The document discusses the Healthcare Fraud Prevention Partnership (HFPP), which enables public and private sector health insurance entities to securely share claims data to detect and prevent healthcare fraud. The HFPP focuses on data analytics and information sharing. It built a data exchange network that defines standards for sharing claims data securely between partner organizations. This improves partners' fraud detection capabilities. The project involved defining data and network standards, and identifying roles for a Trusted Third Party to enable the system. It used an open innovation model of breaking problems into specialized contests to crowdsource solutions from a large community of contributors.

1. HealthCare Fraud Prevention Partnership
NASA Challenge
Jason Zeiler, CMS
Andy LaMora

2. 2
• To exchange facts and information between the public and
private sectors in order to detect and prevent health care
fraud
• To enable members to individually share successful anti-fraud
practices and effective methodologies and strategies for
detecting and preventing health care fraud
• To focus on information sharing in two primary areas:
1. Data analytics
2. Outreach, education and information sharing
Healthcare Fraud Prevention
Partnership (HFPP) Purpose

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Value Proposition
HFPP
Claims
Compromised
Patient Data
Fraudulent
Providers
Partner#Z
Partner #Y
Enhanced
Fraud-
Fighting
Capabilities
Partner #X

4. 4
• The primary objective of the project involved
building a data exchange network that would enable
healthcare insurance-paying entities in both the
public and private sector to safely and securely share
information for purposes of detection and
prevention of fraud, waste and abuse across
partners.
Project Overview

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• Defining a data standard for exchanging healthcare
claims data
• Defining a secure data exchange network
• Identify and defining the roles of the Trusted Third
Party (TTP)
• Providing documentation that drives adoption
• Demonstration of the system with one or more proof
of concept applications
Principle Tasks

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• Solve problems (like developing code) by using
a crowd of people: A Community
– Open Source Communities: Apache, git, etc
– Contributing Communities: wikipedia
– Competition Communities: 541(G) Prize Firms
• What motivates a crowd to work?
– “Guts, Glory, Gold”
• Contests can provide focus and spark to a
crowd
Crowdsourcing

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• Total Registrations: 1406
• Countries Represented: 52
• Total Distinct Contributors: 107
• Total Contests: 55
HFPP Community Stats

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• Projects are “atomized” to many contests
• Contests are hyper-specific
• … which lowers the need for domain experts
• … while leaving the door open to them
How does it work?

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Atomization
MORE THAN 30+
Specialized Contests that
allow for Hyper Specialization

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Atomization
Conceptualization
Specification
Wireframes
Storyboards
Architecture
Assembly
Component Dev
Bug Hunt
Bug Race
Idea Generation

11. Atomization – Why do it?
why

12. Probability
What are the Properties of the Big Contest?
•Seeking in effect: brilliant, disciplined, proficient…
 in one entity
• = Rare!
• = Hard to find
• = Hard to price
And of an Atomized Challenge?
• = Hard to repeat
• = Hard to scale
Find great ideas, from anyone
Let Designers Design
Let Builders Build
Atomizing by skill type = more contests
• and thus opportunities to win
• which increases participation
• which increases contribution
• which lowers risk
• and increases quality
• with shorter turn-around

13. Collaboration
• If you decompose from the start
• AND assume different players at each step
• You are forced to develop great info-sharing practices
• -> Toolsets are key

14. Iteration
• Lots of “shots on goal”
• Allows “early looks” and change cycles
• And with a large enough community, lots of parallel work

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Putting it together at CMS
Open and Directed
Innovation Contests
• Idea Generation
• Conceptualization
Creative Contests
• Logo
• Wireframes
• Storyboards
• Mobile Screen
Software Contests
• Software
Specification
• System Architecture
• Module Architecture
• Component Design
• Component
Development
• User Interface
Prototype
• Assembly
• Test Scenarios
• Test Suites
• Bug Hunts
• Content Creation
Credit: Chip Garner and Anne Wood, CMCS/CHIP
Execut
e
Self Correct
Forge Ahead

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• Back to CMS…
Thanks!

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• Tangible products and code that can be implemented into the
TTP system
• Many ideas and different points of view and solutions to the
issue at hand or overall reason for using a challenge
• Challenges can be an option and a good replacement to
traditional acquisition (less money, time, different
approaches, input and solutions), depending on the project
• The challenge process can also be used to give valuable input
to the traditional acquisition process by adding or filling in
gaps in information that may not have been identified initially
(helping complete the SOW and a better end result)
Challenge Benefits