Hacking Medicare: Why we should use hacking as a method to solve healthcare problems – Part 4


If you missed my previous Hacking Medicare posts, check out Part 1, Part 2 and Part 3.

In Part 3, I talked about how “The Cheetah Project” came about after changes in The Centers for Medicare and Medicaid Services (CMS) contracting processes. These changes demanded one Medicare administrative contractor (MAC) to increase quality and speed while driving costs down – virtually overnight.

The Cheetah Project needed to expand workflow and BPM into operations throughout the enterprise, a feat that would require my team to implement 20 workflows in 13 departments for more than 350 users in five locations in just 20 weeks.

We needed a hack.

The process factory 
My team needed to do some metathinking. We needed to think how about how to think about automating processes.

After all, how do you automate the process for creating automated processes? I started to think about Henry Ford. He was a metathinker. He created an optimized factory to build cars.

Why not build one for Medicare processes?

Process “Legos”  
Fortunately, the MAC was already using a process automation software platform. And that platform was well-suited to act as our process Lego blocks. We conceived, designed and constructed a process factory in a matter of about four weeks.

We designed our process factory to churn out processes like widgets coming off Ford’s assembly line. We assembled a team of employees, contractors and vendors to make the approach work. We had the tool, the factory and the team.

Then a bit of brilliance struck.

A key Cheetah hack that Ford would have loved was the strict division of tasks. Each programmer focused on building a “machine” in the assembly line that could build sub-processes.

We made steady progress, fueled by constant communication. We completed the project four days early, under budget and with few bugs to correct.

Cheetah’s six-ingredient hacking recipe:
Here are some of my learnings from this project that hold true today:

  1. Fortune favors the bold: This was a big idea. We threw out smaller ones.
  2. Trust: Everyone had 100 percent buy-in and 100 percent trust. This was the absolute key ingredient.
  3. Agility: It’s not about how fast you can go down the straight away, it’s about how much control you have in the turns. Things change. Agile processes enable you to adapt quickly and painlessly.
  4. Metathinking: Thinking about how to think – about what you are doing and really trying to accomplish – is a very valuable asset in any significant effort worth doing.
  5. Build a process factory: Organizations should be working on factories, not processes. Projects are not the right vehicles for driving process improvement. It is about continuously tweaking your factory to create the most agile processes.
  6. Obtain the right tools: Our automation tool made all the difference. A less flexible tool would have doomed the project from the start.

Cheetah’s legacy: Saving millions of dollars
Since we released it, Cheetah has had a number of litters and they all came out green. The project has saved Medicare $50 to $100 million so far. Now that’s a health insurance solution.

Cheetah also produced a number of non-monetary benefits including quality improvements, the ability to audit processes, disaster recovery abilities, internal controls, help with compliance and risk reduction.

I am pleased to say that the MAC in this story went on to win multiple CMS contracts due in no small part to the Cheetah process factory and it’s legacy of boldness, agility and, of course, hacking.

In a good way.

Mike Hurley is the industry manager for Health Insurance at Hyland, helping health insurance organizations transform business processes that drive value for members, providers and employees. Mike works with current and prospective customers to use our award-winning product, OnBase, to drive business transformation. He is also responsible for our high-value, high-impact health insurance solutions, the like Mobile Medicare Enrollment Solution for OnBase. Prior to joining Hyland, he was the founder and president of Swim Lane Software, LLC. Hurley founded Swim Lane in 2007 to create a solution that leveraged Software as a Service (SaaS) technology to automate the processing and adjudication of Medicare Claims through unique use Business Process Management (BPM) and Business Rules Management Systems (BRMS) technologies. Preceding Swim Lane, he founded Green Square in 1997 as a national consulting practice that connected technology with business strategy. As a boutique services firm, Green Square was aimed at driving stakeholder value at over 25 BlueCross BlueShield plans in the U.S. Prior to Green Square, Hurley founded Avalon Technologies, Inc., an award-winning systems integrator focused on Enterprise Content Management (ECM), workflow and Optical Character Recognition (OCR) technologies.
Mike Hurley

Mike Hurley

Mike Hurley is the industry manager for Health Insurance at Hyland, helping health insurance organizations transform business processes that drive value for members, providers and employees. Mike works with current... read more about: Mike Hurley