An application for care gap management amongst the underserved communities

The Chicago-based client is developing a digital product for the Federally Qualified Health Centers (FQHCs), whose primary purpose is to help underserved communities. They receive funds from the US government, which allocates a specific budget to such organizations across the country.

But FQHCs don’t get the money directly from the government. Instead, the state designates insurance companies to act as intermediaries. The health organizations thus obtain their funds according to the services they provide.

An FQHC needs to meet several requirements set by the federal government and paying entities. Hence, they receive funds depending on their performance of each one of these requirements.

This process requires complicated calculations that are set up in such a way that clinics struggle to meet them and provide accurate performance measures and accountability. As a result, the numbers fall short, and the FQHC is underpaid.

Another complication is that the calculations do not consistently occur on previously scheduled dates, e.g., every six months. On the contrary, the insurance company decides when to conduct audits. Therefore, the clinic can’t make a previous estimation on how they are doing before the next audit.

In the healthcare industry, confidentiality is vital, so few subject matters experts are available. Additionally, although some physicians were willing to cooperate with the project, they were not aware of the FQHC requirements. It took the team nearly three months to study the data and develop possible solutions.

Technical Challenges

The team was asked to create a platform to help the Federally Qualified Health Centers from US to complete this process. It was a start-to-end project in which TechVariable was to design the architecture and develop the software, involving engineering, testing, and DevOps.