Abstract
When CMS mandated Medicare Advantage supplemental benefit reporting in 2024, we faced an unprecedented data challenge: consolidating 102 benefit types from more than ten disparate systems for two million members. This presentation reveals how prompt engineering and AI-assisted development accelerated our solution delivery.
Our approach leveraged prompt engineering across the entire development lifecycle. We used large language models (LLMs) to rapidly prototype ETL logic for complex healthcare data transformations, generate SQL for dimensional modeling of our health event data mart, and create comprehensive test scenarios that covered edge cases in benefit utilization patterns. Carefully crafted prompts helped us navigate HIPAA compliance requirements, translating regulatory language into technical specifications and generating audit logging frameworks.
The AWS-based solution (EC2, Lambda, S3, RDS) achieved 100% on-time federal reporting while establishing our organization as a compliance leader. More significantly, our prompt engineering strategy reduced development time by 40%, allowing focus on strategic challenges such as converting compliance data into member communication triggers for unused benefits and building reusable components for future regulatory initiatives.
Key lessons include designing prompts that balance healthcare domain specificity with technical precision, iterating on AI-generated code to meet strict security standards, and using LLMs to bridge communication gaps between clinical, technical, and business stakeholders. We transformed a federal mandate into a single source of truth that eliminated redundant processing and enabled data-driven benefit decisions.
Attendees will learn practical prompt engineering techniques for regulated industries, strategies for AI-assisted architecture in complex integrations, and methods to accelerate compliance-driven solution delivery.
Transcript
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Hey guys.
Thanks for joining me.
This is ULA and I have around two decades of IT experience and most
of my experience is providing healthcare solutions in cloud and ai.
Today I would like to talk about a solution we recently implemented for a
federal or CMS mandate where we support.
More than 2 million Medicare member, and this mandate is about how do
we ensure our Medicare members utilize their supplemental benefits?
They are entitled, and even though they have enrolled and entitled,
but most of them, they don't proactively leverage or utilize them.
The goal of this federal mandate was to.
Ensure organizations or Medicare organizations reach proactively these
members asking them to understand what they are entitled for, what are
pending supplemental benefits they can utilize, and what is the duration?
So this is a mandate which was supposed to be implemented in 2024 December.
So let's deep dive into it.
So this initiative represents a pioneering case study in leveraging AI within the
healthcare compliance setting, a new benchmark for efficiency and accuracy.
Its successful implementation is POed to deliver transformative
impact, reshaping industry standards and ensuring equitable benefit
distributions for millions of members.
So the challenge we had is the unprecedented data demands in 2024,
as this was mandated, where our organization is supposed to understand
more than a hundred supplemental benefits we support today, but currently.
More than 10 different vendors, source systems are providing the
services to the organizations.
So how do we ensure that we gather all the information, we filter through
the different benefits as these are complex benefits to understand
they have their own structures.
So the challenge is the data.
How do we play around with the data?
Understand different structures for these 200 plus.
2 million plus members.
So this is the highlight of like in this project, what we have faced,
where we had around 102 supplemental benefit, different benefits.
Each has a distinct demand and istic categorized and standardized, and
there are 10 different source systems.
Integration of these systems and understanding each system to see what
benefit they provide, how they are different from other source systems,
maybe overlap between different systems.
So that's another challenge we had.
And we had two, two plus million members were supported using
the Medicare organizations.
Who are involved in medical as well as PDP or pharmacy benefits.
So how the AI prompt help to solve our project.
So our strategic eruption of prompt engineering and AI assisted
development revolutionized the entire development life cycle, enabling.
Unprecedented acceleration in solution delivery while rigorously upholding
compliance and ensuring absolute accuracy across all the operations.
Accelerated prototyping where harnessing large language models, we
swiftly prototyped complex ll logic.
Significantly compressing development, timely timelines and enabling
rapid adoption to evolve healthcare data transformations optimized.
SQL generations AI driven SQL Generation streamlined the dimensional
modeling of our health event Data mart, ensuring superior performance,
robust scalability, and imp impeccable data integrity for critical
analytics enhanced test scenarios.
Leverage AI leveraging AI v meticulously crafted comprehensive test cases,
covering integrated edge cases in benefit utilization patterns to guarantee
unpowered solution reliability and unwavering laboratory compliance.
How the prompt engineering helped in being in HIPAA compliant,
unlocking unparalleled security and regulatory, our prompt engineering.
Expertise was pivotal navigating the landscape of HIPAA compliance
through meticulously crafted prompts.
We translated dense federal guidelines into a CRI crystal clear,
actionable technical specifications.
This accelerated the dynamic generation of robust audit logging frameworks and
ENT data governance protocols, ensuring steadfast utterance to federal security
standards from concept to deployment.
This AI powered method methodology not only guaranteed unwavering
patient data protection, but also significantly enhanced operations
agility and drastically mitigated.
Compliance risks solidify our, solidifying our commitment to secure
responsible AI innovation in healthcare.
So this is a high level like technical architecture or basically
the background on, apart from the ai, what AWS services we use.
We used EC2 instances and Lambda.
These are serverless and scalable computing resources to efficiently
process vast data sets, ensuring rapid data transformation and seamless
integration for complex works.
We leveraged s St S3 storage to establish a highly secure compliant
data lake for comprehensive storage of raw and processed healthcare
information optimized for accessibility, integrity, and long-term retention.
RDS was leveraged, which is a highly reliable and high performance relational
database to manage critical structured benefits and member data, enabling
accurate reporting and insightful analytics for informed decision
making beyond just a federal mandate.
Our AWS based AI solution delivered.
Unmatched scalability, iron Cloud, security, and unwavering reliability.
Established in the Future Proof Foundation for critical data
operations and driving innovations in patient care and compliance.
This particular solutions set a benchmark being on percent or 10% on time.
The success of this delivery across the industry demonstrated
a new paradigm for operational rigor, accountability, inspiring
others to elevate their standards.
Furthermore, this Unpowered track record grant us strategic or
significant computer advantage.
Opening doors for strategic partnership and fostering sustained growth in
rapidly evolving healthcare landscape.
Unleashing the power of prompt engineering, how prompt engineering
help in accelerated development cycles.
Achieved a remarkable 40% reduction in overall development time by
strategically implementing advanced prompt engineering techniques.
Fostering agile and highly efficient project execution, ensure a proper
hundred percent on time delivery rate for all federal reporting requirement,
demonstrating our capability to streamline complex compliance process through
innovative, prompt driven automation.
Our prompt engineering framework empowered our team to pivot from
tedious repeated coding task to a high value strategic initiative.
This not only dramatically accelerated our delivery timelines, but also solidified
our commitment to maintain the regard risk quality standards our client expects
transforming compliance into strategic advantage.
Unified Data Foundation where streamlined the operations and
ensure the data integrated by establishing a single authority
source of truth, eliminating redundant processing, and fostering accuracy.
This helped in proactive member engagement, engagement and also
future regulatory framework and in empowering strategic decisions where.
Leveraging the newly enriched compliance data to provide a critical insights,
empowering leaders to optimize benefits offerings, refined planning, and drive
superior outcomes across the organization.
Unlocking AI potentials critical in insights from our journey.
So I would like to share how AI has helped in our journey and what can help
others mastering prompt engineering.
Tailored for healthcare AI crafting prompts that expertly blend deep
healthcare domain knowledge with precise technical specifications
proved essential, dramatically accelerating the generation of accurate,
robust, and immediately usable code.
Achieving around cloud security and stringent HIPAA compliance
for AI generated code demanded the meticulous iterate to refinement,
transforming raw output into the production ready, regulatory approved
solutions, LLM as a strategic connectors unifying diverse teams.
The LLM emerged as a powerful catalyst.
Seamless bridging communication divides between clinical experts.
Technical developers and business strategies fostering
unprecedented alignment and accelerating project execution.
Strategic prompt engineering, ensuring compliance healthcare, ai,
applying AI responsibilities in highly regulated healthcare environments.
Integrate HIPAA and industry specific regulation directly into prompt design,
leverage precise legal and clinical terminology for clarity and accuracy.
Demand comprehensive adult audit trails and documentation for
traceability and accountability.
Rigorously validate AI outputs against established security
framework like NIST and ISO.
Continuously refined prompts with clinical and legal experts to ensure
patient safety and regulatory adherence.
So this is a flow where, how the transformative AI helped our
project or any generic project.
So in the discovery phase.
How it helped in the design phase, what we utilize.
So in the discovery phase, harnessing AI powered LLMs to de deeply analyze
the existing risk systems, revealing critical integration points and hidden
dependencies to establish a robust architectural foundation employee to
rapidly generate in issue architecture.
Options in implementation, accelerate deployment.
Cycles by AI driven prototyping.
Prototyping of ETL pipelines and complex data transformations.
Ensuring efficient, reliable deployment, leverage AI to ultimately generate
comprehensive test scenarios, meticulously covering all edge cases to guarantee
system stability and performance.
Automate the generation of precise technical document and compliance report.
Significantly reducing manual effort and ensuring audit readiness and clarity
beyond compliance, driving value.
Through strategic transformation, we didn't just meet a federal mandate.
We leverage it as a catalyst to unlock significant value, dramatically
boosting member engagement and achieving unparalleled operational efficiency.
Unlocking tomorrow's health, AI's transformative power.
We saw beyond many regulatory compliance harnessing advanced AI to not only
meet the mandate, but fundamentally fundamental redefine how we deliver care.
This isn't just a technology, it's about pioneering a smarter, more empathetic.
Healthcare experience for every member.
This initiative also created a broader impact on healthcare
innovation, fostering culture of continuous implement and technological
advancement across the organization.
Furthermore, we established a scalable framework ready for future AI
implementations, ensuring our ability to adopt and lead in the evolving
landscape of medical technology.
I would like to call some key takeaways from our implementation,
how prompt engineering in AI help drive rapid innovation, leveraging
prompt engineering slash development cycles up to 40%, and helped in
high quality solutions and meeting.
Project timelines or federal mandate on time.
Master regulatory challenges utilize AI driven development to seamless translate
regulatory requirements into robust cutting edge technical implementations.
Unlock new growth revenues by redefining compliance from a burden
to a strategic asset Fostering.
Deeper member engagement and significant operational advancement.
Equip yourself with advanced prompt engineering strategies designed
for regulated industries, ensuring unparalleled security, precision, and
adherence to all compliance standards for a future ready healthcare system.
I hope this was helpful.
Thank you.