Presentation on theme: "David Mix, PMP, MBA HIT/MITA Program Manager"— Presentation transcript:
1Medicaid Information Technology Architecture (MITA) A Citizen-Centric Approach David Mix, PMP, MBAHIT/MITA Program ManagerVirginia Department of Medical Assistance Services (DMAS)
2Agenda Why Are We Here? MITA Overview MITA State Self Assessment (SS-A)MITA, Health Information Exchange, and Health ReformWhat is Virginia’s mITA Concept?Next Steps
3Why Are We Here?DMAS conducted a MITA State Self-Assessment (SS-A) in 2007:Required by CMS to get fundingLimited to DMASStrategy is to repeat SS-A every two years to gauge progress and adjust plansNothing 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 ExchangeRegional Extension CentersProvider Incentive ProgramPatient Protection and Affordable Care Act (ACA)Medicaid expansion in 2014Health Insurance ExchangeStandardization of enrollment forms across all health & human services programsMany other grants availableNew Virginia impetus for Reform – executive level business sponsors:HHR Secretary HazelSecretary of Technology Duffey
4What Do We Hope to Accomplish? Shared vision:All HHR AgenciesLocal governmentUnderstand the big picture:Many interrelated efforts with a common denominator: MITAAlignment of Virginia’s efforts to national direction:BusinessTechnologyPlanningFunding
6MITA Overview What Is It? A Centers for Medicare and MedicaidServices (CMS) initiative to transform the Medicaid Management Information System (MMIS) into an enterprise-wide backbone architecture capable of addressing tomorrow’s Medicaid needsBottom line:It is a tool kit to help identify where we are, where we are going, and a means to measure progress66
7MITA Overview What Is the Vision? The Concept of Operations (COO) is a toolthat describes current business operations andenvisions 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.2-5Note Medicaid agencies “in the future” grey box on page I.2-7
8Framework: A Business-Driven MITA OverviewFramework: A Business-DrivenArchitecturelVision, mission,Medicaid Mission& ObjectivesBusinessArchitectTechnicalInformationMedicaid BusinessNeedsMITA Enablersobjectives come firstlArchitectureresponds to businessneedslMITA Business,Information, TechnicalArchitecture modelsare enablers to meetbusiness needs88
10What 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 ArchitectureInformation ArchitectureTechnology ArchitectureDiscuss High-Level View of the Future (pregnant woman example)Starting on Page I.2-5Note Medicaid agencies “in the future” grey box on page I.2-71010
11What 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; andSpace 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.
12What Is an SS-A? The MITA Maturity Model with a 10+ Year Horizon “To-Be”Levels 4 and 5Technology and policy under development. Can not be certain of timeframe. When available, will cause profound change and improvements in business processes.Levels 3-5 YearsHealthcare 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 2All technology, policy, and statutory enablers exist and are widely used. Agency complies with baseline requirements. Level 2 shows improved capabilities over Level 1.Time
13What Is an SS-A? Definition of State Medicaid Levels of Maturity Agency focuseson meeting compliance thresholds forState 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 andaccess to carewithin structures designed tomanage costs(e.g., managed care, catastrophic care management, and disease management).Focus onmanaging costsleads 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.
14MITA, Health Information Exchange, MMIS, and Health Reform Converging Efforts
15mITA Technical Architecture Leveraging mITA’s Framework Can serve as the “Central NervousSystem” for connecting HHSprogramsAllows easy access to and sharing of health information throughout the delivery of careCommon denominator forFederal initiativesState initiativesNot just about Medicaid – it’s about the common denominatorIT Architecture as the enabler for business transformation
16COV-HIE Fitting the HIT Puzzle Together Describe major componentsNote that DC is looking at using the model.
17Converging Efforts Interoperability Example Describe the two cases: Clinical and CitizenNote that converging efforts create opportunities for interoperabilityNote: Transformation to citizen self-directed decision makingNote: 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
19Next Steps Complete SS-A HHR HIT/MITA Program Management Office Align business, technical, and solution architectures to MITA visionBusiness needs and priorities feed into planning and prioritiesHHR HIT/MITA Program Management OfficeFund and oversee 25+ projects to be completed by 2013Known business prioritiesCitizen-centric portal (leverage existing state efforts)Connect COV-HIE to State health systems (DCLS & VDH)To support meaningful useFull automation of member management processesTo support Medicaid expansion and theHealth Insurance ExchangeQuestions?Describe contentsDSS to describe EDSPAfter HITSAC charter expansion, handoff to Dr. RuffinMITA19