section 8 vendor qualifications & experience 8 - vendor qualifications and...8.1 organizational...

May 17, 2011

©2011 Thomson Reuters ● All Rights Reserved ● www.thomsonreuters.com

SECTION 8 VENDOR QUALIFICATIONS & EXPERIENCE

RFP § 4.1.8

In Section 8, we provide a comprehensive profile of Thomson Reuters, its structure and ownership, with a focus on our Healthcare business. We also provide examples of our prior experience in administering Data Warehouse/Decision Support Systems, including client references. Section 8 is organized as follows:

8.1 Organizational Profile

8.2 Corporate Experience

8.3 References

8.1 Organizational Profile Thomson Reuters is the world’s leading source of intelligent information for business and professionals. With 55,000 employees across the world, we combine industry expertise with innovative technology to deliver critical information to decision makers in the healthcare, financial, legal, tax and accounting, scientific, and media markets, powered by the world’s most trusted news organization. See www.thomsonreuters.com.

Our Healthcare business is the leading provider of decision support systems that help organizations across the healthcare industry improve clinical and business performance. Our solutions inform healthcare decisions affecting more than 150 million people in the U.S.

Thomson Reuters has broad and deep experience in the areas important to BMS. Since our healthcare business was founded in 1981, we have provided hundreds of clients with large data warehouse and decision support solutions and other forms of advanced healthcare reporting and analytics. We also lead many research and consulting projects on behalf of our clients, who consider our staff trusted advisors.

8.1.1 Ownership Our legal name is Thomson Reuters (Healthcare) Inc. Thomson Reuters (Healthcare) Inc. is a wholly owned subsidiary of Thomson Reuters U.S. Inc., a Delaware corporation. Both Thomson Reuters (Healthcare) Inc. and Thomson Reuters U.S. Inc. are indirect subsidiaries of Thomson Reuters Corporation, a company organized under the laws of Ontario, Canada. Thomson Reuters has annual sales of $13 billion and is traded on the New York stock exchange under the symbol TRI.

Thomson Reuters is an independent organization. We are not affiliated through ownership or partnership with any insurance company or provider of healthcare. Our Healthcare business is focused entirely on the delivery of intelligent information for our customers. Our independence enables us to remain a source of objective and credible information to everyone in the business of healthcare.

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8.1.2 Management Structure The President and CEO of the Healthcare business of Thomson Reuters is Michael Boswood. Reporting to Mr. Boswood is the Executive Vice President for Healthcare, Jonathan Newpol. Our Government market segment is led by Pate McCartney, Senior Vice President, who reports to Mr. Newpol. As shown on the organizational chart below, the Client Services Director who leads your Account Team will report to Beth Schneider, Vice President of Client Services for State Government.

Our Healthcare business has approximately 2,000 employees. They focus on all aspects of providing market intelligence and benchmark databases, decision support solutions, and research services for managing the cost and quality of healthcare. Located in our Ann Arbor MI headquarters and in regional offices throughout the United States, our staff members have expertise in healthcare informatics, quantitative analysis, software development, database design and maintenance, information technology, and all aspects of service delivery and customer relationship management. We employ clinicians, statisticians, healthcare benefit experts, technology specialists, analysts, database architects, and support staff to ensure that our focus is on delivery of customer results.

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8.2 Corporate Experience Thomson Reuters has 30 years of experience in the maintenance and implementation of large-scale healthcare claims databases, customized data warehouses, and commercial-off-the-shelf (COTS) software products for healthcare decision support. We have built hundreds of integrated analytic databases for our clients across the healthcare sector, and our applications support professionals who manage healthcare in all sectors of the healthcare industry. Today, we manage approximately 85 information products and services delivered to payers, providers, researchers, and consumers, including:

26 state Medicaid agencies

Every healthcare agency of the Federal government

11 public employee health benefit programs

250 large private employers, including 7 of the Fortune 10

100 large health plans

3,000 hospitals and healthcare systems.

Our longest-running data management contract is with the U. S. Agency for Healthcare Research and Quality (AHRQ), for which we collect and maintain the data for the Healthcare Cost and Utilization Project (HCUP). HCUP represents the nation’s largest database of longitudinal healthcare experience.

8.2.1 West Virginia Experience

Thomson Reuters has prior experience working for the State of West Virginia.

West Virginia Health Care Authority

Thomson Reuters is a current contractor to the West Virginia Department of Health and Human Resources (DHHR). Since 2007, we have served as the hospital discharge data contractor to the Health Care Authority (HCA). Under this contract, we collect UB data from all 62 of the state’s inpatient facilities and organize it to facilitate healthcare planning and regulation. Over the years, we have assisted HCA with multiple initiatives, including:

Enhancing data quality reports by creating new reports to meet specific needs

Adding data fields such as length of stay and charges to existing reports. Examples include:

Quality Monitor Report

ALOS Multi-Period Trending Report

Frequently Modified Fields by Facility Report

Adding new errors and warnings to enhance the completeness and accuracy of the source data.

Adding statistical significance testing to flag data quality issues for the hospitals to investigate.

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Developing the migration approach, training, documentation and implementation support for the transition from a flat file submission format to the 837i v4010.

Providing data access to analytic and consulting staff.

Migrating from annual reconciliation to quarterly reconciliation of the database.

West Virginia Health Information Network

Thomson Reuters submitted a proposal to become the West Virginia Health Information Network (WVHIN) Health Information Exchange (HIE) contractor, and we await the State’s final decision. Thomson Reuters would be proud to serve the State on this important project.

8.2.2 A Leader in Medicaid Decision Support Thomson Reuters is a long-time leader in the field of Medicaid decision support. In 1991, we were the first company to install an advanced commercial-off-the-shelf (COTS) healthcare decision support system for a state Medicaid agency, Mississippi. We have worked continuously in state Medicaid decision support since then. We currently serve 26 state Medicaid/CHIP agencies.

In addition, we have worked for the Centers for Medicare and Medicaid Services (CMS) for 30 years, integrating large Medicaid data sets for research and policy analysis. CMS has used our services to provide technical assistance to state Medicaid agencies on a variety of CMS initiatives, including the implementation of 1115 waivers, improvement in the quality of MSIS data, and quality improvement in Home and Community Based waiver programs, to name just a few.

Summary of State Medicaid Experience

The following table lists our current state Medicaid clients and a brief description of each engagement. The table notes the states that use the solutions that we propose for West Virginia: Advantage Suite for data warehousing and decision support, and J-SURS and i-Sight for program integrity.

Current State Medicaid Clients

STATE CLIENT SINCE

THOMSON REUTERS MEDICAID SOLUTION

Alaska 2004 J-SURS for program integrity

Georgia 1996 Advantage Suite for comprehensive decision support, including: provider profiling, program integrity, and other applications

Idaho 2007 Advantage Suite for comprehensive data warehousing and decision support, including: program management and administrative reporting, provider profiling, program integrity, and other applications

Illinois 1998 J-SURS for program integrity

Indiana 2011 Comprehensive systems and services, including J-SURS and i-Sight for program integrity (contract effective January 3, 2011)

Iowa 2008 Consulting services to improve the state’s long-term care programs

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STATE CLIENT SINCE

THOMSON REUTERS MEDICAID SOLUTION

Kansas 2008 Advantage Suite for comprehensive decision support, and operation of a statewide all-payer database

Louisiana 1998 J-SURS for program integrity

Maine 2008 (in implementation) Advantage Suite for comprehensive data warehousing and decision support, including: program management and administrative reporting, provider profiling, and other applications; also J-SURS for program integrity

Maryland 1998 J-SURS for program integrity

Michigan 1998 J-SURS for program integrity

Minnesota 2008 Consulting services to improve the state’s long-term care programs

Mississippi 2006 J-SURS for program integrity

Missouri 2002 Advantage Suite for decision support, with a specialized focus on program integrity

Nebraska 1995 Advantage Suite for comprehensive decision support, including: program management and administrative reporting, provider profiling, program integrity, and other applications

Nevada 2002 Advantage Suite for comprehensive decision support, including: program management and administrative reporting and provider profiling. J-SURS was recently added for program integrity

New Hampshire 2001 Advantage Suite for comprehensive decision support, including: program management and administrative reporting, provider profiling, and program integrity

New Jersey 2001 J-SURS for program integrity

New York 1998 Advantage Suite for provider profiling to support a special quality of care improvement program; J-SURS for program integrity; reporting services for prescription drug program management

North Carolina 2009 (in implementation) Data warehousing and Advantage Suite for comprehensive decision support, including provider profiling; J-SURS for program integrity

North Dakota 1996

(in implementation) Advantage Suite for comprehensive decision support, including: program management and administrative reporting, provider profiling, and program integrity.

A Thomson Reuters legacy system has been in operation in the state since 1996

Ohio 2002 Advantage Suite for comprehensive decision support, including: provider profiling, program integrity, and other applications

Pennsylvania 2006 Consulting services to improve the state’s long-term care programs

South Carolina 2005 Advantage Suite for comprehensive decision support, including: program management and administrative reporting, provider profiling, and program integrity

Virginia 2000 J-SURS for program integrity

West Virginia 2003 J-SURS for program integrity

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In addition, we are adding two new customers with whom we are in contract discussions:

Oklahoma Medicaid recently selected J-SURS as its program integrity data analysis solution.

Mississippi Medicaid recently selected ACS, with Thomson Reuters as its subcontractor, to operate the agency’s data warehouse and decision support system, which includes J-SURS.

Our state Medicaid customers have seen success with their data-driven strategies. These states have enjoyed measurable program improvements that were made possible, at least in part, because of the information solutions delivered by Thomson Reuters. We provide more information about several of these Medicaid customers in Sections 8.2.3.4, 8.2.3.7, and 8.3.

Summary of Federal Experience

We also work with Medicaid and Medicare at the Federal level, helping CMS conduct research and use data to manage cost, design program controls, evaluate program effectiveness, and oversee program integrity. We have worked with CMS for more than 30 years and currently have more than 14 major contracts with CMS, as a prime or subcontractor, including those listed below:

ONE PI Project: Data Analytics System integrating Medicaid and Medicare data for PI

Medicare Medical Home Demonstration Project

Medicaid Money Follows the Person Technical Assistance to the States

Medicare Disease Management Analytic Services

Senior Risk Reduction Demonstration Technical Assistance

Long Term Care Data Management and Analysis System

Medicaid Integrity Contractor Provider Review (2 regions, covering 24 states)

Medicare Zone Program Integrity Contract (Zones 2, 4, & 5): Database and Fraud System

Medicare Program Safeguard Contract: Database and Fraud System

Medicare Administration Contractor (A/B MAC Jurisdiction 3): Database and Analysis

Medicare DME Pricing Data Analysis and Coding

Medicare Value Based Purchasing Initiative: Resource Use Reports

Medi-Medi Project (6 states): Data Management and Fraud Detection

Medicaid and CHIP Policy Implications and Evaluations IDIQ Contract

Medicare DME Pricing Data Analysis and Coding Contract (PDAC): Database and Analysis

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8.2.3 An Experienced Partner for BMS Thomson Reuters brings decades of experience and expertise encompassing areas that are critical to the success of the Bureau’s data warehouse/decision support system (DW/DSS) project:

Delivery of high-quality, reliable information.

Proven success with CMS certification.

Program integrity expertise and results.

Effective program planning and performance measurement.

Information technology capabilities.

Large-scale DW/DSS expertise in healthcare.

Sophisticated healthcare analytics.

In the sections that follow, we discuss our experience in each of these areas of expertise.

8.2.3.1 Delivery of High-Quality, Reliable Information

Our extensive experience with healthcare data management and data quality assurance ensure that the data can be trusted, initially and continuously, over the years. Data is standardized to ensure comparability over time. Data standardization and quality is vital for planning, because trends and patterns cannot be accurately discerned without it. We deliver healthcare data that is prepared, enhanced, documented, organized, and delivered specifically to enable you to make better decisions faster. The best analytic tool is only as good as the data. In the end, the true measure of value is whether the data can be trusted.

Not only do we provide high-quality, reliable data, a hallmark and a key competitive differentiator of Thomson Reuters is the validation, aggregation, and standardization of data from multiple sources necessary to build integrated databases for our customers. We have worked with thousands of healthcare data suppliers and types of data feeds, and our experience covers traditional suppliers, TPAs, HMOs, carve-out vendors, disease management firms, health risk appraisal providers, short-term and long-term disability suppliers, workers' compensation risk managers, absence systems, survey sources, and many varieties thereof. We have built hundreds of integrated analytic databases for employers, health plans, and government agencies. We currently collect data from over 400 data contributors, and receive over 10,000 data feeds monthly.

Given this volume and the critical importance of ensuring we have developed the capacity to collect and edit large volumes of claims data in a highly efficient manner, we have invested significantly in our systems for data acquisition and rigorous data quality assurance, so we can identify input errors and data quality issues early in the process. Once data is submitted, our systems automatically launch processes to log submission, validate record counts and formats, perform edits, and encrypt protected health information. We have learned that by identifying data issues prior to loading the data, we can resolve them more quickly.

In addition to our robust Data Submission system, we have invested significantly in the business processes associated with supplier management, privacy protection, and other legal aspects. Our Data

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Management teams include individuals who are assigned to manage specific data supplier relationships. These individuals are subject matter experts on the data we receive from suppliers.

We will leverage our relationships, systems, experience, and business processes to increase the speed and accuracy of data submissions and reduce the risk associated with migrating data contributors to the new system.

We have developed a set of utilities that transform data submitted by suppliers into standard formats. We use well-established processes for assessing data quality, which are focused on completeness, validity, and reasonableness. In addition, we enhance the data to improve its usability for subsequent processes and analysis (e.g., assigning the geographic area and linking to relative value units).

8.2.3.2 Proven Success with CMS Certification

Thomson Reuters is aligned with and has been very involved with the defining and implementation of CMS’s Medicaid Information Technology Architecture (MITA). We will ensure that the West Virginia DW/DSS meets the CMS certification requirements, initially and throughout the life of the contract. Our solution complies with both the traditional CMS certification checklists for MARS and SURS as well as the new MITA-aligned checklists for Decision Support System/Data Warehouse, Program Management Reporting, Federal Reporting, Program Integrity, and the population-based reporting requirements for Care Management.

We have a 100% success rate at being certified. Our proposed DW/DSS solution, Advantage Suite, has been MARS-certified in three states (Nebraska, Nevada, and New Hampshire) with two additional states in implementation (Maine and Idaho). Our proposed SURS solution, J-SURS, has been SURS-certified* in 10 states (Maryland, New York, Virginia, West Virginia, Mississippi, Louisiana, Illinois, New Jersey, South Carolina, and Michigan) with two additional states in implementation (Maine and Indiana). We have much more experience with CMS certification than does any other DW/DSS contractor. Our leadership status in the Medicaid technology community, and our commitment to keeping our systems MITA-compliant, will help BMS in achieving its vision of a MITA-oriented Medicaid Enterprise.

* In certain states, the system was approved as part of an on-going certified MMIS operation.

8.2.3.3 Program Integrity Expertise and Results

Thomson Reuters has a special focus on program integrity and efforts to control healthcare fraud, waste, and abuse. As a leader in program integrity data analysis for government healthcare:

We support the program integrity function in 22 state Medicaid agencies.

We support CMS program integrity efforts in several ways, including:

In Medicaid, as a Provider Review Medicaid Integrity Contractor to the MIG.

In Medicare, as the data analysis subcontractor on 8 major program integrity contracts.

Our solutions address the full spectrum of program integrity issues, ranging from quality of care concerns to criminal fraud, and fee-for-service as well as managed care. We provide algorithm development, data management, and analytic services to support medical review and fraud and abuse detection and prevention for our customers. We also provide consulting and research to CMS and many state Medicaid agencies to support of a wide range of policy development and program monitoring activities.

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Our clients utilize our program integrity solutions to:

Investigate providers and beneficiaries before and after they are enrolled.

Detect and investigate potential instances of waste, fraud, and abuse.

Prevent overpayment and inappropriate utilization.

In March 2009, Thomson Reuters acquired UPI Government Group, LLC (UPI), a provider of health claims data warehousing and analytical solutions to government agencies, including state Medicaid agencies. This acquisition expanded our Surveillance and Utilization Review (SURS) capabilities and strengthened our relationships with key state government agencies. The company’s federally-certified J-SURS product addresses the core requirements for a Fraud and Abuse Detection System (FADS) and Surveillance and Utilization Review Sub-system (SURS). J-SURS incorporates the ongoing experience of the 14 state Medicaid Program Integrity units that currently use the system.

This hands-on data mining/reporting system, which uses health and encounter claims data to target potential fraud and abuse, produces comprehensive profiles of service utilization by healthcare providers and the services received by recipients. Our experience is that a tool that supports broad usage and puts more “eyes” on the data enhances the opportunity to identify issues and potential problems. Our applications are equally effective at mining Medicaid and other claims-based healthcare program data for abuse and overpayment, making it suitable for a multi-payer business.

We will continue to enhance J-SURS for BMS, utilizing our expert J-SURS staff and our skilled fraud data analysts, data managers, consultants, and thought leaders in the field of program integrity. We offer a wide range of analytic support and consulting services, from light support to on-site analysts to full-scale outsourcing of the program integrity (PI) function. BMS will also realize value from the shared best practices we have garnered from our work with state and federal healthcare organizations across the country. Our capabilities in program integrity continue to expand.

8.2.3.4 Effective Program Planning and Performance Measurement

To the field of Medicaid data warehousing and decision support, the background Thomson Reuters brings is unique and valuable. We are distinguished by our professional consulting support and by our ability to assist our customers in converting data into intelligent information that provides the knowledge to act. We help our customers apply the data to achieve specific outcomes. Our role does not stop when the database is delivered.

Our state Medicaid customers experience measurable benefits from the use of our solutions and services. For example:

South Carolina Department of Health and Human Services

The South Carolina Department of Health and Human Services (SCDHHS) has relied extensively on Thomson Reuters’ products and services to fulfill its mission of managing the Medicaid budget to provide the best healthcare value for South Carolinians, and has agreed to serve as a reference to BMS. In the past two years alone, SCDHHS has used our data warehouse/decision support solution to identify and implement strategies that produced almost 200 million dollars in state and federal budget reductions in the most fair and least painful way possible. Our capabilities have helped SCDHHS:

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Increase fraud and abuse provider recoveries by 145% in the most recent year and achieve a 6:1 return on overall investment in program integrity.

Introduce a pilot pharmacy lock-in program that produced savings of approximately $6,700 per participant.

Monitor a two-fold increase in managed care enrollment and improve managed care data quality, reporting, and rate-setting.

Support strategic planning for the long term care system.

Meet CMS deadlines for Federal reporting and streamline management reporting.

Provide the public with web-based access to data on Medicaid payments to individual providers as the first phase of the State’s government transparency project.

Respond to complex and immediate legislative requests.

Implement an HIE pilot project for the state’s CHIP program.

Enhance collaborations through data sharing with other State agencies and vendors.

Georgia Department of Community Health

The Georgia Department of Community Health (DCH) has relied extensively on Advantage Suite and Thomson Reuters services to meet the challenge of achieving its goals for access and quality of care within the context of ever-pressing state budget constraints; DCH has agreed to serve as a reference to BMS. We have assisted DCH in using the DSS to help set and monitor budgets; identify and quantify cost savings opportunities; detect fraud, waste, and abuse; profile and provide feedback reports to 400+ Primary Care Case Management (PCCM) PCPs; design and evaluate disease and case management programs; implement and monitor capitated Medicaid managed care; and monitor and improve health plan performance, among other areas of support.

Over the 15 years of our relationship, DCH has implemented cost containment strategies that have produced hundreds of millions of dollars in state and federal savings. Most, if not all, recent budget decisions have been data-driven and based on reliable DSS data. Our high-quality data, analytical applications, and consulting support have allowed DCH to make recommendations to the DCH Board, the Governor, and in turn the Legislature, based on solid projections of fiscal and program impact. DCH has been commended by the DCH Board and recognized by CMS for its effective use of data to drive decision-making. DCH uses the DSS throughout the Department to support a broad range of program objectives such as:

Overall program management (e.g., using executive management and program-specific dashboards).

Cost Driver analysis for policy planning and evaluation.

Quality measurement and improvement, including quality metrics for managed care and disease management programs.

Detection and investigation of fraud, waste, and abuse.

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Trend analysis and budget projections.

Support for plan design changes for the State Health Benefit Plan.

Nebraska Department of Health and Human Services

The Department of Health and Human Services (DHHS) is the Medicaid agency for Nebraska. In 1995, Thomson Reuters was awarded a contract to develop and operate a DSS for the Nebraska Medicaid program. Thomson Reuters implemented a solution which has been subsequently upgraded to Advantage Suite. Advantage Suite serves as the MARS and SURS solution for Nebraska. The Advantage Suite database integrates data from the MMIS, including claims, managed care encounters, provider data, eligibility, and other feeds. This enables DHHS to perform advanced analysis and management reporting. Recently, the database has been upgraded to integrate data from “N-FOCUS”, a separate payment system. Thomson Reuters also provides the MSIS solution for Nebraska DHHS.

The current database contains 8 years of claims and eligibility data for over 200,000 eligible members. Our services include data management, analytic consulting, and ongoing support. DHHS has used the system to evaluate accessibility of care, set risk adjusted capitation rates for prepaid health plans, evaluate quality of care, assess data capture and reporting capabilities of primary care providers (PCPs), and obtain baseline information for evaluating program effectiveness. Program integrity, fraud algorithm programming, and other data analysis services are a critical component of this engagement.

Kansas Health Policy Authority

The Kansas Health Policy Authority (KHPA) is responsible for all health insurance purchasing by the State of Kansas, including Medicaid, the State Children’s Health Insurance Program (SCHIP), the State Employee Health Plan, and other optional healthcare programs.

For many years, the State has licensed Advantage Suite to integrate medical, prescription drug, dental, eligibility, biometric screening, personal health assessment, and disease management participation data for the state employee health benefit plan. In 2008, KHPA hired us to design, develop, implement, maintain and operate an agency-wide, comprehensive, Data Analytic Interface System, based on the Advantage Suite data warehouse/decision support system. This database supports KHPA’s efforts to develop and coordinate a statewide health policy agenda, including strategies for effective purchasing and administration of high quality healthcare services, as well as strategies for promoting health and wellness.

The purpose of the Data Analytic Interface System is to combine all of the State’s data assets into a single, integrated data repository that is user friendly, improves staff productivity, produces verifiably correct reports, and performs its functions in a daily business management timeframe. To deliver the system, Thomson Reuters integrated 5-6 years of claims and eligibility data from the Medicaid program, from SCHIP, from the State Employee Health Plan. KHPA also is having Thomson Reuters integrate data from the state’s 20+ commercial health insurers, to create an all-payer claims database (APCD). Altogether, the KHPA Advantage Suite database will contain claims for approximately 1,200,000 individuals. The implementation of the Medicaid program, SCHIP, and State Employee Health Plan has been operational for over a year. Integration of claims data reported to the state by commercial insurers is underway.

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8.2.3.5 Information Technology Capabilities

We are now on our fifth generation of healthcare decision support systems. Our commercial-off-the-shelf (COTS) software is built and maintained by our own in-house, dedicated team of expert software developers focused on advanced healthcare decision support. Each year we invest millions of dollars toward software development. Our latest version of Advantage Suite reflects our successful efforts toward SOA-MITA alignment and the large laboratory of real world experience provided by more than 250 large-scale Advantage Suite customers in Medicaid, health plan, and large employer markets.

Over the years, we have developed a highly customizable, well integrated, enhanced Medicaid data model and have delivered more than 30 updates/upgrades to our software applications in the state Medicaid market. In recent years, we have expanded our experience by building data warehouses for our Medicaid clients that integrate many sources of data beyond traditional claims and eligibility.

We will house the system in the Thomson Reuters North American Data Center in Eagan, Minnesota. Our main campus has five data center facilities with more than 100,000 square feet of critical high-density raised floor space, utility service-independent power capacity, hardened security features, and unparalleled redundancy for critical systems. Each facility operates 24 x 7. More than 500 IT, security, power and other engineers support the infrastructure.

This Tier III Data Center has been designed from inception around continuous operation in a secure, reliable environment. It is audited on a regular basis and has high levels of physical security, in terms of both external and internal access. The facility is fully equipped and currently receives and houses hundreds of millions of healthcare claim and encounter records each year from hundreds of healthcare data suppliers. Based on nearly 30 years of experience working with healthcare claims and managed care encounter data, Thomson Reuters has developed highly efficient and effective methodologies and systems for working with this data.

We perform audits and conduct tests regularly to identify network, system, or application vulnerability as well as to review security, data handling and management practices, physical security, authentication and authorization controls, and HIPAA compliance.

In addition, SAS 70 Type II audits have been conducted for the past six years. Each year, we have achieved certification without exception. The SAS 70 audit covers the key controls involved in Advantage Suite operations, as well as the environment in which our systems are developed and maintained. The SAS 70 certification covers 12 major control objectives and 67 key controls.

8.2.3.6 Large-scale DW/DSS Expertise in Healthcare

BMS will benefit from the expertise Thomson Reuters provides in designing and developing trusted healthcare information databases, applying methodologies for understanding data, and developing easy-to-use tools that organize data for better healthcare decision making. Our core capabilities are:

Data Management: We integrate and organize data across multiple sources to support our customers' management decisions. Our experience is comprehensive, ranging from single source databases to some of the largest, most complex, and diverse data warehouses in the industry.

Software Applications: Our business focus keeps applications relevant to support day-to-day decision-making. We continually update our software to remain at the leading edge with

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advances in the industry. We partner with other leading software developers, such as Cognos, to provide comprehensive solutions to our customers.

Methods and Analysis: We enhance the decision making value of our clients' data using advanced methods, many developed by us and now standard in the industry.

Research: We specialize in health services research, outcomes assessment and evaluation, and cost-effectiveness studies.

Service: We believe leading-edge products must be supported by exceptional service and are recognized for the service we provide for our customers year after year.

People: We seek out the best people in the industry, and our employees are consistently identified by clients as a key reason for selecting and keeping us as a business partner.

Information Assets: We have some of the largest proprietary healthcare databases in the world to support benchmarking, modeling, strategic planning, and healthcare research. Our MarketScan research database has been the source of data for more than 350 peer-reviewed articles since 2000.

Since our inception in 1981, we have been at the forefront of the development of integrated, enterprise decision support systems. The foundation of our ability to deliver large-scale data warehouse projects is the sound healthcare methodologies and data management techniques for which our company is known throughout the industry. No other company in healthcare has a better track record for providing large-scale decision support systems in the healthcare industry to some of the nation’s leading employers, health plans, and government agencies. Healthcare enterprise decision support systems and data warehouse solutions are the major focus of our business, not a sidelight or “add-on” product.

Currently, our largest decision support installation is the data warehouse we maintain for CMS in their Baltimore data center. This data warehouse integrates claims data for almost 45 million Medicare beneficiaries and supports a wide variety of financial and medical review uses.

Additionally, some of the largest healthcare databases in the United States have been built by Thomson Reuters, including those listed in the table that follows.

Client Name Large-Scale Healthcare DW/DSS Projects - Description of Services

Medicare Program Safeguard Contract

The data warehouse for fraud detection in Medicare occupies 5+ terabytes of data, representing services for more than 12 million beneficiaries across 14 states.

Health Care Services Corporation (BCBS IL, NM, TX)

HCSC’s Advantage Suite data warehouse integrates claims data for 12.4 million covered lives. There are over 100 users and the database is updated monthly. HCSC is not only our largest health plan database currently in production, but also one of our heaviest and most advanced client users.

WellPoint Central (Anthem IN, KY, MO, OH, and WI)

We are integrating various data types (medical, pharmacy, lab, dental, vision, CDHP, HRA, HSA, wellness, etc.) for their 18.5 million members and supporting over 20,000 employer accounts with analytic reports. The system will maintain 42 months of data and contains claim service line level detail.

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Client Name Large-Scale Healthcare DW/DSS Projects - Description of Services

Ohio Department of Jobs and Family Services (ODJFS)

ODJFS is the Medicaid agency for Ohio. The Department’s data warehouse integrates 84 months of data from fee-for-service medical claims, drug claims, eligibility data, provider enrollment data, managed care encounter data, capitation data, and other data, to provide an integrated view of the services being provided to the 1.6 million people who are covered by Ohio’s medical assistance programs. The total disk space allocated for production database instances of the Medicaid DSS is 10 Terabytes.

Blue Cross Blue Shield of South Carolina

BCBS of South Carolina’s Advantage Suite database integrates claims data for 1.5 million covered lives.

California Public Employees Retirement System (CALPERS)

CalPERS provides healthcare coverage for approximately 1.2 million people in state and local government in California. We host, maintain, and support their database. The database combines claims, encounter, and eligibility data from several HMOs, PPOs, and other sources into a single analytically-ready database that gives CalPERS the ability to understand cost and use across its entire membership.

General Motors (GM) We host, maintain, and support GM’s database. The database includes medical, prescription drug, and eligibility information for GM’s 1.1 million active employees, retirees, and dependents.

MarketScan Research Databases

Our MarketScan benchmark and research databases support public and private sector research. They represent the pooled experience of our clients for privately insured populations as well as for Medicare- and Medicaid-eligible individuals.

The databases comprise the integrated inpatient and outpatient medical claims and encounters, prescription drug experience, enrollment and eligibility information, and productivity data. These longitudinal databases link medical/ surgical and drug data with provider information and person-level enrollment, benefit plan design, and worker attendance data.

The MarketScan databases offer the largest convenience sample available in proprietary databases, with over 130 million unique patients since 1996. Since 2000, the data have been used in more than 350 peer-reviewed journal articles—a testimony to MarketScan’s comprehensiveness and credibility.

8.2.3.7 Sophisticated Healthcare Analytics

We integrate disparate data, apply advanced clinical and financial analytic methods, and create timely information to rigorously evaluate program outcomes and budgets, investigate fraud and abuse, manage special populations, and support legislative and policy activities. These data-driven strategies generate results; our clients have enjoyed measurable program improvements that were made possible because of the sophisticated analytic information our solutions delivered. Below are a few examples of advanced analytic capabilities we have delivered to two of our State Medicaid clients who have agreed to serve as references to BMS, South Carolina and Georgia.

South Carolina

We have served as the decision support system contractor for the South Carolina Department of Health and Human Services (SC DHHS) since 2005. Below are three examples of how we have provided advanced analytics to help the agency.

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Exploring Cost Growth: Due to the recent weakening economy and state revenue shortfalls, SC DHHS implemented various Medicaid program modifications to address budget reductions. SC DHHS needed to target areas that would achieve their reduction mandates quickly but be data-driven. Therefore, they turned to their Thomson Reuters decision support system to (1) identify focus areas that were driving overall cost increases, and (2) explore legislative and stakeholder requests for program area reductions/preservation.

Our analysts teamed with key SC DHHS program and reporting staff to develop a strategy for examining recent cost growth factors addressing the State’s reporting needs:

Growth patterns and differences when using dates of payments and/or service

Completion factor trends and impact on claims run-out for managed care transition

Low Income Medicaid (LIM) enrollment comparison to unemployment rate growth

Overall cost and use by major funding sources

Overall cost and use by eligibility categories

Seasonal ER, Office Visit, and DME cost and use trends

Focused studies on mental health and low birth weight babies

SC DHHS utilized the analysis to identify high-cost growth areas amenable to budget reduction. They proposed reductions and supported the proposals with data-based results

Examining Hospital Readmissions: With a focus on reducing costs and improving healthcare, SC DHHS was interested in an examination of readmissions and employed Thomson Reuters to conduct a high-level analysis of five specific clinical conditions of interest. We provided readmission rates and net payment information for readmissions within 15 and 30 days, both for the same clinical condition as the initial admit and for all readmissions. Additionally, readmission rates and costs were provided by Major Diagnostic Category (MDC) and for the top 20 Diagnostic Related Groups (DRGs), as ranked by net payments. Following the initial analysis, SC DHHS further stratified this information by the four plan types: (1) Fee-For-Service Plans; (2) Medical Home Network Plans; (3) Managed Care Plans; and (4) Total Health Plans. Lastly, hospital-specific readmission rates by clinical condition at 15 and 30 days were analyzed and information by clinical condition and age group was included for the largest hospitals.

The results of this project have the SC DHHS staff working with the hospitals to identify best practices and programs to reduce readmission rates and improve the quality of care for their Medicaid members.

Monitoring Care Coordinated Programs: SC DHHS embarked on a project to migrate the pre-dominantly fee-for-service Medicaid population to managed care (South Carolina Health Connections Choices). SC DHHS determined that beneficiary choice in plan selection would be a key component in achieving the competition between plans to drive quality and service options.

To assess the progress of the shift to coordinated care, SC DHHS partnered with Thomson Reuters to develop four managed care dashboards (two monthly and two quarterly). SCDHHS needed a simple and easily understood tool that would address the following four areas of concern: (1) Enrollment; (2) Disenrollment; (3) Data Quality; and (4) Care Coordination.

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SC DHHS and Thomson Reuters developed these dashboards using Advantage Suite to assist in identifying trends in enrollment and disenrollment, as well as data quality problem areas that would impact analytic reporting.

Using these care coordination reports, which compares key expenditure and enrollment metrics across managed care plans, SC DHHS worked with their managed care broker to increase focused outreach as needed based on recent trends with managed care plans. In addition, they worked with managed care plans to improve the quality of encounter data submission.

Georgia Department of Community Health

We have served as the decision support system contractor for the Georgia Department of Community Health (DCH) since 1996. Below are three recent examples of how we have assisted the agency in providing high-quality care to recipients:

Low Birth Weight Study: DCH manages the Medicaid program provides services to an average of approximately 1.6 million members in both Medicaid fee for service and managed care arrangements. One focal point to improve population health has been to enhance the care provided to both new and potential mothers in the Medicaid system to limit risk factors that can result in newborn complications. In May 2009, Thomson Reuters was asked to perform a study focused on mothers of low birth weight newborns.

In this study, we analyzed all females who had delivered a newborn within calendar year 2007, regardless of the birth outcome. Working with DCH, we developed custom logic to establish the critical link between newborns and mothers often made impossible using simple Medicaid data. Once the link was established, we created member-specific timeframes for each mother – representing the pre-conception, prenatal, and postpartum stages in order to better understand risk factors and potential outcomes of low birth weight newborn deliveries. Over 30 statistical measures were completed within the study:

The study showed potential risk factors, as well as areas where early intervention might help improve delivery outcomes. DCH was able to better understand low birth weight rates in the Medicaid population and direct policy towards improved care, as well as identify services that could be provided in order to reduce to rate of low birth weight newborn deliveries. This also led to future analyses where the state would allocate additional funding towards potential mothers in the Medicaid system.

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Family Planning Program: The Georgia Family Planning Services Waiver provides funding for family planning services to women in the Medicaid system, such as: contraceptive methods and supplies, evaluation and management services, preventative health services, management of sexually transmitted diseases, and pregnancy testing and counseling. It also provides education and counseling services related to reproductive health, risk reduction, preventative care, substance abuse, domestic violence, and contraception methods. The goals of the waiver are to:

Reduce Georgia’s low birth weight and very low birth weight delivery rates

Reduce the number of unintended pregnancies in Georgia

Reduce Georgia’s Medicaid costs by reducing the number of unintended pregnancies in women who otherwise would be eligible for Medicaid pregnancy-related services.

To apply for the waiver, the state was required to complete an extensive application process, which had to include supporting statistical data. In early 2010, DCH asked Thomson Reuters to help with the application process by developing supportive analytics around population delivery rates and costs. We created a detailed methodology to provide accurate and informative data around the following measures:

Population health of women aged 18-44

Number of newborn deliveries with/without complications

First year of life medical and pharmacy costs for the following newborn delivery outcomes:

Normal Weight Newborns

Low Birth Weight Newborns (LBW)

LBW Newborns + NICU Stays

LBW Newborns + Cerebral Palsy

Very Low Birth Weight Newborns (VLBW)

VLBW Newborns + NICU Stays

The resulting report we provided was included in the state’s application for this program through the Family Planning Waiver. The state was awarded the wavier and launched The Planning for Healthy Babies Program (P4HB) demonstration project, which will run through December 2015. We will support the state by providing program evaluation services.

Establishing Performance and Quality Measures: Each year, the Georgia DCH must demonstrate population health improvements through quantitative and comparative data analytics. In the past, the state used a custom set of performance metrics for just this purpose. However, these custom measures were never comparable to other state or nationwide benchmarks and did not allow the state to effectively evaluate the care of its Medicaid members.

For 2010, it was a state initiative to move towards a unified set of metrics following industry standards. Thomson Reuters was asked to complete over 45 measures using strict guidelines from the Healthcare Effectiveness Data and Information Set (HEDIS) and Agency for Healthcare Research and Quality (AHRQ). Results were completed for three separate years, so the state could see how the implementation of their Managed Care program has impacted the quality of care services as well as track population health over time.

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All HEDIS-based measures were completed using a NCQA certified software package called Quality Spectrum Insight from Catalyst Information Technologies, Inc. This software allowed us to develop highly accurate results that could be compared across other state and national benchmark standards. All AHRQ measures were developed using our proprietary data mining tool, following strict AHRQ technical specifications and guidance.

The final report included over 50 total measures, each following the most stringent and accurate guidelines possible. The state was able to compare these results to those of other states, and submit to CMS as a proxy of quality improvement of care and outcomes within the Medicaid system. All methodologies, source code, and results were validated by Georgia’s External Quality Review Organization (EQRO) to confirm measure accuracy. Measure results can now be found on the GA Department of Community Health website.

8.3 References

REFERENCE #1

Client South Carolina Department of Health and Human Services (DHHS)

Contact

Ms. Kathleen Snider Bureau Chief, Compliance and Performance Review 1801 Main Street Columbia, SC 29201

Phone: (803) 898-1050

Email: [email protected]

Brief Description of Services Provided:

The South Carolina Department of Health and Human Services (DHHS) operates South Carolina’s $4 billion Medicaid program, which provides healthcare coverage for more than 850,000 South Carolinians served by more than 30,000 doctors, hospitals, and other healthcare providers.

In 2005, the State awarded us a 5-year contract to provide a healthcare decision support system (DSS) and executive information system (EIS) using Thomson Reuters Advantage Suite. In 2010 we were awarded the continuation of these services with the addition of MARS reporting. The DSS includes the most recent seven years of claims and provider data from the state’s Medicaid Management Information System (MMIS) and eligibility data from the Medicaid Eligibility Determination System (MEDS). We host and maintain the DSS database in our Data Center. The Department has approximately 100 trained users accessing our solution.

The system supports program planning and evaluation, financial reporting, medical policy development, healthcare utilization management, Medicaid eligibility analysis, actuarial rate setting, and other functions. It also serves as the DHHS surveillance and utilization review system (SURS), as mandated by CMS for the detection and investigation of healthcare fraud and abuse and other purposes. Advantage Suite was approved for continuing SURS certification in South Carolina in 2007, as part of an existing MMIS system and will provide MARS certification in 2011. In conjunction with the DSS/SURS, we are also providing DHHS with fraud detection capabilities including advanced algorithms. We have delivered 58 algorithms to date. DHHS staff actively use the results to target on-site provider reviews, initiate provider self-audits, support cases under investigation by the Attorney General, etc.

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REFERENCE #2

Client Georgia Department of Community Health (DCH)

Contact

Mr. Darryl Dees Manager, DSS Analysis Unit 2 Peachtree Street, NE Suite 5th Floor Atlanta, GA 30303

Phone: (404) 656-5395

Email: [email protected]


Through renewals of two contracts originally awarded in 1996, Thomson Reuters has provided a healthcare decision support system (DSS) and executive information system (EIS) for the Georgia Medicaid program and the Georgia State Employee Health Benefit Plan (SHBP), both of which are administered by the Georgia Dept. of Community Health (DCH). In 2006, DCH awarded Thomson Reuters a single new, consolidated contract through a competitive procurement. Under the new contract, we integrated what were two separate Medicaid and State Employee databases into one combined solution that enables DCH users to easily analyze data on all 2.1 million lives covered under the different programs.

The DSS (Advantage Suite) consists of an integrated, customized database that incorporates medical claims, prescription drug claims, nursing home data, provider files, eligibility, and reference data for Georgia’s 1.6 million Medicaid recipients and 200,000 SCHIP enrollees. For SHBP, the DSS integrates data from diverse employee plans – Indemnity, PPO, HMO, and CDHP. The DSS provides comprehensive analytical capabilities, including advanced healthcare analysis such as the Medical Episode Grouper (MEG). It allows flexible drill-down to detailed clinical and financial information.

DCH’s five most recent years of data for the Medicaid and state employer database include more than 600 million rows of data and require up to three terabytes of disk space. We host and maintain the database in the Thomson Reuters Data Center, with monthly updates.

We also provide in-depth analytical and data management consulting support, serving DCH with a dedicated account team consisting of 9 FTEs, most of whom are based in Atlanta.

REFERENCE #3

Client Louisiana Department of Health and Hospitals (DHH)

Contact

Mr. Quint O'Connor Program Manager, Program Integrity 628 N. 4th Street Baton Rouge, LA 70802

Phone: (225) 216-6148

Email: Quint.O'[email protected]


As a subcontractor to Molina, Thomson Reuters provides its J-SURS tool as the full SURS / fraud and abuse solution for the State. We provided DDI services to install the system and now deliver operations support including system maintenance, monthly data base refresh, and user support and training. Approximately 30-40 Molina staff use the system daily to support data mining, case development, and recovery. Four Molina staff are power users. The State has one power user, who uses the tool every day, and 3-4 casual users. There is one MFCU user. The State/Molina have a “project” model where they meet to determine areas on which to focus, and then the power users develop reports and evaluate initial results, which are then referred to analysts for more detailed investigations. Analysts generate many of the project suggestions.

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8.4 Additional Relevant Experience Besides the three reference projects above, we describe the following additional projects that demonstrate our experience of relevance to the BMS DW/DSS project. The engagements listed here are just of few of the many large-scale healthcare data integration projects that Thomson Reuters has delivered over its 30-year history in the healthcare payer market.

Idaho Medicaid DW/DSS

Thomson Reuters designed, developed, and implemented a comprehensive healthcare decision support system and data warehouse (DSS/DW) for the Idaho Department of Health and Welfare (DHW) as part of the state’s efforts to modernize its Medicaid Management Information System. The DSS/DW system improves DHW’s ability to manage and mine data from the nine million healthcare claims submitted to the state Medicaid program each year.

DHW uses the analytic and reporting capabilities of the DSS/DW to strengthen management of Medicaid programs, measure cost effectiveness and quality of care, forecast budgets, and fulfill federal Management and Administrative Reporting (MAR) requirements. The system generates information that supports program planning and evaluation, financial reporting, healthcare utilization management, Medicaid eligibility analysis, actuarial rate setting, and other functions. It also serves as the Department’s Surveillance and Utilization Review System (SURS), which is mandated for every state Medicaid program by the federal government to help detect healthcare fraud and abuse.

Our solution integrates an analytically ready data warehouse with advanced methodologies and business intelligence applications, including Advantage Suite, to provide a powerful decision support system. It is specifically configured to meet the unique needs of the Idaho Medicaid program and replace the previous information system.

MaineCare (Medicaid) DW/DSS

MaineCare is the State’s Medicaid program, which is operated by the Maine Department of Health and Human Services. In 2008, MaineCare chose Unisys (now Molina Medicaid Services) as its prime contractor to implement a new Medicaid Management Information System (MMIS). Thomson Reuters has built a data warehouse customized for Maine that integrates data from healthcare claims, eligibility files, and many other data sources. This integrated, analytically-ready, data warehouse and decision support system utilizes Advantage Suite, which delivers built-in healthcare intelligence for turning the source data into meaningful, actionable information. The implementation process is nearing completion.

The DW/DSS will enable MaineCare to better understand and manage healthcare benefits for its 371,000 enrollees. MaineCare will use the system to coordinate the care of high-cost patients, plan and monitor the state Medicaid budget, make policy changes, respond to information requests from the state legislature and the general public, and better control the costs of the Medicaid program. The system also will serve as the certified Management and Administrative Reporting System (MARS), and J-SURS will be installed as the SURS solution.

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Missouri Medicaid DSS and Fraud Detection System

The Missouri Department of Social Services, MO HealthNet Division (MHD), is the Medicaid agency for Missouri. Since 1997, Thomson Reuters has been the prime contractor providing a comprehensive decision support system (DSS) for managing the MHD Medicaid program, which covers more than one million beneficiaries. A competitive re-bid resulted in renewal of the contract and replacement of the original DSS in 2002 with our newest software as a Fraud and Abuse Detection System (FADS). We have delivered more than 200 fraud algorithms to date. The system supports the agency’s overall program monitoring and investigation needs and is used to manage health costs, quality, and access to care. MHD's 30 most recent months of Medicaid data are included in the databases. We host and maintain the databases in the Thomson Reuters Data Center.

In 2007 Thomson Reuters conducted a comprehensive review and gap analysis of the MHD program integrity department. As a result, MHD expanded its relationship with us later that year. We assumed primary responsibility for the analytic claims-based investigation for MHD Program Integrity, with the goal of streamlining the investigative process. This engagement also included the implementation of our data mining tool.

CMS One PI Project

“One PI” (Program Integrity) is a CMS initiative to link Medicare and Medicaid data analytically in support of cross-program analysis and payment integrity analytics at the national level. Thomson Reuters is part of a team to deliver this integrated data repository for CMS.

The project involves building an analytically-ready database of Medicare and Medicaid claims, using Advantage Suite, so users can analyze the claims for program integrity purposes. Initially the system will be used to find over-payments, fraud, waste, and abuse, but the same software solution that we provide for One PI may also be leveraged for research, cost and use analysis, program analysis, disease management, and other cross-cutting program management functions.

The architecture for this project uses the Teradata relational database management system as the back-end database and Business Objects and our decision support tools as the initial front-end analytic applications. The overall solution enables advanced analytics of Medicare and Medicaid data via a modernized web-based portal infrastructure. The solution includes advanced methods such as episodes of care, hospital admissions, and other analytic constructs to provide enhanced analytic capabilities. The solution integrates data across the Medicare and Medicaid programs and will integrate all claim types (Part A, Part B, DME, and Part D) into a single repository that will provide proven views to help analysts manage and analyze this extremely large database.

The initial data sets included in the implementation of this data warehouse are the Ohio and Pennsylvania Medicaid claims and enrollment data. Separate data are received per state as well as per data type (professional, facility, drug, eligibility, and provider), making the data loading process complex. Additionally, the project team has integrated Medicare data for all 45 million beneficiaries into the data warehouse. Our experience in healthcare, data integration, and data quality has played a key role in the success of building the One PI system.

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CMS Medicare Program Safeguard Contract

Thomson Reuters serves as the fraud detection software and data analysis subcontractor to CSC AdvanceMed, a Medicare Program Safeguard Contractor (PSC) in eight states. As a part of this team, we have provided the analytic data warehouse development, analytic systems, reporting and healthcare fraud domain expertise on several PSC task orders encompassing millions of Medicare beneficiaries. We integrate data from Medicare Part A, Part B, Home Health, Durable Medical Equipment, and provider data from multiple source systems, as well as beneficiary enrollment data. We designed, developed, implemented, and now maintain and operate a multi-state database to facilitate rapid fraud detection and analysis and provide our DataProbe software tool for rules-based data mining. Through this contract, the AdvanceMed Team has identified tens of millions of dollars in Medicare program fraud, waste, abuse, overpayments, and vulnerabilities. The Thomson Reuters data warehouse environment is updated monthly and currently includes 5+ Terabytes of data for over 12 million Medicare beneficiaries.

CMS is in the process of reconfiguring the PSC contract; it will be replaced with Zone Program Integrity Contractor (ZPIC) engagements. Thomson Reuters currently has ZPIC contracts for Zones 2, 4, and 5.

CMS MSIS Encounter Data Quality

Since 1999, CMS has received managed care encounter data from states’ Medicaid Statistical Information System (MSIS) file submissions. States use this standardized system to transmit administrative Medicaid data to CMS. Concerns regarding the completeness and accuracy of MSIS encounter data posed potential challenges for its eventual use in supporting program development, monitoring activities and conducting research. CMS retained Thomson Reuters for a project spanning 2000–2007 to:

1. Develop a process to assess MSIS encounter data completeness and quality;

2. Provide standardized assessment feedback aggregated to the state level, managed-care entity level, and by key MSIS data fields; and

3. Explore using the data to calculate Medicaid managed care program performance measures.

The data completeness and quality assessment activities applied objective review criteria to standard CMS data quality reports. Using data deemed sufficiently complete, Thomson Reuters developed analytic tables with aggregated counts that included basic descriptive analyses of the Medicaid managed care population, utilization counts of services represented by encounters, and, simple quality/clinical analytic tables. These processes helped identify common and state-specific issues related to the completeness and quality of MSIS encounters. We provided feedback to CMS and the states via customized feedback reports. Together, these project components provided CMS with an ongoing process to evaluate and to improve MSIS encounter data submissions. This enabled CMS to continually assess the feasibility of using MSIS for Medicaid program management and oversight as states' encounter data collection practices mature.

SAMHSA Integrated Data Analysis and Technical Assistance Projects

Thomson Reuters was the prime contractor for a multi-year project, the Integrated Medicaid and State Agency Mental Health and Substance Abuse Data Analysis and Technical Assistance Project, for the US. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA). This project was one of a series of related projects that SAMHSA undertook to better

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understand the total cost, use, and outcomes of mental health and substance abuse (MH/SA) treatment across multiple funding programs.

Our role in this initiative began with a project called “Development of an Integrated Database and Spending Estimates for Mental Health and Substance Abuse Treatment” (the Integrated Database). We led the process of designing, piloting, developing, and implementing a database that integrated data from state mental health systems, alcohol and other drug program data systems, and Medicaid data systems. Data from three states is in the database: Delaware, Oklahoma, and Washington. We linked in demographic and diagnostic data and used probabilistic matching techniques to create unique person identifiers across programs for longitudinal population-based analysis. The project served as a model for how such integrated databases could be developed. Our company maintained this Integrated Database over the course of five years and supported the efforts of researchers to access integrated datasets from it. We used the services of four subcontractors to conduct the research.

A related project, also led by Thomson Reuters, was entitled “Integrated Medicaid and State Agency Mental Health and Substance Abuse Data Analysis and Technical Assistance” (the Technical Assistance project), which began in September of 2001. The objective was to educate and support individual states in building and maintaining their own integrated MH/SA databases, using the original three-state Integrated Database as a model. We tailored the Technical Assistance to the states to meet the specific needs of each participating state and included advice in linking data across multiple settings, evaluating data elements from the different health systems, comparing and understanding how the data conform to standards, and designing custom reports and analyses. This project concluded in 2007.

In the final two years of the Technical Assistance project, we supported a unique CMS/SAMHSA initiative. This joint initiative provided support to state projects using health information technology to create shared data systems, fostering the development of a community of state and federal partners interested in learning from each other to improve behavioral health outcomes. The emphasis shifted from linking existing data systems, to creating interoperability in systems through improved data standards, shared programs, and innovative approaches to collecting and sharing information including the expanded use of web-based systems and electronic health records (EHR). This effort built on the CMS MITA initiative.

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