Hacking Medicare: Why we should use hacking as a method to solve some of our healthcare problems – Part 1


I recently became addicted to a podcast called the TED Radio Hour. Each week it takes a topic and cleverly weaves TED talks together that relate to the topic.

One episode, titled “Hacking our way to a better world,” really stuck with me. While we often – and rightfully so – focus on the negative aspects of hacking when it happens in the world, most of us are unfamiliar with how “hacking for good” can change how we think about solving difficult problems.

Why hacking is the answer to some of our healthcare problems
I have noodled on this episode for so long because I am mesmerized with the segment on hacking climate change. It is compelling.

It also got me thinking about the problem I wake up with each morning: How do we drive down the cost of healthcare by improving the underlying processes?

I know, it may not be as sexy as coming up with some iPhone app that shrinks your waistline, but it is the problem that I am trying to solve.

Why care? Because we waste billions each year on inefficient sharing of healthcare data and documents. I really hate waste.

We could use that money to deliver wellness initiatives, help seniors, relieve suffering and cure diseases.

Hacking Medicare fraud and waste  
I want to start a grass roots movement to hack Medicare processes.

Before you call the FBI, here’s what I mean.

The Centers for Medicare and Medicaid Services, while much maligned over the last several years, has done an admirable job of efficiently and effectively delivering healthcare to seniors. In most cases, its processes are vastly more efficient (and inexpensive) than the commercial sector.

Medicare processes millions of transactions per day between payers and providers. Some of these transactions are data, yet many are still unstructured data (content in the form of paper, fax, voice and so forth).

While much of the data flows smoothly, content tends to flow like molasses on a cold day, clogging processes and costing billions.

This is a problem tailor-made for hacking.

Want to know how? Tune in for Part 2, where I will discuss my thought experiment in hacking Medicare.

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 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.

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