcare applications have such low self-service numbers. The tasks themselves are complicated, and they overlap with each other across a number of dimensions.