Hacking Medicare: Why we should use hacking as a method to solve some of our healthcare problems – Part 2


I am a bit embarrassed to share this simple hack. It feels a little old-school, because workflow software has been around for almost 40 years now. Perhaps longer.

In fact, many payers and providers already use workflow software to share data and documents within their organizations. My simple hack is to set those workflows free, extending them beyond the confines of your organization’s walls.

Let’s see how this hack works.

A simple example to illustrate the efficiencies of workflow
When contacted by a provider or a Medicare Administrative Contractor (MAC), the Centers for Medicare & Medicaid Services (CMS), need medical documentation. So Medical Review personnel at the MAC simply call up an electronic form, select the provider from a drop-down list and choose the patient via their Medicare Number and date of birth.

Finally, they select the date(s) of service and check off the documentation they need from the provider on the eform. Then they hit send. It’s that easy. But wait, there’s more.

That’s when the magic takes over:

  • Workflow software encrypts and transports the request to a secure content hub, which authenticates both the sender and transaction, and then forwards the information to the Provider.
  • The Provider receives the request and it is launched directly into their workflow system to verify the member/patient and collect the requested information.
  • When complete, the workflow encrypts the documentation, attaches it to the eform and sends it back to the secure content hub.
  • The workflow software notifies the MAC that the documentation has arrived and delivers it right to the individual who requested the information.

Show me the money
Why should we employ this hack? In addition to increased speed and accuracy, big savings, that’s why.

Here are six more reasons:

  1. It’s simple. All the technology needed already exists – no new miracle technologies required. In fact, the model has already been successfully tested with phase one of the Electronic Submission of Medical Documentation (ESMD).
  2. It’s inexpensive. Actually, it is in place today and you can fund it via a Software as a Service (SaaS), pay-as-you go model.
  3. It’s cost-effective. CMS (and Providers) would save millions per month on reduced snail-mail costs alone. Once you factor in labor savings and increased effectiveness, the numbers are ginormous.
  4. It’s secure. The security model is already in place for Medicare. No new technologies, no new vulnerabilities.
  5. It’s fast. This could be in production in weeks, as no development is required.
  6. It’s self-funding. No new funding is required. Private contractors and software companies can provide the services on a SaaS model to fund the endeavor.

There you go. We can hack our way to better healthcare! We can hack our way to a better, stronger and more efficient Medicare program!

The question is, can we get out of our own way long enough to think differently about some of these problems? That actually may be the ultimate hack.

But enough about me, what’s your Medicare hack? If you don’t have one yet, don’t worry. After Part 3 and Part 4, I’m sure you’ll come up with one.

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