Do You Know What Government’s $80 Billion Problem Is?

Today, your agency is collecting more data than ever before. For many agencies, they are not only challenged by the volume, velocity and variety of data, but also extracting meaningful insights from the information. It’s fair to say that the world has become data-driven. Government agencies are well aware: data will shape the agency of the future. For agencies, the first step towards their bright data-driven future is to start thinking differently about their data.

Agencies are realizing that in order to think differently, they must invest differently. Part of this investment requires new kinds of data infrastructure. We have seen that relational databases simply cannot provide the robust insights needed for a modern agency. A good example of this is health data. Health data is a booming industry. With challenges such as retaining patient confidentiality, complex legislation and information sharing restrictions, health data has become a vibrant participant in the big data movement.

Health practitioners are constantly challenged to effectively leverage the massive amounts of data that they collect. In such a complex environment, the world of healthcare has been riddled with waste, fraud and abuse. The FBI estimates that in FY 2012, healthcare fraud cost the US about $80 billion. This is roughly equivalent to the size of the federal government IT budget for FY 2014. Take a moment and imagine what modest improvements could do as to how agencies are combating waste, fraud and abuse.

Mike Doane, Technical Director of Federal Healthcare, MarkLogic, provided some insights of some areas where fraud occurs. Doane said, “A lot of people understand the concept of health care fraud, but don’t know what it means.” He commented that health care fraud is something that is perpetrated by many different actors. Doane also shared common areas of fraud:

  • False storefronts
  • Beneficiary shopping (compromised benes)
  • Networks of fraudsters
  • Ambulance trips – no check-in
  • Home health
  • Double-billing
  • DME proliferation
  • ID theft
  • Prescriptions (forged, resold, etc.)
  • Upcoding
  • Kickbacks

Since there are now more actors and increasing threats, Doane believes that new approaches to detect waste, fraud and abuse are needed. This means that agencies are now responsible for monitoring an entire ecosystem of care, not just their individual office or agency. The good news for agencies is that there are tools now available to support their efforts to combat waste, fraud and abuse. The bad news is that agencies need to embrace new ways of thinking, and make smart investments that will help curb fraud. I sat down to think about how agencies can begin this process. Below I have provided six essential elements to fight waste, fraud and abuse in healthcare.

  • Invest in new data management, detection and monitoring tools: tools are needed to quickly and efficiently merge data from various resources.
  • Consider enterprise wide solutions: once new tools are adopted, they cannot simply just stay with one agency or team, access needs to be provided across an entire team for collaboration.
  • Increase data collaboration: increased data collaboration will be needed across many different providers, data resources can cross state, local, and federal levels of government. This will provide a full view of an agency’s data assets.
  • Precise and real time awareness: any system should be able to spot abnormalities in near-real time, and send out alerts to appropriate individuals. This will save time for investigators, and also help reduce additional instances to quickly investigate.
  • Identity verification: when an agency aggregates data from multiple resources, they must have in place proper protocols to manage and confirm identities across systems.
  • Hire data scientists: data is powering everything we do, and government agencies need people qualified and ready to lead the charge on proper data management within their agency.

These six steps are just the beginning of your journey into leveraging your health data. And to help you get started, I have provided some additional resources. I’d recommend that you start by listening to a GovLoop and MarkLogic training webinar, in which we learned about many of the different ways to use your health data (here is the link to the archived version). Additionally, MarkLogic has many documents identifying how to best unlock insights from your health data, and the tools to help you get there. Below are a few resources that I highly recommend you view:

The tools to extract knowledge from your data do exist, and they will help you to think about your health data differently. Although challenges will always persist, there is always time and money to be saved by thinking differently about information. Today, as we create more data than ever before, it is essential that we think about data terms of the full data assets. This means organizations must link their data together and move beyond just relational databases, towards enterprise wide, cloud based and agile data infrastructures.

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For more than a decade, MarkLogic has delivered a powerful, agile and trusted Enterprise NoSQL database platform that enables organizations to turn all data into valuable and actionable information. Organizations around the world rely on MarkLogic’s enterprise-grade technology to power the new generation of information applications. MarkLogic is headquartered in Silicon Valley with offices in Washington D.C., New York, London, Frankfurt, Utrecht, and Tokyo. For more information, please visit www.marklogic.com.
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Dale M. Posthumus

Unfortunately, new tools and policies are needed now, not just for this new paradigm. The Washington Post just this past week reported on how bad is Medicare, Veteran’s benefits, Social Security, and other problems. It is not just tools, but also policies. The Post story told the example that the IRS is only interested in its own info and doesn’t bother to share valuable info with other agencies. Together, new policies and tools can help to address this problem. New attitudes are also required.

Pat Fiorenza

Thanks for sharing your thoughts, Dale. Will have to check out the Washington Post story. Completely agree that new tools and policies are needed now.