Healthsense - Carolina Compilers

A multi-modal, HIPAA compliant data analytics platform that empowers SC DHHS with the bandwidth and flexibility to efficiently serve South Carolina's Medicaid system as effectively as possible.

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Healthsense: The Healthcare of Tomorrow, Today.

Overview

HealthSense Insights is a robust, scalable analytical platform designed specifically for the SCDHHS ecosystem. Our mission is to combat the estimated $100 billion lost annually to Medicaid fraud and waste in the U.S. by providing transparent, actionable insights through advanced AI and data-analytics integration.

Platform Details

1. Proprietary non-Black-Box Algorithms

We prioritized transparency and auditability over generic black-box AI:

  • SARIMA Ensemble Modeling: Our enrollment and earnings forecasting utilizes a Seasonal Autoregressive Integrated Moving Average ensemble, achieving a 94.7% model confidence.
  • Explainable Risk Scoring: Every potential anomaly is processed through a risk scoring system where specific behavioral rules contribute to a cumulative score. This allows auditors to see the exact logic behind every flag.
  • Scenario-Based Forecasting: Supports real-time updates for multiple economic scenarios, including a Baseline, Medicaid Expansion, Economic Downturn, and High Unemployment.

2. Full Compliance & Security

Built from the ground up with the SCDHHS workflow and legal requirements in mind:

  • HIPAA & Audit Readiness: Designed for HIPAA compliance with continuous data-analytic log creation.
  • Banned List Integration: Automatically flags similar profiles against the LEIE (List of Excluded Individuals) for SC Medicaid.
  • Workspace Isolation: Features separate workspaces for different users and organizations to maintain strict data privacy.

3. Advanced Multi-modal Architecture

  • Cloud Backend: Utilizes AWS S3 for raw data storage and Supabase for secure user authentication and credential validation.
  • Automated Data Pipeline: Handles mixed data formats (CSV/ZIP/YAML, etc.), performing automated unzipping, deduplication, and normalization to ensure data is "analysis-ready".
  • Flexible Access: Includes a professional customizable Dashboard for executives and a CLI Tool for developers.

Carolina Compilers

HealthSense is the result of our desire to truly improve the lives of everyone in South Carolina suffering from a lack of access to Medicaid resources - especially because of maliciously false claims. This project was born from a shared motivation to solve this massive real-world problem - to protect the integrity of public healthcare resources.

Throughout this process, we:

  • Mastered New Frameworks: We pushed beyond our comfort zones to implement advanced SARIMA ensemble modeling, multi-modal cloud integration, and secure HIPAA-aligned architectures.
  • Forged a Team: Working together for the first time, we evolved into a cohesive unit capable of building a complex, full-stack MVP from scratch using actual SC Medicaid data.
  • Commitment to DHHS: We have built a functional foundation that we are eager to take forward and refine in collaboration with the SCDHHS.

Why HealthSense?

HealthSense offers the premier solution for South Carolina DHHS:

  1. Best-in-Class Workflow Integration: Built specifically for the SCDHHS environment, matching the department's compliance and workflow needs.
  2. Unmatched Scalability: Our architecture supports month-by-month projections up to 10 years, ensuring the platform grows alongside real-time changes. Our data lifecycles also ensure minimum latency and allow for scaling.
  3. Maximum Functionality: From real-time chatbot assistance to deep-dive billing pattern analysis, HealthSense is the most complete Medicaid intelligence tool - available now.

Quick Start (CLI)

# Install dependencies
npm install

# Build and link the CLI
npm run build:cli
npm link

# Run a 6-month enrollment forecast
healthsense forecast --months 6 --scenario baseline

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