Post on 15-Jan-2015
description
HealthCare Fraud Prevention Partnership NASA Challenge
HealthCare Fraud Prevention Partnership NASA Challenge
Jason Zeiler, CMSAndy LaMora
2
• To exchange facts and information between the public and private sectors in order to detect and prevent health care fraud
• To enable members to individually share successful anti-fraud practices and effective methodologies and strategies for detecting and preventing health care fraud
• To focus on information sharing in two primary areas:1. Data analytics2. Outreach, education and information sharing
Healthcare Fraud Prevention Partnership (HFPP) Purpose
3
Value Proposition
HFPP
Claims
Compromised Patient Data
Fraudulent Providers
Part
ner #
Z
Partner #Y
Enhanced
Fraud-
Fighting
Capabilities
Partner #X
4
• The primary objective of the project involved building a data exchange network that would enable healthcare insurance-paying entities in both the public and private sector to safely and securely share information for purposes of detection and prevention of fraud, waste and abuse across partners.
Project Overview
5
• Defining a data standard for exchanging healthcare claims data
• Defining a secure data exchange network• Identify and defining the roles of the Trusted Third
Party (TTP)• Providing documentation that drives adoption• Demonstration of the system with one or more proof
of concept applications
Principle Tasks
6
• Solve problems (like developing code) by using a crowd of people: A Community– Open Source Communities: Apache, git, etc– Contributing Communities: wikipedia– Competition Communities: 541(G) Prize Firms
• What motivates a crowd to work?– “Guts, Glory, Gold”
• Contests can provide focus and spark to a crowd
Crowdsourcing
7
• Total Registrations: 1406• Countries Represented: 52• Total Distinct Contributors: 107• Total Contests: 55
HFPP Community Stats
8
• Projects are “atomized” to many contests• Contests are hyper-specific• … which lowers the need for domain experts• … while leaving the door open to them
How does it work?
9
Atomization
MORE THAN 30+Specialized Contests thatallow for Hyper Specialization
10
Atomization
Conceptualization
Specification
Wireframes
Storyboards
Architecture
Assembly
Component Dev
Bug Hunt
Bug Race
Idea Generation
Atomization – Why do it?
why
Probability
What are the Properties of the Big Contest?•Seeking in effect: brilliant, disciplined, proficient…
in one entity• = Rare!• = Hard to find• = Hard to price
And of an Atomized Challenge?
• = Hard to repeat • = Hard to scale
Find great ideas, from anyone
Let Designers Design
Let Builders Build
Atomizing by skill type = more contests• and thus opportunities to win• which increases participation• which increases contribution• which lowers risk• and increases quality• with shorter turn-around
Collaboration
• If you decompose from the start• AND assume different players at each step• You are forced to develop great info-sharing practices• -> Toolsets are key
Iteration
• Lots of “shots on goal”• Allows “early looks” and change cycles• And with a large enough community, lots of parallel work
15
Putting it together at CMS
Open and Directed Innovation Contests• Idea Generation • Conceptualization
Creative Contests• Logo• Wireframes• Storyboards• Mobile Screen
Software Contests• Software
Specification• System Architecture• Module Architecture• Component Design• Component
Development• User Interface
Prototype• Assembly• Test Scenarios• Test Suites• Bug Hunts• Content Creation
Credit: Chip Garner and Anne Wood, CMCS/CHIP
Execute
Self CorrectForge Ahead
16
• Back to CMS…
Thanks!
17
• Tangible products and code that can be implemented into the TTP system
• Many ideas and different points of view and solutions to the issue at hand or overall reason for using a challenge
• Challenges can be an option and a good replacement to traditional acquisition (less money, time, different approaches, input and solutions), depending on the project
• The challenge process can also be used to give valuable input to the traditional acquisition process by adding or filling in gaps in information that may not have been identified initially (helping complete the SOW and a better end result)
Challenge Benefits