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

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

3. 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)
Health Information Exchange
Regional Extension Centers
Provider Incentive Program
Patient Protection and Affordable Care Act (ACA)
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

4. 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

5. MITA Overview
MITA

6. 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 6

7. 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.”
Discuss High-Level View of the Future (pregnant woman example)
Starting on Page I.2-5
Note Medicaid agencies “in the future” grey box on page I.2-7

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

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

10. 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
Discuss High-Level View of the Future (pregnant woman example)
Starting on Page I.2-5
Note Medicaid agencies “in the future” grey box on page I.2-7 10 10

11. 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., 10years; 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.

12. What Is an SS-A? The MITA Maturity Model with a 10+ Year Horizon
“To-Be”
Levels 4 and 5
Technology and policy under development. Can not be certain of timeframe. When available, will cause profound change and improvements in business processes.
Levels 3-5 Years
Healthcare industry begins to use technology available in other business sectors. Adopts policies to promote collaboration, data sharing, consolidation of business processes.
“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.
Time

13. What Is an SS-A? Definition of State Medicaid Levels of Maturity
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).
Focus on
managing costs
leads to program innovations.
Agency focuses on adopting national standards, collaborating with other agencies in developing reusable business processes, and promoting one-stop-shop solutions for providers and consumers.
Agency encourages intrastate data exchange.
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.

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

15. mITA Technical Architecture Leveraging mITA’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

16. COV-HIE Fitting the HIT Puzzle Together
Describe major components
Note that DC is looking at using the model.

17. Converging Efforts Interoperability Example
Describe the two cases: Clinical and Citizen
Note that converging efforts create opportunities for interoperability
Note: Transformation to citizen self-directed decision making
Note: When determine eligibility service is mature; it could give approval.
Note: An Enrollee Member service could be automated to add enrollment (both services could handle 75%+ of adds/reinstates)
Note the eligibility determination is NOT presumptive eligibility – the research/verification is automated. Once fully implemented (all needed service interfaces available, an approval could be given automatically).
Note that all eligibility determinations would need to be done by DSS/LDSS (long term) 17

18. What is Virginia’s mITA concept?

19. Next Steps Complete SS-A HHR HIT/MITA Program Management Office
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?
Describe contents
DSS to describe EDSP
After HITSAC charter expansion, handoff to Dr. Ruffin
MITA 19