Project Assignment
Project Title- College of Public Health - Medicaid Project
Short Description -
DR Martin and DR Halpern (both faculty members in Health Services Administration and Policy) as part of a proposed research project would like to create a proof of concept web-based service for Medicaid patients to more accurately find providers accepting their coverage in the Philadelphia area.
Medicaid patients often have difficulty-finding physicians who accept their insurance, and current state-curated Medicaid lists are often out of date. The goal of this project would be to create a mobile optimized website or app listing Philadelphia physicians who accept Medicaid (searchable by physician specialty) and allow users to identify nearby physicians or those easily accessible by public transportation using GPS features. We plan to use this proof of concept solution as part of a grant submission to secure funding for further development and evaluation.
Current system
What are you doing now? What parts are done manually? What parts are automated? How are the automated? What current websites are related to this project?
This is a proof of concept system so there is no existing system to replace. The business process exists for anyone who wants to find a physician who will accept his or her insurance.
Who would use the system?
The clients would administer the system and anyone who had internet access could use the system to locate a physician.
Project Outline
Please describe what you would like the new system to do. What are the required features that you want? What is the problem or critical issue the project would solve? Include any relevant artifacts (documents used as part of this process). Are there any risks or areas to be aware of or concerned?
? The system would need to be able to load a list of Medicaid providers from an Excel spreadsheet.
? The users would be able to input parameters to narrow the search results
? It must be GPS enabled so the system "knows" the location of the person requesting the query.
? The administrators would need to be able to add, change or delete (inactivate) an existing Medicaid provider.
? The system would have a link to Google maps so the person could find out where and how to get to the provider
? Data about the provider would need to be maintained such as specialization - location - etc.
? The users would need to be able to download information
? Must work on mobile devises - responsive design.
Optional Features: TBD
Other items for the team to know -
The following API will allow for automating searches. They do pull NPI numbers and there are basic free searches that can be conducted. This API would help us automate the search commands a bit more.
There seems to be some other APIs which will pull Medicaid NPIs as well.
Mike is not available on 9/6 at 9:00am - he could meet at 10:30 or between 2 to 5:30 on 9/6. Thomas is away on 9/7 & 9/8.
Expected Results of the Project - Individuals who are looking for a physician who accepts their insurance would be able to enter parameters and get back a list with information about the provider.
Summary
Today there are many families in Philadelphia that rely on Medicaid for health insurance. However, these Medicaid recipients are having a tough time finding physicians who accept their insurance, and still rely on visiting Federally Qualified Health Centers (FQHC) for help finding physicians. This system will be an accurately maintained, online Medicaid physician directory with features to help recipients find local physicians. Members of the College of Public Health will test a group of users with this system against a control group to measure the efficacy of online physician search options for Medicaid recipients.
Current system
Currently there are no websites specifically for Medicaid accepting physicians. There are Federally Qualified Health Centers that have paper lists of all providers that have been approved to accept Medicaid patients. Providers are listed after applying to, then being accepted by the Pennsylvania Medicaid program. However, providers don't need to tell the state if they stop accepting Medicaid. Since the lists at the FQHC are only printed a few times a year they'll list many physicians but only very few accept Medicaid.
System Goals
The main goal of the new system is to decrease the effort involved in finding a nearby doctor who accept Medicaid. The system will pull lists of Medicaid providers from multiple sources to validate if the doctor is accepting Medicaid at the time of the search. This will provide more accurate search results for Medicaid patients seeking a physician, and improve the ease of access as the web site will be accessible to anyone.
System Users
• Administrator
o Ability to add, update, remove Medicaid providers to the system
• Medicaid Recipients
o Ability to search for Medicaid providers and select parameters for their search including location and doctor specialties.
Scope of Work
This document identifies high level system capabilities. Later documents will go more in-depth and will specify the detailed requirements. These capabilities are required:
• Manage list of physicians
o Admins will be able to add, edit or remove physician listings
o Admins will be able to automatically pull list of Medicaid accepting physicians from online sources
• Search for Medicaid accepting physicians
o Users can search for physicians by location and doctor specialties
o Use user location to display closest physicians first
• Directions to the physician's location
o Show directions to the physician after user selects a physician
o Users can select directions by transportation type, including public transportation
Possible Features
• Anonymous patient feedback forms
o Patients can flag listed providers as not accepting Medicaid.
o Patients can rate how much they like the website with a 5-star scale
Expected Benefits
The main benefit of the new system will be to increase access to Medicaid accepting physicians in Philadelphia. People seeking physicians that accept Medicaid will have a much faster time finding the care they need. Physicians that accept Medicaid will also be able to assist more patients that truly need to be seen.
• Increased awareness of Medicaid accepting physicians
• Increased accessibility to Medicaid physicians
• Increase number of patients seen by physicians accepting Medicaid
• Simplify process of finding Medicaid accepting physician
• College of Public health can measure effectiveness of online search options
Project Timeline
Analysis Phase (semester 1):
- Project Team will provide Client with various requirements gathering and analysis documents throughout the entire semester
- Client will review all documents, and answer questions in a timely basis
- Each document will further define the requirements of the system.
Design Phase (semester 1):
- Team will move from analysis to design, building screens and other user interface items
- Client will review all documents and provide feedback
Build Phase (semester 2):
- Team will work in 3 iterations, or sprints, to develop the software
- Client will review the software and be required to devote time to testing after each phase
- Teams will also test via a defined Quality Assurance and Testing Plan
Implementation Phase (semester 2):
- Team will fully document the system via a User Manual and a Support Manual
- Team will move the software from a development, to QA, to production environment
- Team will train main users
- Client will sign off.
Meeting Minutes
SUMMARY OF DEVELOPMENTS:
The objective of this meeting was to understand the business process of the Medicaid project and to gain a better understanding of the goals of the proposed proof of concept.
Specific items discussed:
? The goals of the proof of concept and the value gained by the users of the system
- Create a functional app or mobile tailored website where Medicaid patients are able to easily find physicians who accept Medicaid.
- Statistics and case study of how this system improved Medicaid patients' ability to find qualified physicians
? The proposed system's functionalities
- The user would open the application, select parameters including location (could also choose their current location), and doctor's specialties in order to find a Medicaid physician near them for their specific health need. The essential functions would include a glossary of specialties to choose from as well as a list of doctors who accept Medicaid nearest to their specified location.
- The application should show navigation through public transportation as users may not have their own means of transportation.
- Utilize multiple sources to find Medicaid physicians and validate the information. The validation phase would be to ensure the physician is currently accepting Medicaid.
- An aggregate score would be deducted from the sources, and depending on the score the physician may be added to the list of Medicaid providers.
? The current system Medicaid recipients are using to find providers
- Zocdoc is a mobile application and website for finding doctors. It includes doctor reviews, searching by insurance plan and doctor specialties, and the ability to book an appointment. Doctors are required to pay a fee to be included in their listings, so in turn it is biased against doctors who accept Medicaid.
- Medicaid patients can currently use paper directories to find doctors who accept Medicaid. These lists are usually outdated and contain doctors who no longer accept Medicaid. Patients would find a doctor in the listing and give them a call to make sure they currently accept Medicaid. There is also an online directory of doctors who accept Medicaid, however currently only physicians can access it
* Issues with paper directories or online directories of physicians accepting Medicaid:
? Department of Human Services provides a list of such physicians, but it is not available to the public
? There is a delay between a being physician recognized as a Medicaid acceptor and subsequent addition to the electronic system
? Physicians are not required to communicate to anyone that they have changed their stance on accepting Medicaid
- Federally Qualified Health Centers (FQHCs), health centers that are required to see all patients, even those without health care.
? Importance of parents of children using the new system
- It is easier for children to get access to Medicaid as many pediatricians accept Medicaid, so this should not be an issue
? Sources to find statistics about Medicaid participants
- The Kaiser Family Foundation.
Attachment:- Medicaid-CD.pdf