U.S. Healthcare Payment Reform 
Applying HPCC Systems to Medicare’s Bundled 
Payments Innovation Program
• 
Centers for Medicare & Medicaid Services (CMS) 
• 
Today :“Fee for Service” model 
• 
Providers don’t have incentives f...
3 
time 
Episode #2 
Episode #1 
Episode #3 
BPCI: Episode Overlap 
Episode #2 
Episode #1 
Episode #3 
time 
Episode #2 
...
4 
Hadoop & Pig 
• 
Pig: procedural and relational-centric 
• 
Cannot process data at the record level 
• 
Slow 
• 
Cannot...
5 
HPCC & ECL 
• 
ECL: non-procedural and record-centric 
• 
Record-level processing 
• 
Fast* 
• 
Inline data 
• 
Unit Te...
6 
Unit Tests 
simplified_ip_claim_layout := RECORD 
UNSIGNED INTEGER bene_id; 
UNSIGNED INTEGER claim_id; 
STRING claim_t...
7 
Beyond Processing Data 
• 
Security & User Authentication 
• 
Share “jobs” with other developers 
• 
Custom visualizati...
8 
Timeline View
9 
Problem with the (learning) curve 
• 
Not as steep as expected 
• 
Lots of great tutorials, documentation and white pap...
10 
Wish list 
• 
Less cryptic error messages 
• 
Error: System error: -1: Graph[13], if[15]: SLAVE 172.31.40.116:20100: N...
11 
Thank you! 
Questions ? Feedback ? 
•www.linkedin.com/in/lucpezet 
•mezzetin.blogspot.com
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HPCC Systems Engineering Summit Presentation - U.S. Healthcare Payment Reform: Applying HPCC Systems to Medicare’s Bundled Payments Innovation Program

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Presenters: Tony Cheng, General Manager and Luc Pezet, Information Engineer, Archway Health Advisors

Medicare’s Bundled Payments for Care Initiative (BPCI) is the largest Medicare payment innovation program. Bundled payments involve paying a “package price” for all the services required to treat an episode of care. Unlike the current “fee for service” model, providers will assume financial risk and have financial incentives to improve efficiency and patient outcomes.
Currently, more than 5,000 providers have applied to this program, representing $47 billion of Medicare spending.
Archway Health Advisors is building a platform that helps providers like hospitals and nursing homes manage their bundled payments program. Analyzing complex Medicare claims payment data is critical to understanding the risks of participating in the bundled payment program.
We are using HPCC Systems to power the data management and analytics required to successfully manage the risks and look for care improvement opportunities. We will review our HPCC Systems implementation and provide some examples of the analysis that we are providing our customers.

NOTE - the video of this presentation is the 3rd one in the embedded YouTube link.

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HPCC Systems Engineering Summit Presentation - U.S. Healthcare Payment Reform: Applying HPCC Systems to Medicare’s Bundled Payments Innovation Program

  1. 1. U.S. Healthcare Payment Reform Applying HPCC Systems to Medicare’s Bundled Payments Innovation Program
  2. 2. • Centers for Medicare & Medicaid Services (CMS) • Today :“Fee for Service” model • Providers don’t have incentives for saving money or coordinating care across providers. • Rewards quantity of services vs. quality of care • The Bundled Payments for Care Initiative (BPCI) • Payment arrangements • Based on financial and performance Bundled Payments Overview 10/3/14 3
  3. 3. 3 time Episode #2 Episode #1 Episode #3 BPCI: Episode Overlap Episode #2 Episode #1 Episode #3 time Episode #2 Episode #1 Episode #3 PROCESSING A B C
  4. 4. 4 Hadoop & Pig • Pig: procedural and relational-centric • Cannot process data at the record level • Slow • Cannot specify inline data • Cannot (unit) test within Pig
  5. 5. 5 HPCC & ECL • ECL: non-procedural and record-centric • Record-level processing • Fast* • Inline data • Unit Tests in ECL
  6. 6. 6 Unit Tests simplified_ip_claim_layout := RECORD UNSIGNED INTEGER bene_id; UNSIGNED INTEGER claim_id; STRING claim_type; STRING provider_number; INTEGER4 through_date; STRING status_code; INTEGER4 admission_date; INTEGER4 discharge_date; STRING ms_drg_code; END; // Using inline dataset simple_ip_claims := DATASET([ {1,1,'0','010001',20000201,'',20000120,20000201,'61'}, ], simplified_ip_claim_layout); ip_claims := Samples.ip_claims(simple_ip_claims); // OR passing NAMED parameters ip_claims := Samples.ip_claims2( bene_id := 1, claim_id := 1, claim_type := '00', ... ms_drg_code := '61');
  7. 7. 7 Beyond Processing Data • Security & User Authentication • Share “jobs” with other developers • Custom visualizations of results
  8. 8. 8 Timeline View
  9. 9. 9 Problem with the (learning) curve • Not as steep as expected • Lots of great tutorials, documentation and white papers online • Data distribution and SKEW(…) errors • Activity Graph is your friend
  10. 10. 10 Wish list • Less cryptic error messages • Error: System error: -1: Graph[13], if[15]: SLAVE 172.31.40.116:20100: No access to Dali - this normally means a plugin call is being called from a thorslave, (0, 0), -1, • (Unit) Testing Framework
  11. 11. 11 Thank you! Questions ? Feedback ? •www.linkedin.com/in/lucpezet •mezzetin.blogspot.com

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