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

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

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

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

MITA Overview MITA

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

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

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

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

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

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.

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

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.

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

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

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

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

What is Virginia’s mITA concept?

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