Medicaid Information Technology Architecture MITA A Citizen-Centric Approach

Medicaid Information Technology Architecture (MITA) A Citizen-Centric Approach MITA David Mix, PMP, MBA HIT/MITA Program Manager Virginia Department of Medical Assistance Services (DMAS) david. mix@dmas. virginia. gov 1

Agenda • • Why Are We Here? MITA Overview MITA State Self Assessment (SS-A) MITA, Health Information Exchange, and Health Reform • What is Virginia’s m. ITA Concept? • Next Steps 2

Why Are We Here? • DMAS conducted a MITA State Self-Assessment (SS-A) in 2007: – – • Required by CMS to get funding Limited to DMAS Strategy is to repeat SS-A every two years to gauge progress and adjust plans Nothing significant had changed in early 2009 to warrant the effort; 2010 became a very different story… New Federal impetus for Health Reform: – American Recovery and Reinvestment Act (ARRA) • • • – Patient Protection and Affordable Care Act (ACA) • • • Health Information Exchange Regional Extension Centers Provider Incentive Program Medicaid expansion in 2014 Health Insurance Exchange Standardization of enrollment forms across all health & human services programs Many other grants available New Virginia impetus for Reform – executive level business sponsors: – HHR Secretary Hazel – Secretary of Technology Duffey 3

What Do We Hope to Accomplish? • Shared vision: – All HHR Agencies – Local government • Understand the big picture: – Many interrelated efforts with a common denominator: MITA • Alignment of Virginia’s efforts to national direction: – – Business Technology Planning Funding 4

MITA Overview MITA 5

MITA Overview What Is It? • A Centers for Medicare and Medicaid Services (CMS) initiative to transform the Medicaid Management Information System (MMIS) into an enterprise-wide backbone architecture capable of addressing tomorrow’s Medicaid needs • Bottom line: – It is a tool kit to help identify where we are, where we are going, and a means to measure progress 6

MITA Overview What Is the Vision? • The Concept of Operations (COO) is a tool that describes current business operations and envisions future transformation. – “In the future, Medicaid agencies and other payers’ roles change from those of performing operations that require a large administrative staff (e. g. , to manage paper flow, telephone, fax, EDI, and Web-based transmissions; make decisions; and respond to inquiries) to those of executive management and professional teams (e. g. , to analyze program trends, needs, and gaps; plan strategically; monitor program objectives and health outcomes; make performance based payments; and participate in the nation’s healthcare goals. ” 7

MITA Overview Framework: A Business-Driven Architecture l Vision, mission, objectives come first l Architecture responds to business needs l MITA Business, Information, Technical Architecture models are enablers to meet business needs Medicaid Mission & Objectives Medicaid Business Needs MITA Enablers Business Architect Information Architect Technical Architect 8

MITA State Self Assessment (SS-A) A MITA Tool 9

What Is an SS-A? • The State Self-Assessment is a MITA process for States to measure their process maturity level against the Federal Baseline Model. • It serves to align each State’s enterprise efforts towards the national vision. – Business Architecture – Information Architecture – Technology Architecture 10

What Is an SS-A? The MITA Maturity Model • A maturity model measures the improvement and transformation of a business across two dimensions – time and space: – Time marks progress from today to a realistic future; i. e. , 10 years; and – Space dimension shows how the business looks at present and what its capabilities are likely to be as it matures. • MITA Framework requires a maturity model to define boundaries and provide guidelines for the transformation of the Medicaid Enterprise from its As-Is level of maturity to progressively higher levels of performance. 11

What Is an SS-A? The MITA Maturity Model with a 10+ Year Horizon Maturity “To-Be” Levels 4 and 5 Levels 3 -5 Years “As-Is” Levels 1 and 2 All technology, policy, and statutory enablers exist and are widely used. Agency complies with baseline requirements. Level 2 shows improved capabilities over Level 1. Healthcare industry begins to use technology available in other business sectors. Adopts policies to promote collaboration, data sharing, consolidation of business processes. Technology and policy under development. Can not be certain of timeframe. When available, will cause profound change and improvements in business processes. Time 12

What Is an SS-A? Definition of State Medicaid Levels of Maturity Level 1 Level 2 Level 3 Level 4 Level 5 Agency focuses on meeting compliance thresholds for State and Federal regulations, primarily targeting accurate enrollment of program eligibles and timely and accurate payment of claims for appropriate services. Agency focuses on cost management and improving quality of and access to care within structures designed to manage costs (e. g. , managed care, catastrophic care management, and disease management). Agency focuses on adopting national standards, collaborating with other agencies in developing reusable business processes, and promoting onestop-shop solutions for providers and consumers. Focus on managing costs leads to program Agency encourages intrastate data Agency benefits from widespread and secure access to clinical data and focuses on improvement of healthcare outcomes, empowering beneficiaries and provider stakeholders, measuring objectives quantitatively, and ensuring overall program improvement. Agency focuses on fine-tuning and optimizing program management, planning and evaluation since it has benefited from national (and international) interoperability and previously noted improvements that maximize automation of routine operations. 13

MITA, Health Information Exchange, MMIS, and Health Reform Converging Efforts 14

m. ITA Technical Architecture Leveraging m. ITA’s Framework • Can serve as the “Central Nervous System” for connecting HHS programs • Allows easy access to and sharing of health information throughout the delivery of care • Common denominator for – Federal initiatives – State initiatives • Not just about Medicaid – it’s about the common denominator – IT Architecture as the enabler for business transformation 15

COV-HIE Fitting the HIT Puzzle Together 16

Converging Efforts Interoperability Example 17

What is Virginia’s m. ITA concept? 18

Next Steps • Complete SS-A – Align business, technical, and solution architectures to MITA vision – Business needs and priorities feed into planning and priorities • HHR HIT/MITA Program Management Office – Fund and oversee 25+ projects to be completed by 2013 – Known business priorities • Citizen-centric portal (leverage existing state efforts) • Connect COV-HIE to State health systems (DCLS & VDH) – To support meaningful use • Full automation of member management processes – To support Medicaid expansion and the Health Insurance Exchange • Questions? MITA 19