National Health Plan

The Problem

The Medicaid health insurance plans that the client operates are measured and compensated by the respective government agency according to the results of HEDIS measures.  HEDIS is an independent assessment organization that scores health insurance plans based on health outcomes of their covered members.  In order for the client to optimize their performance on HEDIS measures, they needed to aggregate data to understand how healthcare providers impacted those measures for their members.   With business plans in place to incentivize providers for health outcomes of their covered members, a technology solution was needed to operationalize the measurement, compilation and presentation of data to the healthcare providers who were part of the client network.  There were terabytes of data from multiple data sources that the business rules depended upon.

How We Helped

SDS collaborated with the client on a strategy to maximize the business knowledge of the client resources, and the technical depth of the SDS team. We agreed to a shared resource model.  SDS identified a dozen skilled people to include software developers, a scrum master, quality assurance professionals, and system engineers.  Six of the personnel backfilled subject matter experts (SME) from the staff at the client office.  Those SME’s joined the other 6 resources from the SDS staff to assemble the HPI development team and the project began at SDS office.

Modelling to forecast future outcomes, communication through reports from the client to the providers, and used internally by the client to configure incentive contracts with providers.

Results

  • The first two-week sprint produced working code to repair broken reports in the old, manual system. Working code was delivered every two weeks thereafter.
  • Continuity of product ownership was guaranteed throughout the project by involving the client development staff on the project, as well as by allowing some of the SDS project resources to be hired by the client.
  • Tens of millions of dollars have been realized, and much more forecasted, as a result of operationalizing this system.