On Designing of a Low Leakage Patient-Centric Provider Network

When a patient in a provider network seeks services outside of their community, the community experiences a leakage. Leakage is undesirable as it typically leads to higher out-of-network cost for patient and increases barrier for care coordination, which is particularly problematic for Accountable Care Organization (ACO) as the in-network providers are financially responsible for patient quality and outcome. We aim to design a data-driven method to identify naturally occurring provider networks driven by diabetic patient choices, and understand the relationship among provider composition, patient composition, and service leakage pattern. We construct a healthcare provider network based on patients' historical medical insurance claims. A community detection algorithm is used to identify naturally occurring communities of collaborating providers. Finally, import-export analysis is conducted to benchmark their leakage pattern and identify further leakage reduction opportunity. The design yields six major provider communities with diverse profiles. Some communities are geographically concentrated, while others tend to draw patients with certain diabetic co-morbidities. Providers from the same healthcare institution are likely to be assigned to the same community. While most communities have high within-community utilization and spending, at 85% and 86% respectively, leakage still persists. Hence, we utilize a metric from import-export analysis to detect leakage, gaining insight on how to minimizing leakage. In conclusion, we identify patient-driven provider organization by surfacing providers who share a large number of patients. By analyzing the import-export behavior of each identified community using a novel approach and profiling community patient and provider composition we understand the key features of having a balanced number of PCP and specialists and provider heterogeneity

Semi-Annual Report to Congress for the Period of April 1, 2006 to September 30, 2006

[Excerpt] I am pleased to submit this Semiannual Report to the Congress, which highlights the significant activities and accomplishments of the Office of Inspector General (OIG) for the six-month period ending September 30, 2006. During this reporting period, our investigative work led to 295 indictments, 260 convictions, and over $76 million in monetary accomplishments. In addition, we issued 66 audit reports and questioned$90.2 million in costs. During this reporting period, the OIG continued to provide audit and investigative oversight of the Department of Labor’s (DOL’s) response to Hurricanes Katrina and Rita. We issued six management letters related to this effort. One of the letters identified individuals who had received disaster unemployment assistance (DUA) from one state, while also receiving DUA or state unemployment compensation from another state. In addition, an OIG investigation led to the indictment of a disaster-reconstruction company owner who had allegedly neglected to pay approximately $1.4 million in employee taxes owed to the Federal and state governments. OIG audits included significant recommendations to address vulnerabilities identified in DOL programs and operations. For example, we issued a performance audit that determined that DOL’s coal mine hazardous condition complaint process needed improvement. We also conducted several audits assessing the adequacy of the Department’s information security program and identified challenges in the areas of access controls and protection over personally identifiable information. Our investigations continue to combat labor racketeering in the workplace and fraud involving DOL programs. One particular investigation resulted in several former high-ranking officials of Laborers’ International Union of North America Local 91 in the State of New York either pleading guilty or being sentenced for conspiring to commit violations of the Hobbs Act. Another significant case involved Ralphs Grocery Company. Ralphs pled guilty to several felony counts related to charges that it illegally rehired locked-out workers during the supermarket labor dispute in Southern California more than two years ago. In June 2006, the company agreed to pay$70 million in fines and restitution. Finally, recognizing the need to collaboratively combat document and benefit fraud, the OIG joined with the Departments of Homeland Security, Justice, State, and other agencies to form task forces in 10 major cities. Led by the U.S. Immigration and Customs Enforcement, the task forces have been highly effective in targeting criminal organizations and ineligible beneficiaries engaged in this type of fraud. In one case, an investigation found that the owner of a labor leasing company used counterfeit labor certification forms to apply for at least 250 green cards. The owner of the company pled guilty to charges and faces 37 to 46 months’ incarceration. The OIG remains committed to promoting the economy, integrity, effectiveness, and efficiency of DOL programs and detecting waste, fraud, and abuse against those programs. I would like to express my sincere appreciation to a professional and dedicated OIG staff for their significant achievements during this reporting period

End-to-End Privacy for Open Big Data Markets

The idea of an open data market envisions the creation of a data trading model to facilitate exchange of data between different parties in the Internet of Things (IoT) domain. The data collected by IoT products and solutions are expected to be traded in these markets. Data owners will collect data using IoT products and solutions. Data consumers who are interested will negotiate with the data owners to get access to such data. Data captured by IoT products will allow data consumers to further understand the preferences and behaviours of data owners and to generate additional business value using different techniques ranging from waste reduction to personalized service offerings. In open data markets, data consumers will be able to give back part of the additional value generated to the data owners. However, privacy becomes a significant issue when data that can be used to derive extremely personal information is being traded. This paper discusses why privacy matters in the IoT domain in general and especially in open data markets and surveys existing privacy-preserving strategies and design techniques that can be used to facilitate end to end privacy for open data markets. We also highlight some of the major research challenges that need to be address in order to make the vision of open data markets a reality through ensuring the privacy of stakeholders.Comment: Accepted to be published in IEEE Cloud Computing Magazine: Special Issue Cloud Computing and the La

ECG Signal Reconstruction on the IoT-Gateway and Efficacy of Compressive Sensing Under Real-time Constraints

Remote health monitoring is becoming indispensable, though, Internet of Things (IoTs)-based solutions have many implementation challenges, including energy consumption at the sensing node, and delay and instability due to cloud computing. Compressive sensing (CS) has been explored as a method to extend the battery lifetime of medical wearable devices. However, it is usually associated with computational complexity at the decoding end, increasing the latency of the system. Meanwhile, mobile processors are becoming computationally stronger and more efficient. Heterogeneous multicore platforms (HMPs) offer a local processing solution that can alleviate the limitations of remote signal processing. This paper demonstrates the real-time performance of compressed ECG reconstruction on ARM's big.LITTLE HMP and the advantages they provide as the primary processing unit of the IoT architecture. It also investigates the efficacy of CS in minimizing power consumption of a wearable device under real-time and hardware constraints. Results show that both the orthogonal matching pursuit and subspace pursuit reconstruction algorithms can be executed on the platform in real time and yield optimum performance on a single A15 core at minimum frequency. The CS extends the battery life of wearable medical devices up to 15.4% considering ECGs suitable for wellness applications and up to 6.6% for clinical grade ECGs. Energy consumption at the gateway is largely due to an active internet connection; hence, processing the signals locally both mitigates system's latency and improves gateway's battery life. Many remote health solutions can benefit from an architecture centered around the use of HMPs, a step toward better remote health monitoring systems.Peer reviewedFinal Published versio

Sentara Healthcare: A Case Study Series on Disruptive Innovation Within Integrated Health Systems

Examines how integration and ties with health plans, physicians, and hospitals helped protect against revenue volatility and enabled experimentation; factors that facilitate integration; innovative practices; lessons learned; and policy implications

Life Sciences Innovation as a Catalyst for Economic Development: The Role of the Massachusetts Life Sciences Center

This report provides an up-to-date, independent evaluation of the $1 billion, 10-year Massachusetts Life Sciences Initiative and the Massachusetts Life Sciences Center (MLSC) charged with the responsibility of carrying out its mission. The initiative was established in July 2008 by Governor Deval Patrick's Administration and the Legislature to encourage the growth of discovery and production in the life sciences, including biotechnology, pharmaceuticals, medical diagnostics, medical devices and bioinformatics in the Commonwealth. Based on the region's existing comparative advantage in life sciences research and development (R&D) emanating from the laboratories of its leading universities and medical institutions, this substantial infusion of public funds was undertaken with the ambitious goal of making this cluster of industry sectors the most successful in the world. This evaluation comes at a propitious time, given the state of fiscal affairs in the Commonwealth and the nation. Virtually every unit of government is scrutinizing the use of each tax dollar to ensure that public revenue is being spent effectively and efficiently. Put simply, our goal in this evaluation was to gather as much data as possible to assess whether the Commonwealth's sizeable commitment of public resources is paying off in the form of a life sciences "super cluster" capable of attracting massive amounts of investment dollars, generating well-paying jobs for Massachusetts residents and yielding additional tax revenue for the Commonwealth