Spending in the healthcare industry continues to grow, reaching $2.8 trillion spent annually. However, excess costs from inefficient services and administrative waste prevent the industry from actually delivering the greatest health value for the investments citizens make. John Supra, Deputy Director for Operations and Information Management and CIO at South Carolina’s Department of Health and Human Services (SCDHHS) is tackling this challenge head on.
In his WSO2Con 2014 keynote, Supra discussed the efforts to modernize state Medicaid systems to reduce the per-capita cost of healthcare in South Carolina’s Medicaid program while improving the patient experience. He also discussed the critical role that open technologies and platforms play in driving innovation within the healthcare industry.
Vision: Automate the Basics to Increase Services
Through October 2013, SCDHHS’ Medicaid program relied 100% on paper-based applications. For state employees handling eligibility and enrollment, the work involved moving paper from one place to another, leaving no time to deliver value-added services that would improve the customer’s experience.
Supra recalled that he and his team saw an opportunity to transform the process of connecting and sharing information and bring in new possibilities, such as services to support healthy living and improved scheduling experiences through software applications.
Supra explained, “Shouldn't the experience be like, ‘Give me the data, allow me to check the data electronically, choose a plan because Medicaid has different plans, figure out who the providers are in your area because we know where you live, maybe schedule an initial appointment because we know that primary care matters for healthy outcomes. Then we connect to healthy living. This is why thinking from a platform perspective is so critical to our state's Medicaid program and actually drives different behaviors in Medicaid and the government.”
Ending the Monolithic Era
A key aspect of realizing the SCDHHS vision for improved services is re-architecting the state’s Medicaid Management Information System (MMIS), Supra observed. The current system is a single, monolithic system with limited APIs and interfaces, closed systems, and flat file data exchanges, he explains. The system is also expensive to maintain, making it difficult to innovate.
Significantly, Supra noted, basic enterprise services, such as collaboration, communication, and shared document imaging systems don’t exist since the system operates from the perspective that everything is a silo. Additionally, the data the team has to run its programs typically comes back a month later, meaning the system can’t be adjusted dynamically.
“We need to destroy it and think about a modular MMIS,” Supra stated. “Breaking this up into components that are based on enterprise services and open source platforms will allow us to think about reporting analytics separately in nearly real time.”
Bringing Greater Transparency to Healthcare
Although the vision is to transform the platform, like many private enterprises SCDHHS has started with a focused project that offers clear benefits. The project, Supra explained, is the New South Carolina Health Data Transparency Site. Through the site, the team is working to provide hospital, nursing home and procedure data, as well as data about their federally qualified health centers (FQHC). Most of the data can be downloaded for personal use, and a user can view and sort within the application.
Unlike other projects where it may take months to make a minor change, Supra and his team developed the website in a matter of months using open source technologies, taking publicly available data and existing data in the department’s network to build a system with a strong user experience.
The website has started the conversation of transforming healthcare and health delivery policy, Supra observes. “We’ve provided data that starts to ask ‘Why is the system like that? How does it relate to policy-making? How does it relate to decision making?” he explained. “It also takes a burden off our staff who used to chase this data around when people asked. We tell them it's available on the site, and we support them by saying ‘click here.’ It's an important start because often people are making policy decisions without good data.”
Supra noted that his team now aims to take some of the work going on in the private sector and employer-sponsored insurance, to drive information to consumers and help them understand the choices they make.
Open Source Spurs Innovation
As Supra and his team continue to drive innovation, he views open source as playing a central role.
“Like our health transparency site, open source gives myself as a CIO the opportunity to bring things into our environment, to test them, to set up an API, to show that value without some of the procurement challenges,” Supra explained. Open source also allows innovative companies to participate without having to navigate all the contractual language involved in government procurement, he added.
Among the open source technologies Supra and his team have been evaluating are WSO2 Application Server and WSO2 Enterprise Service Bus. Additionally, Supra noted that, as SCDHHS moves into a more DevOps-centric approach, the department is looking at WSO2 App Factory and WSO2 API Manager and how they can help to make the environment more interoperable and accessible.
“As open source tech on government procurement, it makes it easy for us to bring in the technology, to really experiment with it, and we've been working with the WSO2 team for eight to nine months on that experimentation.”
For more information about how to drive innovation within the healthcare services industry, see Supra’s WSO2Con US 2014 full presentation.