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1 CENTERS for MEDICARE & MEDICAID SERVICES Medicaid Information Technology Architecture May 19, 2003

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Page 1: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

1

CENTERS for MEDICARE & MEDICAID SERVICES

Medicaid Information Technology Architecture

May 19, 2003

Page 2: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

2

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture 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

Page 3: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

3

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

MITA Initiative: MITA Initiative: zData SharingzReusable ComponentszModularityzOpen ArchitecturezStandardszCollaborationzSecurity

Key PrinciplesKey Principles

Page 4: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

4

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

Driving Forces/ChallengesDriving Forces/Challenges

“Blue Books” Claims

Recipient TPL

LegislativeMandates Code

SetsUtilization

Review

ManagementReports

Recipient Provider

Claims

MMIS

Medicaid Program Changes

Rapid Changes in Technology

Resource Limitations

Specs for 6 Medicaid

Management Information

System Modules

Early ‘70s General Systems Design--

“Blue Books”

Page 5: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

5

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

Today

WebAnalytics

Online AnalyticalProcessing

(OLAP)

World WideWeb

1995

MultidimensionalDatabases

EnterpriseInformation

Portals

Data Mining

Analytic Applications

MMIS Evolution and Trends—1970 to Today

MMIS Evolution and Trends—1970 to Today

Source: ified from Data Warehousing and E-Commerce, William J. Lewis

1990

Ad HocQuery Tools

DataWarehouses

RelationalDatabases

1985

Decision SupportSystems (DSS)

Executive Information

Systems (EIS)

1970

TransactionSystems

ExtractFiles

FinancialReportingSystems

ReportingSystems

(MARS +SURS)

mod

Page 6: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

6

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

Conceptual Architecture—Past Evolving to PresentConceptual Architecture—Past Evolving to PresentTPL

SURSFraudDetect

PriorAuthorization

Enrollment

OutsourcedFunctions

WebPortal

DataWare-house

EVSAVRS

RxPOS

DD, DOA,DMH

Waivers

OtherState

Agencies

State,LocalPublicHealth

EligibilityDetermin-

ation

SCHIPEPSDTNEDSS

IZ

CMSCDC

SAMHSA

DOFStateBank

Clearing-house

ManagedCare

Contracts

ContractedBenefit

ManagementDrugs, Mental

HealthMMIS CoreSubsystems

CodeSets

UtilizationReview

ManagementReports

Recipient Provider

Claims

Page 7: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

7

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

Conceptual Architecture—one state exampleLegacy architecture with some standards applied to facilitate data sharing

Conceptual Architecture—one state exampleLegacy architecture with some standards applied to facilitate data sharing

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

Page 8: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

8

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

Page 9: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

9

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

The MITA Initiative: The MITA Initiative: Support

Transition

Develop Architectural Components

Establish Framework

MITA

A JourneyA Journey

Page 10: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

10

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

The MITA Initiative: The MITA Initiative: z Awarded task order 9/02 (CSC-prime, Fox

Systems & FourThoughtGroup – subs) z Established MITA Technical Group (MTG)z Conduct interviews, surveys, focus

groupsz Presented MITA vision & strategy at 2003

National MMIS Conference—validated assumptions

z Ongoing data collection & requirements gathering

z Review possible changes to policiesz MITA conceptual architecture framework

document currently in 2nd release (in-house review) final deliverable date is 9/2003

z Communicate, publicize, and market our efforts

MITA

Establish Framework

A JourneyA Journey

Page 11: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

11

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

The MITA Initiative: The MITA Initiative:

zMITA Model Focuses on:�Organization�Business�Data�Application�Technology�Interfaces�Security

MITA

Develop Architectural Components

A JourneyA Journey

Page 12: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

12

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

The MITA Initiative: The MITA Initiative:

z Transition plan guidelinesz Technical assistancezOther tools and templates

MITASupport

Transition

A JourneyA Journey

Page 13: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

13

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

MITA Initiative– Our Ongoing ApproachMITA Initiative– Our Ongoing Approach

zBuild partnershipszCollaborate with industryzCoordinate with other initiativeszListen to our partnerszLeverage work done to date

Page 14: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

14

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

Conceptual Architecture ApproachConceptual Architecture Approach

SteeringCommittee

MTG

CMSCO/RO

States

S-TAG

PS-TG

OtherIndustryLeaders

OtherFederal

Agencies

StandardsSettingOrgs

MITATeam

Public Health Data Standards

Consortium

eGov, NHII, CHIand other initiatives

S-TAGMMIS Redesign

Workgroups

PS-TG PapersMedicaid Vendor

Community

Page 15: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

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MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

Conceptual Architecture—The Process

Conceptual Architecture—The Process

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

Analysis and Design

Data Collection

Validation

Page 16: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

16

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

Why Is the MITA Initiative So Important? Why Is the MITA Initiative So Important?

MITA will enable:zImproved managing and monitoring of

programs through the sharing of data zEfficient use of scarce resources through

the development and sharing of reusable softwarezQuick response to changes in programszGreater access to high-quality data

Page 17: CENTERS for MEDICARE & MEDICAID SERVICES · PDF fileSub system Authorization Enrollment i i ... zMITA conceptual architecture framework ... Architecture CENTERS for MEDICARE & MEDICAID

17

MedicaidInformationTechnologyArchitecture

MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES

MITAShare the Vision

Shape the Future

Chart the Course


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