Open Innovation’s Newest Challenge: Improving Medicaid

“The Centers for Medicare & Medicaid Services (CMS) is committed to fighting Medicaid fraud, which diverts funds from needed medical care for the most vulnerable Americans.  That’s why we’re announcing a challenge – the Provider Screening Innovator Challenge – to develop software tools that will help stop fraudsters from entering the Medicaid program under the pretense of serving patients.”

The above passage was written by Julie Boughn on the CMS Blog - The official blog for the Centers for Medicare & Medicaid Services (CMS) responsible for Medicare, Medicaid and CHIP. This initiative, the CMS Provider Screening Innovator Challenge, will take place as a series of Open Innovation contests over the next 8 to 9 months in a partnership between the National Aeronautics and Space Administration (NASA), Harvard Business School, the State of Minnesota, and TopCoder. With over $500,000 available for prizes, this series of contests will showcase how the TopCoder community can tackle rather complex software builds via process-driven, atomized Open Innovation competitions.

For the official press release – click here

If you are researching the Gov2.0 arena or are just a supporter of the greater Open Innovation space, there are at least 4 complexities & nuances worth discussing further as it pertains to the CMS Provider Screening Innovator Challenge. They are:

• This effort is taking place without the need for traditional government vendor contracts. This alone is a shift worthy of praise, one that allows an entity such as TopCoder to bring our community to these challenges and structure scores of smaller, atomized contests that will innately draw out hyperspecialists to the work at hand. It fosters incredible flexibility & scale and helps ensure no single-point of failure will derail the overall effort. This is a big step forward.
• The entire project, all aspects will be open source. The ability for States to download the outputs and create State-specific applications on top of the open source solutions will provide another layer of value and help to greatly streamline costs.
• These outputs will all be built to the new standards set forth under the Medicaid Information Technology Architecture (MITA) 3.0 framework focusing on factors of interoperability, common standardization and adaptability of the technologies comprising the outputs. For an overview of MITA 3.0 and to better understand the importance of building to these specifications, we recommend this article that provides a comprehensive look into the updated architecture.
• The entire project is taking place on the Center of Excellence for Collaborative Innovation platform powered by TopCoder. Led by NASA, the CoECI was launched to enable acceleration of US Government implementation of new models of problem solving using collaborative innovation methodologies, such as crowd sourcing and open innovation, to meet agency requirements.

On the TopCoder Blog we routinely discuss that Open Innovation practices can deliver the complex and “never been done” and the CMS Provider Screening Innovator Challenge is certainly both. The first of many competitions comprising this entire effort has already kicked-off and if you are thinking about competing or just want more information on these contests, please visit this Center of Excellence page. Look for the short May 30th post entitled “And We’re Off!” on that page which includes links to the 2 kick-off contests.

Can this challenge help improve Medicaid fraud detection? We believe the answer is yes. We believe the solutions lie in Open Innovation and we encourage you to share this remarkable story and follow along as the details unfold before us.