From Idea to MVP: the Story of the Successful Partnership in Healthtech

This article explains how we build an MVP (minimum viable product) for our business partners, medASTUTE. It shows our creative and technical software development process, from problem statement to software design and its implementation. But for the story to be complete, we need to take a step back and start with the background information.

medASTUTE: The story of our partner

Based in the United States, medASTUTE is a specialty healthcare consulting company that helps individuals and businesses make better healthcare decisions regarding cost, quality, efficiency and compliance by utilizing data, technology and decades of industry experience.  This mission is embodied in the company’s motto: Our Experience | Your Advantage.  

Part of medASTUTE’s expertise includes partnering with organizations possessing complementary products and services to address specific and/or complex needs. One such example involved a software vendor-partner doing outreach to physician practice groups (PPGs) across the United States, encouraging them to participate in a new governmental provider reimbursement program.

What is Primary Care First?

Known as Primary Care First (or PCF), it is a voluntary, five-year alternative payment model from the Centers for Medicare and Medicaid Services (CMS). Available in 26 U.S. regions (currently), PCF is designed to reduce Medicare spending by preventing avoidable hospital admissions and improving quality and access to care. It increases patient access to advanced primary care services and physician practice groups. It utilizes an innovative payment structure (with generous financial incentives built in) to support these additional services to Medicare beneficiaries.

Primary Care First solution sales strategy

As part of its strategy, medASTUTE’s partner offered to help eligible PPGs apply to PCF and to support the ones that opt in the program (with a start date of January 1, 2022) by integrating its software platform within their day-to-day operations. 

The result?  After a few thousand outreaches, only a tiny handful signed up. Naturally, “selling” a PCF benefits practice is going to require more than just a marketing campaign.  

How do you quantify PCF’s advantages? How do you quantify ANYTHING? With data, of course! In this case, PPG data.  

Send us your data – seriously?! To figure out fares under PCF (a fee-for-value model), a PPG must understand their current situation within a fee-for-service payment arrangement. This can be accomplished by accessing the PPG’s financial data, analyzing it and then getting the revenue potential under PCF. To understand this, medASTUTE’s partner would need access to PPG’s billing system or to receive direct analyzed data from a PPG. Naturally, that is a tough sell. The PPG must run queries and share lots of their data even before they find out if they want to be a customer or not.

A novel idea

Fortunately, after some research, along with a touch of creativity, medASTUTE developed an approach to selling PCF to potential clients:  

1. Use proactive and consultative sales.    

• Use CMS data, not the PPGs.
• Instead of asking PPGs to run dozens of queries or grant access to their billing systems, query CMS directly.

2. Don’t invent (or re-invent) the wheel.

• CMS makes claims and risk-score data available if you know how to access it.
• This data is used by CMS to establish fixed reimbursement rates (i.e., capitation).
• Data from prior years are free; recent data must be purchased.

The solution is to create a rough, yet functional PCF calculator – to build a tool that is intended to help the physician groups assess the potential cost impact of participating in the Primary Care First model and, thereby, shorten the sales cycle. With this idea, medASTUTE needed just the right partner to perfect its concept. medASTUTE turned to GreenM for help.  

Why GreenM?

GreenM’s domain expertise and commitment to IT excellence, a strong work ethic, a results-oriented team culture, and, most of all, a long-standing relationship with medASTUTE built on mutual trust and reliance made us a good partner for medASTUTE. This project is one of the first solutions that MedASTUTE worked on with GreenM. It is focused on supporting health plan sales with analytics and shows a possibility of quick turnaround thanks to well-made analytical software.

Implementation: How to build an MVP

While the calculator would rely (initially) on older, publicly available CMS data, the MVP would demonstrate to the physician practices the potential upside of adopting PCF. The PPG would be, in effect, incentivized to learn more about PCF and continue the sales dialogue by understanding the revenue opportunity using more current data.

Timeline  

Implementation of the enhanced calculator was swift. Development was completed in under a month. 

Technology Stack

• Amazon CloudFront  
• Amazon API  
• Amazon S3  
• AWS Lambda  
• Python’s Flask  

How does the PCF Calculator work?

The tool calculates a PPG’s estimated annual PCF and FFS revenues based on:

• Publicly available NPI (National Provider Identifier) data (not recent but directionally accurate)  
• List of NPI numbers for clinicians at that PPG  
• Estimated number of Medicare FFS beneficiaries (can be edited by the PPG)  
• Leakage rate (can be edited by the PPG)  
• List of PCF services  
• Hard-coded rates

Taking all of this into account, the output is a dashboard page containing a variable parameters section for total number of Medicare FFS beneficiaries and leakage rate entries, as well as charts showcasing: 

• Estimated yearly revenue (comparing PCF vs. FFS)  
• Components of the PCF yearly payments  
• Average estimated per visit payments (PCF vs. FFS)  

These help hospitals see how much, if at all, the physician practice group will benefit by shifting from FFS to PCF.

Limitations

Behind the scenes, NPIs go through a validation process. If all NPIs were found in the Medicare database, then the dashboards are calculated and displayed. Potential issues may arise for two reasons:

1. Invalid NPI  
2. No Medicare patients attributed to a specific NPI  

Nevertheless, this does not negate the calculator’s purpose and effectiveness as a consultative sales tool.

Conclusion

This case perfectly illustrates how two companies – one business-oriented, the other IT-oriented – can come together to develop a scalable IT solution to a real business problem. We worked alongside medASTUTE to develop an app that optimizes a labor-intensive sales process, educates potential clients and demonstrates the beauty and power of analytics to drive business results. 

References:

https://innovation.cms.gov/innovation-models/primary-care-first-model-options 

https://innovation.cms.gov/files/x/pcf-faqs.pdf