For many healthcare patients, the era of the single family physician who treats all ails is no longer the norm. Modern healthcare often means multiple visits and several doctors. As part of the effort to improve healthcare and control costs, the Affordable Care Act requires healthcare providers to keep better track of those multiple visits and practitioners, with an eye on tracking services and costs for treating specific illnesses or injuries.
For Booz Allen’s client, the Centers for Medicare & Medicaid Services (CMS), developing the “Episode Grouper (EG)” was complex. A knee replacement, for example, counts as one episode, and services are tracked from orthopedists, hospitals, and rehabilitation facilities. But these services are reported by the healthcare provider, rather than the patient. Any EG solution would also need to omit unrelated services from those same providers.
In partnership with Brandeis University, Booz Allen started with agile and service-oriented architecture principles. For example, the team separated the rules for imputing information from the tool that interprets them. Clinical experts continually populate the “rules engine” through a simple portal. Then the EG reads those rules, interpreting them to provide the details for each episode. The team also used a cloud-based computation technology to improve performance, running a 10 percent sample in less than a day instead of two weeks.
The work, while still in development, has already met federal regulations and is enabling new insights that will improve health outcomes, from testing to surgery to rehab
