2

Blue Cross Blue Shield of Michigan‟s Uses MDM for ICD-10

Dennis Winkler

BCBS of Michigan

John Wollman

Highpoint Solutions

3

Agenda

• Introductions

• About Blue Cross Blue Shield of Michigan and the ICD-10 Program

• Why MDM for ICD-10?

• The Encyclopedia

• Encyclopedia‟s underpinnings: the ICD-10 Appliance

• Architecture

• MDM Platform Use

• Q&A

4

Introductions

John Wollman

Executive Vice President, Healthcare

John.wollman@highpoint-solutions.com

Dennis Winkler

Technical Program Director of Program Management and ICD-10

DWinkler@BCBSM.com

5

Agenda

• Introductions

• About Blue Cross Blue Shield of Michigan and the ICD-10 Program

• Why MDM for ICD-10?

• The Encyclopedia

• Encyclopedia‟s underpinnings: the ICD-10 Appliance

• Architecture

• MDM Platform Use

• Q&A

6

Blue Cross Blue Shield of Michigan • Michigan‟s largest nonprofit health insurer

• Independent licensee of the Blue Cross and Blue Shield Association

• Providing Health Insurance in Michigan for more than 70 years

• Mission is to improve the health of Michigan's people, communities, economy and health care system

• Several lines of business:

• Commercial

• Individual

• Medicare Advantage

• Medicare HMO

• Medicaid

• Administers health benefits to more than 4.3 million members residing in Michigan in addition to members of Michigan-headquartered groups who reside outside the state

7

ICD-10 Defined

• International Classification of Diseases, Version 10 (ICD-10) is a “new” standard for classifying diagnoses and procedures

• Established by the World Health Organization

• Mandated for usage in the U.S. by October 1, 2013

• The U.S. is the 100th country to adopt it

• Predecessor (ICD-9) is antiquated and “out of codes”

• ICD-10 is a significant expansion in codes and mappings from ICD-9 (which has been the standard for decades)

• 17,000 ICD-9 Diagnosis codes -> 71,000 ICD-10 Diagnosis codes

• 4,000 ICD-9 Procedure codes -> 72,000 ICD-10 Procedure codes

• In addition to the codes, there are about 396,000 mappings between the codes provided by the government

8

BCBS Michigan‟s ICD-10 Program

• A multi-year, large program to remediate BCBS Michigan‟s systems and processes to support and, where possible, benefit from the new standard

• Began in 2009 with an assessment

• Currently about 50 resources working on the program in some fashion

• Significant effort, requiring remediation of systems and affecting almost every area of the business

• Most processes and systems use the diagnosis and procedure codes in some way

• The impact is widely spread from a process perspective

• The impact is widely spread from a systems perspective

• The potential for business impact (financial, productivity, etc.) is huge

9

Agenda

• Introductions

• About Blue Cross Blue Shield of Michigan and the ICD-10 Program

• Why MDM for ICD-10?

• The Encyclopedia

• Encyclopedia‟s underpinnings: the ICD-10 Appliance

• Architecture

• MDM Platform Use

• Q&A

10

The Business Problem with ICD-10

• The essence of the ICD-10 „problem‟ is how to work within an environment that is migrating from 17k codes to 150k+ codes?

• This manifests itself into three primary components:

• Initial load

• Ongoing maintenance (annual update process)

• How to share this information since there are no SMEs in ICD-10

• The concept of sharing the information told us that we needed a central location to store the information

• The processes of the initial load and ongoing maintenance told us how to use the repository

• The next step was to determine if we should build or buy

• Given the advanced capabilities of tools in the marketplace, it was apparent we needed to buy vs. build

11

ICD-10 and the annual update

• The current annual update process at BCBSM is manually intensive and based on receiving/processing about 200 updates per year

• With the introduction of ICD-10, we are looking at upwards of a ten fold increase in volume

• We knew that the current manual process couldn‟t handle the number of codes that ICD-10 would introduce as part of the annual update process

• The sheer volume of ICD-10 codes would make these steps error prone.

• We would use the repository as a core component associated with re-engineering the annual code update process

12

Use of the Repository in the annual update

• Receive, research and

review of the new/deleted

codes by clinical staff

• Performing medical code

research through

sophisticated and powerful

query capabilities

• Providing functional „where-

used‟ capabilities to assist

in the annual update impact

assessment

• Providing technical „where-

used‟ capabilities to assist

in the annual update impact

assessment

The annual update process

consists of three primary steps:

The repository would be used

to assist by:

• Update the business

supported information as

required by business staff

• Update the BCBSM

production systems

(including analytics) by IT

13

ICD-10 and the MDM solution

• The business team members understood the need to better manage the huge volume increase in ICD-10 codes

• Although they understood the need, they didn‟t know what or how an MDM solution could assist in solving their issues

• The business team members were involved in all the vendor demos

• When they viewed the Informatica ICD-10 appliance, they immediately knew how the tool would help them manage the ICD-10 code environment

• The Informatica ICD-10 Appliance was subsequently purchased and installed at BCBSM

• Once the business understood the value and benefits of managing the ICD-10 codes, selling the concept of Master Data Management via the concept of an ICD-10 Encyclopedia was easy

14

Agenda

• Introductions

• About Blue Cross Blue Shield of Michigan and the ICD-10 Program

• Why MDM for ICD-10?

• The Encyclopedia

• Encyclopedia‟s underpinnings: the ICD-10 Appliance

• Architecture

• MDM Platform Use

• Q&A

15

The Encyclopedia

• MDM Applied to ICD-10:

• Centralized storage, management, governance point for diagnosis/procedure master data

• Containing ICD-9 and ICD-10 codes and mappings

• Containing government supplied and BCBS Michigan‟s value added mappings (the BlueGEMS)

• Supporting multiple business processes and analytics

• Supporting multiple invocation methods (Web Services, Batch)

• Storing the relationships from codes to places they are used (benefit tables, user lists, medical policies, etc.)

• Providing Impact Analysis when new codes are added, codes are changed or codes are deleted

16

The Encyclopedia

• Envisioned by the project team

• Initially considered to be a “custom build” opportunity

• We became aware of the Informatica MDM Hub-based ICD-10 Appliance and

decided to “buy”

• Engaged HighPoint to implement the system starting in September, 2011

• System deployed into Pilot in November of 2011

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Key Opportunity

• The Encyclopedia will add substantial value to the ICD-10 program team, but

this was not the only driver for adopting Master Data Management

• We envision using Master Data Management against other domains over time

• Member (in process)

• Provider

• Benefit

• Etc.

• The ICD-10 mandate provided the opportunity (and funding) to bring in the right

infrastructure and processes to support a master data management program

that would have been hard to fun on its own

18

Agenda

• Introductions

• About Blue Cross Blue Shield of Michigan and the ICD-10 Program

• Why MDM for ICD-10?

• The Encyclopedia

• Encyclopedia‟s underpinnings: the ICD-10 Appliance

• Architecture

• MDM Platform Use

• Q&A

19

What No One Really Wants

Provider

Contracting

Claims

Care Management

ICD-10/ICD-9

Mappings &

Translations

ICD-10/ICD-9

Mappings &

Translations

Analytics

ICD-10/ICD-9

Mappings &

Translations

ICD-10/ICD-9

Mappings &

Translations

Outbound

Transactions 2

Inbound

Transactions 2

Outbound

Transactions 1

Other Data

Inbound

Transactions 1

Extracts

Gate

way

ICD-10/ICD-9

Mappings &

Translations

Care Management

ICD-10/ICD-9

Mappings &

Translations

Clai8ms

ICD-10/ICD-9

Mappings &

Translations

Claims

ICD-10/ICD-9

Mappings &

Translations

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The Ideal Scenario

Apply proven master data management principles and tools to establish a central layer with ICD-9/ICD-10 mappings, translations, and business rules that all applications can use

Provider Contracting Care Management

Data

Warehouse

Claims

FWA, Other

Systems

Gate

way Trading Partner 2

Transactions

Syndicated Data Sources

Trading Partner 1

Transactions

Other Business Partners

Trading Partner “N”

Transactions

Business

Partners

Claims

Claims

Care Management

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Architectural View

Informatica

MDM Hub API MDM Hub Schema

Informatica Data

Director & Consoles ICD-10 Model

Pre-populated

with ICD-9,

ICD-10, GEMS,

Reimburseme

nt Maps

End Users

HighPoint ICD-10

Web Services

HighPoint ICD-

10 Applications

Applications

Claims Medical

Management

Other

Transactional Analytic

Batch Feeds

Batch Feeds Batch

Feeds

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MDM Platform Use

• Using all components of the MDM Hub

• A robust and feature-rich IDD application including:

• Extensions for Reporting from the IDD

• Multiple “child” relationships for codes and mappings

• Web services for application integration

• Some use SIF

• Some don‟t (direct reads to the database)

• A Power User “front-end” application for loading, analysis and reporting

23

Implementation Specifics

• Very rapid deployment to pilot phase

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Implementation Specifics

• Critical Success Factors

• Engaged, cross functional team

• Iterative approach to realizing requirements

• Increment 1 – Schema and IDD Configuration

• Increment 2 – Loaders, utilities and reports

• Increment 3 – Web Services and connectors

• Leveraged HighPoint “assets” and ICD-10/Healthcare expertise

• “Mock UAT” Process for UI

25

Agenda

• Introductions

• About Blue Cross Blue Shield of Michigan and the ICD-10 Program

• Why MDM for ICD-10?

• The Encyclopedia

• Encyclopedia‟s underpinnings: the ICD-10 Appliance

• Architecture

• MDM Platform Use

• Q&A

26

Questions?

27

Thank You for Participating in this Session!