1. Commonwealth of Virginia Puzzle: To clarify or solve (something confusing) by reasoning or study David E. Mix, PMP, MBA HIT/MITA Program Manager Department of Medical Assistance Services Commonwealth of Virginia David.mix@dmas.virginia.gov

2. 2 Puzzle Pieces American Recovery and Reinvestment Act (ARRA) HITECH: Health Information Exchange (HIE), certified Electronic Health Record (EHR), Provider Incentive Program, meaningful use looking for better outcomes and coordination of care Patient Protection and Affordable Care Act (PPACA) Health Benefit Exchange (HBE/HBX), Eligibility Systems, Medicaid expansion looking for better user experience and coordination of services DHHS efforts towards simplified enrollment standards and Federal verification service with IRS, DHS, SSA Enhanced funding for eligibility systems to support HBE/HBX Other factors X12 5010/NCPDP D.0, ICD10, NCCI, Provider screening regulation State mandates State budget challenges State assets (as-is) Executive support Multi-Secretariat collaboration championed by Dr. Bill Hazel, Secretary of Health and Human Services Secretary of Technology, Jim Duffey and the Virginia IT Agency (VITA) HIT Advisory Commission, Health Reform initiative, and HIT Standards Advisory Committee Virginia Department of Motor Vehicles technology modernization efforts State Agency legacy system silos

3. 3 Puzzle Picture To assemble a complex puzzle, a picture of the completed puzzle is helpful Medicaid IT Architecture (MITA) V2.0 Concept of Operations (COO) document provides a picture of the assembled puzzle Includes HIE, EHR, and eligibility systems (basis for HBE/HBX) While focus is on Medicaid/CHIP it does reflect interoperability with other social service programs Technology base is program agnostic Business case: one of cost avoidance

4. 4 Virginias Strategy Leverage MITA as core strategy to address both ARRA and PPACA requirements Adopt MITA vision (self-directed services) Look at requirements from an enterprise perspective Use MITA State Self Assessment process to align efforts to Federal direction Maximize Federal funding assistance Leverage Virginias existing assets VITA provides enterprise infrastructure Governance, standards, competency centers (new), hosting, disaster recovery, strategic planning, help desk, cost allocation/rate setting, IT procurement/project approval, project management Strategic planning at Secretariat level with State Agency alignment begins to reflect migration path to enterprise interoperability Legacy systems can interoperate on the enterprise using standards-based services/interfaces Enterprise technical infrastructure becomes an enabler of business transformation

5. 5 Work In Progress Federal funding approved Establishing HIT/MITA program office Secretariat level Fund and manage multiple HIT/MITA projects Data sharing/trust initiative IT strategic planning initiative Establishing a common physical technical architecture Compliant with MITA Technical Architecture Standard Pay-for-use environment – available to all Federal/State/local programs Foundation for HIE and HBE/HBX interoperability with State systems Includes a Master Data Management (MDM) product for person/organization information Targeting significant improvement to Medicaid enrollment accuracy Establish Service Oriented Architecture (SOA) and MDM competency centers Establish authentication service Tied to MDM product Used for public facing portals (HIE & HBE/HBX etc) Developed by Virginia Department of Motor Vehicles

6. 6 Planning In Progress Federal funding requested for interfacing Health Department and State Lab systems to the enterprise for access by HIE Planning for replacement of multiple eligibility systems with an integrated solution Reflected in MITA Transition Plan Meets CMS seven conditions and standards for funding

7. 7 References MITA http://www.cms.gov/MedicaidInfoTechArch/ Virginia MITA transition plan http://dmasva.dmas.virginia.gov/Content_pgs/mita.aspx Virginia HIE Strategic and Operations Plan http://www.hits.virginia.gov/ Virginia State Medicaid HIT Plan http://dmasva.dmas.virginia.gov/Content_pgs/pr-arra.aspx Virginia IT Agency (VITA) Enterprise standards http://www.vita.virginia.gov/oversight/dm/default. aspx?id=10344