CENTERS for MEDICARE & MEDICAID SERVICES

Medicaid Information
Technology Architecture

February 10, 2003

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Agenda

� Where We Are Today

� The Vision for the Future

� How We Plan to Translate the Vision Into Reality

� MITA Initiative
� The Conceptual Architecture

� The Approach

� What All This Means for States Over the Next 3 to

5 years

� Next Steps

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Where We Are Today

Today

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Driving Forces/Challenges

Resource
“Blue Books” Limitations “Blue Books”
Claims MARS
Recipient SURS
Provider
MMIS
Reference
“Blue
RecipientBooks”
Provider

Claims
Legislative Recipient
Claims Medicaid Program
Code Utilization
Mandates Sets TPL Review Changes
Management
Reports

Rapid
Changes in
Technology
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 Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

MMIS Evolution and Trends—

1970 to Today
Enterprise World Wide
Information Web
Portals
Financial Executive
Reporting Information
Systems Analytic
Systems (EIS) Applications
Web
Analytics
Data
Transaction Data Mining
Warehouses
Systems
Decision Support
Systems (DSS)
Extract Ad Hoc Online Analytical
Files Query Tools Processing
(OLAP)
Relational
Databases
Reporting
Systems Multidimensional
(MARS +SURS) Databases

1970 1985 1990 1995 Today

Source: modified from Data Warehousing and E-Commerce, William J. Lewis 5

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Vision for the Future

6
Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Current Medicaid IT Architecture

State Federal/CMS

Data
Warehouse

MMIS MSIS
1
2
3

1. Decision Support System

2. Immunization Registries
3. Eligibility Determination Systems

7
 Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Planned Medicaid Systems Architecture

State Federal/CMS

Data
Warehouse
Web-Based Interface
MMIS 4
1
a b
2 MSIS 5
c d
3 e f 6
Web-Based Interface

1. Decision Support System 4. State Summary Data Reports

2. Other Public Heath Data Sets 5. Annual Person Summary
3. Eligibility Determination Systems 6. Clinical Services Data Marts
Note: States will be able to access data marts directly and the granular database through CMS on request.
8

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Future CMS Medicaid + Medicare IT Data

Sharing

MEDICARE
Medicare- MEDICAID
Managed
Care Data 1
System

Quality Net
Paid Claims MSIS 2
OSCAR
History File

3
Enrollment
Database

1. State Summary Data Reports

2. Annual Person Summary
3. Clinical Services Data Marts 9
Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Inter-Agency Data Sharing

State
CDC Data Sets HRSA

CMS
State Medicaid Data Sets
Information
Data Sets Technology (both Medicaid
Architecture
and Medicare)

10
Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

How We Plan To

Translate The Vision

Into Reality

11

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

The MITA Initiative

Initiative

12

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

The MITA Initiative

A national framework supporting

improved systems development

and health care management for

the Medicaid enterprise

13

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

MITA Initiative
Key Principles

� Data Sharing

� Reusable Components

� Modularity
� Open Architecture
� Standards

� Collaboration

� Security

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Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

MITA Initiative
Support the
Transition
MITA

Develop the
Architectural
Components

Establish the
Framework

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 Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

MITA Initiative
MITA

� Strategic Plan
� Conceptual Architecture
� MITA Steering Committee
� MITA Technical Group
� Review Policies
� Methodology Guidelines
� Publicize and Market Establish the
Framework

16
 Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

MITA Initiative
MITA

Develop the
� Common Requirements Architectural
Components
� Implementation Standards
� Reusable Components
� Enterprise Process Model
� Enterprise Data Model

17
 Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

MITA Initiative
MITA
Support the
Transition
� Transition Plan Template
� Other Tools and Templates
� Education

18
Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

The Conceptual Architecture

19
Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Establish the Framework—

Conceptual Architecture

The goal is to provide the states

with a conceptual architecture

which will serve as a framework for

improved system development and

data exchange within and among

states, federal agencies, and other

health care partners.

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 Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

What Is the MITA Conceptual Architecture?

� MITA IS NOT: � MITA CAN BE

� Installable software (WITH YOUR HELP):

� Mandated requirements � Guidelines incorporating new

technology
� A single mold (one size does
not fit all) � Roadmap for implementation
� A model system � Consensus on what should be
required when systems are

replaced

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Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Key Principles—Making Them Real

� Standards
� Reusable components
� Multi-centric

22

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Conceptual Architecture—Past

Recipient Provider

Claims
Code Utilization
Sets Review

Management
Reports

23
Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Conceptual Architecture—Past
TPL
SURS DD, DOA,
Fraud DMH
Detect Waivers
Outsourced
Functions State,
Other Local
Prior State Public
Authorization Agencies Health
Enrollment EVS
AVRS

Rx Contracted
Data POS Benefit
Ware- Management
house Drugs, Mental
MMIS Health
Subsystems
Eligibility
Determin­
ation Managed
Care
Web
Contracts
Portal

Clearing-
house
SCHIP DOF
EPSDT CMS State
NEDSS CDC Bank
IZ SAMHSA

24
Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Conceptual Architecture—
Bridge to the Future
TPL
SURS DD, DOA,
Fraud DMH
Detect Waivers
Outsourced
Functions State,
Other Local
Prior State Public
Authorization Agencies Health
Enrollment EVS
AVRS

Rx Contracted
Data POS Benefit
Ware- Management
house Drugs, Mental
MMIS Health
Subsystems
Eligibility
Determin­
ation Managed
Care
Web
Contracts
Portal

Clearing-
house
SCHIP DOF
EPSDT CMS State
NEDSS CDC Bank
IZ SAMHSA

25
Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Conceptual Architecture—Future

OTHER
SURS
Fraud
TPL
DD, DOA,
DMH
Waivers
STAKEHOLDERS SURS
Fraud
TPL

Detect Detect
Outsourced Outsourced
Functions State, Functions
Other Local

State 1 Prior
Authorization
Enrollment EVS
AVRS
State
Agencies
Public
Health
Prior
Authorization
Enrollment EVS
AVRS
State 2
Rx Contracted Rx
Data Benefit Data
POS POS
Ware- Management Ware-
house Drugs, Mental house
MMIS Health MMIS
Subsystems Subsystems
Eligibility Eligibility
Determin-
ation Managed
Sta Determin-
ation

rity nda
Care
Web Web
Contracts
Portal Portal

cu rds
Se
Clearing-
house
SCHIP DOF SCHIP
EPSDT CMS State CMS
EPSDT
NEDSS CDC Bank CDC
NEDSS
IZ SAMHSA SAMHSA
IZ

DATA
EXCHANGE

State 3
Prior
Authorization
Enrollment EVS

Access
AVRS

Policy
Rx
Data POS
Ware-
house
MMIS
Subsystems
Eligibility
Determin-
ation
Web
Portal

OTHER
AGENCIES

26
Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

From Concept to Approach

MITA
� What the
Conceptual MITA
will look like
� How we plan to
build it

27
Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

The Approach

Approach

28

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Conceptual Architecture—Approach

� Build Partnerships

� Leverage Work Done to Date

� MITA Project Process

� Data Collection

� Analysis and Design

� Validation

29

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Conceptual Architecture Approach

CMS
MMIS Redesign CO/RO
Workgroups S-TAG
Steering MTG
Committee

Other
Federal
States Agencies
Public Health
PS-TG Papers
Survey
Standards
S-TAG Setting
Orgs

MITA Other
Team Industry
Leaders
PS-TG Others

30

 Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Conceptual Architecture—
The Process
Data Collection
Analysis and Design

Validation

Current Business Application

Projects
Architecture Processes Architecture

Sequencing
Mission Organizational
Data Plan and
Programmatic Structure and
Architecture Transition
Requirements Roles
Strategy

Vision, Facility Technology Business

Strategy Locations Architecture Cases

Document Mission, Develop Target Develop Target Develop Business

Vision, Strategy, Business Information Systems Cases and
Current Architecture Architecture Architecture Sequencing Plan

31
Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Conceptual Architecture—
The Process
Data Collection
Analysis and Design

Validation

32

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

What All This Means for

States and CMS Over the

Next 3 to 5 Years

33

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Why Is the MITA Initiative So Important?

MITA will enable:

� Improved managing and monitoring of programs

through the sharing of data

� Efficient use of scarce resources through the
development and sharing of reusable software

� Quick response to changes in programs

� Greater access to high-quality data

34

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

Why Now?

� No better time than now to improve our systems and

realize the benefits of improved effectiveness and
efficiency
� Wait too long and the cost of deferred modernization
becomes so steep that catch-up is unaffordable
� Great strides have been made in data
standardization—we can benefit NOW
� Achieve a significant return on our investment
TODAY
� MITA can make the business case to CMSO senior
leadership about how we can redefine the MMIS
boundaries and create appropriate financial
incentives to support the vision
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 Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

We Need Your Help

Sunday Monday Tuesday Wednesday Thursday

Bridge to the New MITA Focus Group:

Architecture Industry Visioning Report of Visioning
Session Session Results

MITA Focus Group:

State Visioning
Session

Lunch Break

MITA Overview

MITA Meeting with NEDSS and the

S-TAG, NMEH, and Medicaid IT
PS-TG Members Architecture –
Complimentary
Initiatives

MITA Room (Cabildo C)—Questionnaire

36
Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

MITA is a journey, not a destination.

destination.
37

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

MITA

Share the Vision

Chart the Course

Shape the Future

38

Medicaid
Information
Technology
Architecture
CENTERS for MEDICARE & MEDICAID SERVICES

39