centers for medicare & medicaid services€¦ · data mining analytic ... architecture centers...
TRANSCRIPT
CENTERS for MEDICARE & MEDICAID SERVICES
Medicaid Information Technology Architecture
February 10, 2003
1
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Agenda Agenda
� Where We Are Today
� The Vision for the Future
� How We Plan to Translate the Vision Into Reality
� MITA Initiative
� The Conceptual Architecture
� The Approach
� What All This Means for States Over the Next 3 to 5 years
� Next Steps
2
Where We Are Today
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Where We Are Today
3
4
MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
Driving Forces/ChallengesDriving Forces/Challenges
“Blue Books” Claims
Recipient TPL
LegislativeMandates
CodeSets
UtilizationReview
ManagementReports
Recipient Provider
Claims
MMIS
Medicaid Program Changes
Rapid Changes in Technology
Resource Limitations “Blue Books”
MARSSURS
Reference
“Blue Books”Claims
Recipient Provider
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Web Analytics
Online Analytical Processing
(OLAP)
World Wide Web
Multidimensional Databases
Enterprise Information
Portals
Data Mining
Analytic Applications
MMIS Evolution and Trends— 1970 to Today
MMIS Evolution and Trends— 1970 to Today
Ad Hoc Query Tools
Data Warehouses
Relational Databases
Decision Support Systems (DSS)
Executive Information
Systems(EIS)
Transaction Systems
Extract Files
Financial Reporting Systems
Reporting Systems
(MARS +SURS)
1970 1985 1990 1995 Today
Source: modified from Data Warehousing and E-Commerce, William J. Lewis 5
6
Vision for the FutureVision for the Future
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Current Medicaid IT ArchitectureCurrent Medicaid IT Architecture
State Federal/CMS
7
Data Warehouse
MMIS MSIS 1
2
3
1. Decision Support System 2. Immunization Registries 3. Eligibility Determination Systems
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Federal/CMSState
Data Warehouse
Web-Based Interface
Web-Based Interface
MMIS
b
dc
e f
a
6
4
5MSIS
1
2
3
Planned Medicaid Systems ArchitecturePlanned Medicaid Systems Architecture
1. Decision Support System 2. Other Public Heath Data Sets 3. Eligibility Determination Systems
4. State Summary Data Reports 5. Annual Person Summary 6. Clinical Services Data Marts
Note: States will be able to access data marts directly and the granular database through CMS on request. 8
9
MEDICARE
MEDICAID
1. 2. 3.
Medicare-Managed Care Data
System
Enrollment Database
Quality Net OSCARPaid Claims
History File
1
3
2MSIS
Future CMS Medicaid + Medicare IT Data Sharing
Future CMS Medicaid + Medicare IT Data Sharing
State Summary Data Reports Summary Annual Person
Clinical Services Data Marts
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
10
Inter-Agency Data SharingInter-Agency Data Sharing
State Data Sets
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture
CMS Data Sets
(both Medicaid and Medicare)
HRSACDC
State Data Sets
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture
How We Plan To Translate The Vision
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
How We Plan To Translate The Vision
Into Reality Into Reality
11
The MITA Initiative
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
The MITA Initiative
12
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
The MITA InitiativeThe MITA Initiative
A national framework supporting improved systems development and health care management for
the Medicaid enterprise
13
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
MITA Initiative Key Principles MITA Initiative Key Principles
� Data Sharing
� Reusable Components
� Modularity
� Open Architecture
� Standards
� Collaboration
� Security
14
15
MITA InitiativeMITA Initiative
Support the Transition
Develop the Architectural Components
Establish the Framework
MITA
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
16
MITA
MITA InitiativeMITA Initiative
� Strategic Plan
� Conceptual Architecture
� MITA Steering Committee
� MITA Technical Group
� Review Policies
� Methodology Guidelines
� Publicize and Market Establish the Framework
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
17
MITA
MITA InitiativeMITA Initiative
� Common Requirements
� Implementation Standards
� Reusable Components
� Enterprise Process Model
� Enterprise Data Model
Develop the Architectural Components
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
18
MITA
MITA InitiativeMITA Initiative
� Transition Plan Template
� Other Tools and Templates
� Education
Support the Transition
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
19
The Conceptual ArchitectureThe Conceptual Architecture
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Establish the Framework— Conceptual Architecture
Establish the Framework— Conceptual Architecture
The goal is to provide the states with a conceptual architecture which will serve as a framework for improved system development and data exchange within and among states, federal agencies, and other health care partners.
20
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
What Is the MITA Conceptual Architecture?What Is the MITA Conceptual Architecture?
� MITA IS NOT: � MITA CAN BE
� Installable software (WITH YOUR HELP):
� Mandated requirements
� A single mold (one size does not fit all)
� Guidelines incorporating new technology
� Roadmap for implementation
� A model system � Consensus on what should be required when systems are replaced
21
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Key Principles—Making Them RealKey Principles—Making Them Real
� Standards
� Reusable components
� Multi-centric
22
Conceptual Architecture—PastConceptual Architecture—Past
23
Code Sets
Utilization Review
Management Reports
Recipient Provider
Claims
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
24
Conceptual Architecture—PastConceptual Architecture—Past
TPL SURS Fraud Detect
Prior Authorization
Enrollment
Outsourced Functions
Web Portal
Data Ware-house
EVS AVRS
Rx POS
DD, DOA, DMH
Waivers
Other State
Agencies
State, Local Public Health
Eligibility Determin
ation
SCHIP EPSDT NEDSS
IZ
CMS CDC
SAMHSA
DOF State Bank
Clearing-house
Managed Care
Contracts
Contracted Benefit
Management Drugs, Mental
HealthMMIS Subsystems
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
25
Conceptual Architecture— Bridge to the Future
Conceptual Architecture— Bridge to the Future
TPL SURS Fraud Detect
DD, DOA, DMH
Waivers
Prior Authorization
Enrollment
Outsourced Functions
Other State
Agencies
State, Local Public Health
Eligibility Determin
ation
SCHIP EPSDT NEDSS
IZ
CMS CDC
SAMHSA
DOF State Bank
Clearing-house
Managed Care
Contracts
Contracted Benefit
Management Drugs, Mental
Health
Web Portal
Data Ware-house
EVS AVRS
Rx POS
MMIS Subsystems
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
26
MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
OTHERAGENCIES
Conceptual Architecture—FutureConceptual Architecture—Future
TPLSURSFraudDetect
DD, DOA,DMH
Waivers
PriorAuthorization
Enrollment
OutsourcedFunctions
OtherState
Agencies
State,LocalPublicHealth
EligibilityDetermin-
ation
SCHIPEPSDTNEDSS
IZ
CMSCDC
SAMHSA
DOFStateBank
Clearing-house
ManagedCare
Contracts
ContractedBenefit
ManagementDrugs, Mental
Health
WebPortal
DataWare-house
EVSAVRS
RxPOS
MMISSubsystems
TPLSURSFraudDetect
DD, DOA,DMH
Waivers
PriorAuthorization
Enrollment
OutsourcedFunctions
OtherState
Agencies
State,LocalPublicHealth
EligibilityDetermin-
ation
SCHIPEPSDTNEDSS
IZ
CMSCDC
SAMHSA
DOFStateBank
Clearing-house
ManagedCare
Contracts
ContractedBenefit
ManagementDrugs, Mental
Health
WebPortal
DataWare-house
EVSAVRS
RxPOS
TPLSURSFraudDetect
DD, DOA,DMH
Waivers
PriorAuthorization
Enrollment
OutsourcedFunctions
OtherState
Agencies
State,LocalPublicHealth
EligibilityDetermin-
ation
SCHIPEPSDTNEDSS
IZ
CMSCDC
SAMHSA
DOFStateBank
Clearing-house
ManagedCare
Contracts
ContractedBenefit
ManagementDrugs, Mental
Health
WebPortal
DataWare-house
EVSAVRS
RxPOS
MMISSubsystems
State 1
OTHERSTAKEHOLDERS
WebPortal
DataWare-house
EVSAVRS
RxPOS
PriorAuthorization
Enrollment
EligibilityDetermin-
ation
MMISSubsystems
WebPortal
DataWare-house
EVSAVRS
RxPOS
PriorAuthorization
Enrollment
EligibilityDetermin-
ation
MMISSubsystems
State 3
TPLSURSFraudDetect
PriorAuthorization
Enrollment
OutsourcedFunctions
WebPortal
DataWare-house
EVSAVRS
RxPOS
EligibilityDetermin-
ation
SCHIPEPSDTNEDSS
IZ
CMSCDC
SAMHSA
MMISSubsystems
TPLSURSFraudDetect
PriorAuthorization
Enrollment
OutsourcedFunctions
WebPortal
DataWare-house
EVSAVRS
RxPOS
EligibilityDetermin-
ation
SCHIPEPSDTNEDSS
IZ
CMSCDC
SAMHSA
MMISSubsystems
State 2
DATA EXCHANGE
Access Policy
StandardsSecurity
27
MITA
From Concept to ApproachFrom Concept to Approach
� What the Conceptual MITA will look like
� How we plan to build it
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
The Approach
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
The Approach
28
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Conceptual Architecture—ApproachConceptual Architecture—Approach
� Build Partnerships
� Leverage Work Done to Date
� MITA Project Process � Data Collection
� Analysis and Design
� Validation
29
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Conceptual Architecture ApproachConceptual Architecture Approach
Steering Committee
MTG
CMS CO/RO
States
S-TAG
PS-TG
Other Industry Leaders
Other Federal
Agencies
Standards Setting Orgs
MITA Team
Public Health Survey
Others
S-TAGMMIS Redesign
Workgroups
PS-TG Papers
30
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Conceptual Architecture— The Process
Conceptual Architecture— The Process
Data Collection
Analysis and Design
Validation
31
Develop Business Cases and
Sequencing Plan
Sequencing Plan and
Transition Strategy
Projects
Business Cases
Develop Target Information Systems
Architecture
Data Architecture
Application Architecture
Technology Architecture
Develop Target Business
Architecture
Organizational Structure and
Roles
Business Processes
Facility Locations
Document Mission, Vision, Strategy,
Current Architecture
Mission Programmatic Requirements
Current Architecture
Vision, Strategy
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Data Collection Data Collection
Conceptual Architecture— The Process
Conceptual Architecture— The Process
Analysis and Design
Validation
32
What All This Means for States and CMS Over the
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
What All This Means for States and CMS Over the
Next 3 to 5 Years Next 3 to 5 Years
33
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Why Is the MITA Initiative So Important? Why Is the MITA Initiative So Important?
MITA will enable:
� Improved managing and monitoring of programs through the sharing of data
� Efficient use of scarce resources through the development and sharing of reusable software
� Quick response to changes in programs
� Greater access to high-quality data
34
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
Why Now?Why Now?
� No better time than now to improve our systems and realize the benefits of improved effectiveness and efficiency
� Wait too long and the cost of deferred modernization becomes so steep that catch-up is unaffordable
� Great strides have been made in data standardization—we can benefit NOW
� Achieve a significant return on our investment TODAY
� MITA can make the business case to CMSO senior leadership about how we can redefine the MMIS boundaries and create appropriate financial incentives to support the vision
35
36
We Need Your HelpWe Need Your Help Sunday Monday Tuesday Wednesday Thursday
MITA Focus Group: Industry Visioning
Session
Bridge to the New Architecture
MITA Room (Cabildo C)—QuestionnaireMITA Room (Cabildo C)—Questionnaire
Lunch Break
MITA Meeting with S-TAG, NMEH, and
PS-TG Members
NEDSS and the Medicaid IT
Architecture – Complimentary
Initiatives
MITA Overview
MITA Focus Group: State Visioning
Session
Report of Visioning Session Results
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
MITA is a journey, not a destination.
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
MITA is a journey, not a destination.
37
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
MITA
Share the Vision
Chart the Course
Shape the Future
38
Medicaid Information Technology Architecture
Medicaid Information Technology Architecture CENTERS for MEDICARE & MEDICAID SERVICES
39