Tackling Future CMS Requirements

Tony Trenkle Chief Information Officer and Director,

Office of Information Services

Topics for Today

•  CMS Operations •  Shared Services •  Big Data •  Data Center Consolidation •  Mobility

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CMS Operations

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•  More than 98 million beneficiaries (not counting additional potential 30+ million Americans that will be added through health care reform).

•  CMS expends approximately 1 trillion dollars annually on Medicare, Medicaid, and CHIP programs.

•  More than 900 million Medicare fee-for-service claims

•  More than 1.6 billion claims for Medicaid beneficiaries

•  More than 11 million home health assessment records

•  More than 13 million nursing home assessment records

CMS Operations  

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CMS IT

•  Counting payments to the states the FY12 operating plan was $3.8 billion.

•  If CMS were a separate agency, that would make us the third largest IT budget behind only DoD and DHS.

•  CMS’s IT infrastructure is very decentralized and funded mostly on a programmatic basis.

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TRANSFORMATION GOALS •  Meet Legislative Mandates with

Enterprise IT Shared Services

•  Create the Data Infrastructure to maximize CMS Data and Information Product Use

•  Transform IT Portfolio Management and Governance

•  Transform CMS IT Operations

•  Improve CMS’ Information Security and Privacy Posture

•  Identify and Adopt Innovative Technologies

•  Improve Organizational Effectiveness

Critical IT Challenges …CMS IT Transformation Goals

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CHALLENGES •  Huge ACA IT Requirements

•  Successful Health Reform depends on more and better data

•  IT funding from multiple budgets

•  Complex and Old IT infrastructure

•  Decentralized IT infrastructure

•  Rapid Technological change

•  Heavy Contractor Presence/Aging Federal workforce

Shared Services

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•  What: Scalable, reusable business/technical solutions that serve multiple business processes

•  Why: Tight budgets, need to leverage solutions across business lines and enhance interoperability

•  Four initial “big hitters” selected to be implemented

–  Enterprise Identity Management (EIDM) –  Enterprise Portal

–  Master Data Management (MDM)

–  Business Rules Engine

Enterprise Shared Services

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Stages of Shared Services

FY2012 Foundation

work

FY2013 Supporting

major programs

FY2014 Showing real ROI

for programs

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CMS Enterprise Shared Services: EIDM

Business Rules Engine Service

Enterprise Portal

Master Data Management

Enterprise Identity

Management Shared Service

Individuals will have a single identity for engaging in business with CMS that meets all federal security requirements

Remote Identity Proofing (RIDP)

User Identification, Verification and Authentication

Enterprise Identity Management (EIDM)

Managing connections from user to a CMS application

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•  Reduce overall CMS access management costs by combining existing authentication and authorization systems

–  Over 175 CMS applications with 135,000+ users currently using seven different access management systems

•  Meet the requirements to support the ACA Health Insurance Exchange –  Exchanges will potentially add 30 – 50 million users –  Legislation requires a simple and clear path for customer experience

•  Improved experience for external users that access multiple CMS systems (e.g., providers) that currently have different proofing

•  Future: Ability to rely on other identity proofers (federated identity) •  Current Status

–  Contracts have been awarded for remote ID proofing and enterprise ID management –  First application uses will begin to be implemented over the next several months

What do we deliver to business?

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CMS Enterprise Shared Services: Portal

Master Data Management

Enterprise Identity

Management

Business Rules Engine Service

Enterprise Portal Shared Service

A central preferred channel for beneficiaries, providers, organizations and States to receive CMS information, products, and services

Secure access to enumeration, e-enrollment, e-Registration, status checking, and reporting services

Improved usability and higher customer satisfaction

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•  Consistent user interface design to support a “single face of CMS” •  Integrated access to multiple CMS websites/portals reduces need

for users to access multiple URLs to access the information or applications they need

•  Ability for users to customize/personalize their portal experience. •  Current Status

–  Initial portal capability has been implemented. –  Additional portlets will be added in the next several months

What do we deliver to business?

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CMS Enterprise Shared Services: MDM

Enterprise Identity

Management

Business Rules Engine Service

Enterprise Portal

Master Data Management

Shared Service

A suite of data records and services that will allow CMS to link and synchronize beneficiary, provider and organization data to multiple disparate sources

Provider and beneficiary profiles (book of record) will be obtainable through a singe call to a trusted, authoritative data service that is part of the MDM system

Relationships between beneficiaries, providers and organizations can be tracked across all CMS programs

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•  Foundational, centralized source of reference data for Providers, Beneficiaries, Organizations/Plans, and Programs and relationships between these entities

•  Integrated data from many disparate data sources (including Medicaid)

•  Data services and BI tools that applications can consume to access the data

•  Current Status: –  Initial support provider and beneficiary alignment/assignment for ACO SSP and

Pioneer demos was implemented in May –  Other capabilities will be implemented in the next several months

               

What do we deliver to business?

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CMS Enterprise Shared Services: BRES

Enterprise Portal

Master Data Management

Enterprise Identity

Management

Business Rules Engine

Shared Service

A software tool that can execute one or more business rules within CMS IT application code

Establish business rules governance policies for creating and enhancing business rules

Management of all enterprise rules, define the relationships between different rules and relate some rules to the IT applications accessing the service

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•  “Rules engine” tool that supports rule development and translation to consumable code that applications can call

•  Centralized repository of business rules that new applications can use as-is or modify

•  Standardized complex logic currently embedded in many different systems (e.g., what is a dual eligible)

•  Current Status: –  Support ACO Pioneer processing with beneficiary and provider cross-check

rules 9/2012 –  Discussions underway to capture cross-program precedence rules for

coordinated care programs

What do we deliver to business?

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Medicare Provider Experience – Today at CMS

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Provider Enrolment Chain and

Ownership System (PECOS)

National Plan and Provider

Enumeration System

(NPPES)

Future State – Increased Automation and Self-Service

Provider Book of Record

Automated Data Capture, Self Service

Updates

Automated Verification &

Screening

Provider Portal

Enumerate

Enroll A, B

Register Demos,

PQRS, etc..

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2

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1.  Iden(ty  2.  Licensure  3.  Legal  4.  Criminal  5.  Geo-­‐Spa(al  6.  Exclusion  Data  

Used by

Medicaid

MACs

Program Integrity

ACOs

7.  Tax  and  Business  8.  Provider  Death  No(ce  9.  Provider  Financial  

Informa(on  10.  State  Provider  Enrollment  

&  Eligibility  

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CMS and Big Data

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What is “Big Data”? © 2012 NetApps Inc. All rights reserved

Complexity

Volume Speed

“Big Data” refers to datasets whose volume, speed and complexity is beyond the ability of typical tools to capture, store, manage and analyze.

Coined by Francis Diebold, professor of economics at the University of PA in 2000, when “Big” meant Gigabytes / day1

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Data Trends

STRUCTURED DATA

80% UNSTRUCTURED

DATA

Ø 80% of world’s data is unstructured (Rise of Mobility devices, and machine generated data)

Ø 44x as much data over the coming decade (35 zettabytes by 2020)

Ø Majority of data growth is driven by unstructured data (Active archives, Medical images, Online movies and storage, Pictures)

Ø  Information is centric to new wave of opportunities (Retail, Financing, Insurance, Manufacturing, Healthcare,…)

Ø  Industry is employing Big Data Technologies for Information extraction.

Source:  Intel  Developers  Forum,  September  2012  Co-­‐presenta(on  by  Rajiv  Synghal,  Principal,  Kaiser  Permanente;  “Big  Data  

and  Analy(cs  in  Healthcare  and  Life  Sciences.”      h[p://intelstudios.edgesuite.net/idf/2012/sf/aep/HLCS002/HLCS002.html  

World’s Data

UNSTRUCTURED DATA

Ø 90% of Kaiser’s data is unstructured (80% of EHR and Image data)

Ø 25x as much data over the coming decade. (One exabyte by 2020)

Ø Majority of data growth is driven by unstructured data (Medical Images, Videos, Text, Voice)

Ø  Information is centric to providing Real time Personalized Healthcare. (Requires Contextual – device, environment, spatial, Demographics, Social, and Behavioral profiles in addition to medical information)

Ø Kaiser is evaluating Big Data Technologies…

Kaiser’s Data

STRUCTURED DATA

90% UNSTRUCTURED

DATA

•  Currently, we store and maintain: –  ½ a terabyte of data each month

(roughly 1.7 million pieces of 8 1/2 x 11 paper)

–  370 terabytes of Medicare data

–  30 terabytes of Medicaid data

–  10 terabytes of unstructured data –  Quality data –  Encounter data –  Other

•  By the end of 2015: –  Medicare Claims Data will reach approximately 700 terabytes –  Medicaid Claims Data will reach approximately 100 terabytes

Big Data at CMS  

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Risk to Payor Risk to Provider

Fee-For-Service Shared Savings Episodic Bundling Global

Payment Traditional

Fee-For-Service Traditional Capitation

Payment Mechanisms are Shifting

Current Future

Accountable Care Organizations

Patient Centered Medical Homes

Care Models Clinical Service Centers (Retail Clinics etc..)

Episodes of Care (CABG,

AMI etc.)

IT and Data are the lynchpins 24

Data Warehousing Vision

Maximize the full potential of CMS’ vast data resources to realize an enterprise data warehouse environment that can support the internal and external analytics for CMS’s future business model and to help transform the national healthcare sector.

•  Goal #1: Design a scalable, sustainable data warehouse environment that supports integration of new data sources such as encounter, quality and clinical data to the traditional claims, beneficiary, and provider data sources.

•  Goal #2: Provide an easily accessible, efficient, and secure environment for analyzing and extracting the vast sums of CMS data.

•  Goal #3: Enable business use of data without the need to understand underlying technologies, evolving to a self-service model.

•  Goal #4: Provide CMS user communities with the tools and information required to make timely informed decisions and drive innovation (including but not limited to internal and external users, such as analysts, researchers, states, provider organizations, and Accountable Care Organizations).

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Data Warehousing Business Drivers

•  CMS’s role is changing from paying claims to defining quality of care, supporting multiple payment models, and driving national healthcare improvements. This will require quicker, easier answers to broader, more complex questions using more data.

•  Legislative mandates require increased coordination with other agencies and with external parties, driving CMS to standardize data definitions and formats and to embrace industry best practices.

•  CMS is becoming an information clearing house to support external researchers doing increasingly sophisticated analytics that will drive innovation in the national healthcare sector.

•  Budget and operational pressures require CMS to improve efficiency, reduce costs, provide quicker time to market and to provide better return on investment.

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2011 Environment

Public Use Files

Feedback Reports

7000 DUAs / Data Cuts

Multiple Data Repositories/

Analytics/ Knowledge Creation

•  Mostly unidirectional communication

•  Several differing points of entry into CMS

•  Multiple accounts for CMS customers for various programs

•  Corrections, Alterations, Clarifications take time

•  Costly

•  Cumbersome, yet manageable... For now.

END USER

Raw Data Streams

Providers

Researchers

Plans

States

CMS

Feedback Loop

Phone/Fax

eMail

USPS

Help Desk

END USER

The Current Environment

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Will lead to: • Hundreds of thousands of new DUAs and data cuts • Large increase in feedback reports, public use files and DUAs • Increasingly inefficient transfer of data/knowledge • Increased costs

Increasing Demands for CMS Information from: • ACO Smart Reports • 10332 (Availability of Medicare Data for Perf. Measurement • 3002 (PQRS Improvements) • 6002 (Physician Sunshine ) • 3003 (Quality Resource Utilization Reports) • 3007 (Physician Value Modifier) • CBRs for Non-Physician, Non-Hospital Providers • 10331 (Physician Compare)

END USER

Multiple Data Repositories/

Analytics/ Knowledge Creation

Providers

Researchers

Plans

States Raw Data Streams

2013-2014 Environment If There is No Change

CMS

Near Future Environment If There is No Change

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CMS Gateway

Data Enclave

Portal

Web Services

BENEFITS •  Improved business

intelligence

EXTERNAL USER

Program Data Streams

Collection

Organizing data

Maximizing Use of Data

Dissemination

Desired Future CMS Data Environment

•  Easy, timely and secure access to information

•  Reduced cost of operations

INTERNAL USER

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Providers

Researchers

Plans

States

Health 2.0 marketplace

Operations

Contractors

Fed Partners

CMS Data Products

•  Partnered with Oak Ridge National Laboratories to test new ways of faster and more efficient data management (Knowledge Discovery Infrastructure). Follow up activities will be conducted in Baltimore to test scalability and applicability.

•  Created new office to focus on data management and analysis to partner with the Office of Information Services.

•  Beginning analysis for data warehouse consolidation as part of DW strategy

•  Virtual Data Center work will help with providing more flexible environments

Key 2012 Activities

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Data Center Consolidation

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Baltimore Data Center

• MAPD Apps • HITECH

• Data Warehouses EDC 1,

• Medicare FFS Claims • Public Websites

• CWF Hosts

EDC 2 • Medicare FFS Claims

• HITECH NLR • 1-800-Medicare-

NDW

IBM Boulder • HIGLAS

Buccaneer • Quality Net

• CCW

UC San Diego • MIG Data Engine

(Medicaid)

Medicare Program Integrity

• PSCs, RACs, & ZPICs

MAC Data Centers

Research Data Centers

Development Contractors

Current CMS Data Center Environment

Inconsistent requirements for security, architecture and Software Development Life Cycle (SDLC)

Mixture of Direct and Indirect Contracts

Varying pricing and ownership models across data centers

Inefficient use of computing resources

Over 80 operational data

centers have been identified by the

OMB Data Center

Consolidation Initiative

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CMS Data Center Consolidation Strategy

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Will award a multi-billion dollar Virtual Data Center (VDC) IDIQ contract in 2012 that will: •  Support Federal and HHS data center consolidation strategies •  Consolidate the CMS data center footprint across 6-8 data centers. •  Reduce overall energy consumption by improving server virtualization, IT

equipment utilization and environmental control devices

• Eliminate redundant spending and solutions on software, infrastructure and operations

• Leverages shared resources, reduces time to market for new initiatives and provides high availability to mission critical applications

• Improve security, disaster recovery times, and effectively employ cloud and virtualization technologies.

VDC and Energy Use

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•  Partnered with the Department of Energy and Lawrence Berkeley Laboratories to have VDC Contractors to provide an Energy Conservation Measures Plan that will be evaluated as part of their overall technical solution which will include but not be limited to:

•  Current Power Usage Effectiveness (PUE) of contractor owned and contractor operated VDC facilities.

•  Minimum baseline for PUE improvement that will be monitored and reported periodically after the initial baseline report.

•  Energy consumption as it relates to CMS system’s resources, both dedicated and shared.

•  Technical solution alternatives that will improve PUE, adhere to security standards and achieve performance objectives.

•  Return on investment, realized by CMS, over a specific task orders period of performance.

Mobility

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•  Identifying the user and business requirements for mobile technologies;

•  Identifying the security and privacy requirements for mobile technologies;

•  Developing configuration baselines for mobile technologies; and

•  Providing recommendations on identified mobile technologies for implementation

HHS Mobility Strategy

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•  Work with HHS through the CTO Council and CIO Council to ensure that CMS policies and initiatives are in line with the overall Department approach and the Federal Digital Government Strategy

•  CMS has engaged in an effort to continually investigate technologies that position us to deliver services via a more mobile and agile framework.

•  The following technologies are being implemented to the CMS support population:

–  Mobile Workforce – 100% mobile capability –currently being implemented, will complete early next year

•  Windows 7/Office 2010 •  Dell 6320/HP 2760P Convertible Tablets •  Cisco Virtual Private Network for remote access •  67% work remotely on a consistent basis with as much as 85% working episodic •  100% Telework - 120 day pilot

–  Mobile Device Management-being piloted for full implementation in the next 1-2 years •  Replace RIM devices with selection options for iOS and Android •  Deploy iPads – manage with MDM enterprise system •  Bring your own device

CMS Strategy for Mobility Internal Users

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Unified Communications Anywhere, Anytime, Any Medium

Voice Over IP

Wi-Fi

Desktop VTC

Softphone

Instant Messaging & Presence

Converged Network

Unified Desktop

Enriched experience for CMS employees through integrated data, voice, video & services

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•  Optimize websites for mobile users –  Engage with customers to identify at least two existing priority customer-facing

services to optimize for mobile use. •  CMS has worked with Medicare beneficiaries and 1-800-MEDICARE customer

service representatives (CSRs) to identify Medicare.gov top tasks. This feedback was incorporated into the redesign and drove the design of the Medicare.gov mobile site's navigation structure.

–  Optimize at least two existing priority customer-facing services for mobile use and publish a plan for improving additional existing services.

•  CMS has launched a redesign of the Medicare.gov website which uses responsive design. This means that the website fully supports access on smartphones and tablets

•  Looking to mobile optimize other priority public websites within the next 12 months.

•  Ensure that shared services support mobility

Supporting Mobility Needs of Stakeholders

•  Creative tensions abound –  Rise of end user tools vs. centralized IT management –  Growing need for data and data analytics vs. maintaining

appropriate security and privacy –  Budget controls vs. more diverse IT needs

•  Policy/business requirements and technology solutions are becoming harder to align

•  Skill set needs are becoming more complicated •  New and different partnerships will be needed

What Does it all mean?

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