Current Work / Solutions | Explore Digits

Current Work and Solutions

We care deeply about what we do and ensure we have the resources to meet and exceed the expectations of our customers. We view our projects as a partnership between us and our customers; their mission is our mission. We focus on certain areas to stand out and guarantee we always deliver

Program Integrity

Explore Digits supports Center for Medicare and Medicaid (CMS) and other partners in program integrity (PI) by leveraging our experience with cutting-edge technology, advanced data analytics and statistics, cloud migrations, and DevSecOps. Explore Digits supports CMS' vision of a well-functioning healthcare system that ensures program integrity and combats fraud, waste, and abuse across CMS programs. Examples of our PI work include:

Comparative Billing Report and Program for Evaluating Payment Patterns Electronic Report Data Analysis (CBR/PEPPER DA)

Working with the CPI Provider Compliance Group (PCG) to evaluate the effectiveness of the CBR and PEPPER Programs – two non-punitive programs aimed at reducing improper payments. The team developed and implemented a sophisticated evaluation framework to assess the impact of these programs on changing provider billing behavior, while also estimating impacts on utilization and health equity.

Comprehensive Error Rate Testing (CERT)

Explore Digits, as a subcontractor, provides statistical support in developing the statistical design and estimation methodology for the Medicare Fee-for-Service improper payment measurement program, CERT. Additionally, Explore Digits supports the development of the annual CERT reports and provides support analyzing ad-hoc requests regarding the CERT program data and results.

Exchange Improper Payment Measurement Statistical Contractor (EIPM)

Explore Digits, as a subcontractor, provides statistical support in developing the statistical design and estimation methodology for the Healthcare Exchanges improper payment measurement program, EIPM. Explore Digits leverages application-level data from the Federally Facilitated Exchange to sample applications for review. Additionally, Explore Digits supports the development of the annual EIPM reports and provides support ad-hoc analytic requests.

Payment Error Rate Measurement

Explore Digits, as a subcontractor, provides analytical support to the statistical contractor. The team supports analysis and sampling of state Medicaid data to ensure statistical validity in assessing the payment error rate for state Medicaid and CHIP. ED leverages knowledge of Medicaid programs and data systems to assess the completeness of the state's Medicaid and CHIP universes. The PERM team ingests every state Medicaid and CHIP claims universe and reconciles against official expenditure reporting documents. The team also leverages T-MSIS to perform universe creation, sample creation, and the abstractions of key elements required to perform medical and eligibility reviews.

Prime Contracts

We provide technical solutions with a heart, which means we are adept using advanced technologies and solutions, but we prioritize understanding the customer, their workflows, and their mission. Our company was created to help the government and private sector clients solve long-standing challenges.

Legacy System Information Technology Maintenance and Modernization (LSITMM)

Explore Digits is a prime contractor on the Legacy System Information Technology Maintenance and Modernization (LSITMM) contract with CMS. We are working with CMS to operate and maintain existing Medicare legacy systems while we modernize, operate, and maintain new Medicare systems while meeting current and new stakeholder needs.

Comparative Billing Report and Program for Evaluating Payment Patterns Electronic Report Data Analysis (CBR/PEPPER DA)

Explore Digits is the prime contract on the Comparative Billing Report and Program for Evaluating Payment Patterns Electronic Report Data Analysis (CBR/PEPPER DA) contract. The team is evaluating two programs of CMS' Center for Program Integrity (CPI) - the CBR and PEPPER programs - to determine how provider billing behavior changes in response to these programs.

Feedback Analysis System (FAS)

Explore Digits is the sole contractor on the Feedback Analysis System (FAS) contract with CMS' Clinical Standards and Quality Group, Information Systems Group. Explore Digits created the artificial intelligence (AI) and machine learning (ML) platform to assist CMS in gaining insights from unstructured text data to support numerous use cases. The first use case is an instance of SPA and supports CMS policy makers in the regulatory process by analyzing public comments CMS receives in response to rule making. The second use case is an instance of Smart Survey Advisor and supports CMS in analyzing unstructured text data that is generated as part of the nursing home survey (inspection) process for the 15,000+ nursing homes that CMS has responsibility for certifying and continuing to ensure compliance with CMS' conditions of participation.

USAID CDM-XDR SentinelOne

Explore Digits is at the forefront of enhancing cybersecurity for the United States Agency for International Development (USAID) through the Continuous Diagnostics and Mitigation (CDM) initiative. Our team is pivotal in deploying the SentinelOne XDR tool across USAID’s network, which spans 18,000 devices including servers and workstations.
Our responsibilities encompass the full integration of the SentinelOne system and providing ongoing operational service support. This includes near real-time monitoring, detection, and proactive isolation of security and privacy incidents, ensuring robust protection and resilience against cyber threats.

Department of Education PEPS and eApp Systems

Explore Digits has played a crucial role in the operations and maintenance of the Department of Education's Post-Secondary Education Participants System (PEPS) and the Application for Approval to Participate in the Federal Student Aid Programs (eApp). Our team has ensured the robust management and seamless integration of these systems, supporting approximately 6,000 educational institutions in maintaining compliance with Federal Student Aid requirements.
Our engagement has encompassed comprehensive system enhancements, security management, disaster recovery, and program management. Explore Digits has been integral in enabling accurate and timely administration of financial aid through sophisticated data interfaces and continuous system improvements, thereby directly supporting the Department’s mission in overseeing nationwide educational programs.

Solutions

Explore Digits is committed to improving the US healthcare system, and thereby the health, safety, and quality of life of all those it serves. We are also committed to improving the lives of older adults, through technology, analytics, and empathy-driven solutions.

Smart Policy Assist (SPA)

Smart Policy Assist (SPA) is a cloud-based application that leverages natural language processing so policy makers can more easily and effectively manage the rule-making process. SPA provides insights to policy makers by analyzing public comment and providing machine learning insights into sentiment, themes, and stakeholders. Policy makers have found that SPA is effective and can save upwards of 99% of analyst time compared to traditional manual methods of the rule-making process.

Our team has integrated advancements in Large Language Models (LLM's) to provide users of SPA with a streamlined approach to receive insights from policies and public comment.

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Smart Survey Advisor

Smart Survey Advisor was developed to help federal regulators of healthcare facilities analyze the unstructured text data resulting from facility surveys (inspections). This tool leverages data science, AI, and NLP practices to provide users with the ability to analyze and gain actionable insights from large quantities of unstructured data that was previously inaccessible. The application is designed with end users in mind to enhance the workflow of the inspection process, and can be used for quality assurance, training, or identifying policy and guidance enhancements.

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Smart Research Advisor

Smart Research Advisor is a cloud-based application to support researchers to manage the workflow of human subjects research, including recruitment through data analysis and publication. Our integrated data collection platform simplifies survey and other data collection, as well as research participant tracking and communication. Our embedded analytic tools removes the need for researchers to procure expensive statistical software.

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We care deeply about what we do and ensure we have the resources to meet and exceed the expectations of our customers. We view our projects as a partnership between us and our customers; their mission is our mission. We focus on certain areas to stand out and guarantee we always deliver

Program Integrity

Comparative Billing Report and Program for Evaluating Payment Patterns Electronic Report Data Analysis (CBR/PEPPER DA)

One Program Integrity (OnePI)

Comprehensive Error Rate Testing (CERT)

Exchange Improper Payment Measurement Statistical Contractor (EIPM)

Payment Error Rate Measurement

Prime Contracts

Legacy System Information Technology Maintenance and Modernization (LSITMM)

Comparative Billing Report and Program for Evaluating Payment Patterns Electronic Report Data Analysis (CBR/PEPPER DA)

Feedback Analysis System (FAS)

USAID CDM-XDR SentinelOne

Department of Education PEPS and eApp Systems

Solutions

Smart Policy Assist (SPA)

Smart Survey Advisor

SAS Migration to Python, Pyspark

Smart Research Advisor

Explore Digits