MITA Beyond MMIS Presentation


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This presentation was given at the 2008 Medicaid Directors Conference

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MITA Beyond MMIS Presentation

  1. 1. MITA Beyond MMIS John Lau, MAXIMUS Jh L Ron Bennett, Deloitte Consulting Gary Garofalo, MAXIMUS Moderator: Paul Brannan, Alabama MMIS Coordinator Brannan
  2. 2. Agenda 1. Background & Overview 2. The Medicaid Enterprise Technology Platform 3. Key issues & drivers for states and y vendors 4. Core Business Services 5. Dependencies 6. Promise of SOA 7. Case Studies 7C St di - Texas Eligibility (TIERS) - Indiana MMCS (EB) 2 of 13
  3. 3. Background & Overview 1. 1 MITA one of the most important concepts for Medicaid operations in many years 2. Has the potential to transform the administration and delivery of Medicaid services across a variety of business services 3. Generally been seen as pertaining solely to MMIS 4. Broader view of the state Medicaid Enterprise Technology indicates th concept cannot b li it d to Thl i di t the t t be limited t MMIS. 5. Our aim here is to describe how MITA affects other Medicaid Business p ocesses in addition to MMIS and ed ca d us ess processes add t o Sa d then to describe early experiences in implementing applications in the Medicaid Enterprise Technology domain with MITA consistent, non MMIS application architectures 3 of 13
  4. 4. The Medicaid Enterprise Technology Platform Must be broadly conceived as including several highly interrelated applications in addition to MMIS Includes: (Use dot points & definitions) •MMIS •MMCS •Eligibility •EHRs (soon) •Portals (growing) Portals Derivatively – Data Warehouses 4 of 13
  5. 5. The Medicaid Enterprise Technology Platform In the current technology environment, these applications, though highly interdependent, are very awkwardly coupled. The platforms are not only different, they usually span several generations of t l diff t th ll l ti f technology. It is not entirely unusual to see “network model” databases in the applications for example. MMIS EHRs MMCS Eligibility 5 of 13
  6. 6. Key Issues/Drivers for States and Vendors 1. Fundamental Business Process shifts are being demanded 2. 2 Program and Business Rules changing 3. Shifting role of the Portal as part of 1 above 4. Need for states to extend functionality to a broader set of agents and partners 5. S/W components must be engineered to adapt to evolving sets of agency goals 6. Need to incorporate new technologies and more COTS products 7. Business Process Management must be engineered into the solutions 8. C 8 Costs! ! 6 of 13
  7. 7. Core Business Services MMIS MMCS Eligibility EHRs Systems Mailhouse Mailhouse Mailhouse Mailhouse Document Document Document Document Management Management Management Management Imaging & Content Imaging & Content Imaging & Content Contact Center Management Management Management Web Portal Contact Center Contact Center Contact Center File Transfers Web Portal Web Portal Web Portal Security Data E t D t Entry Data Entry Data Entry Recipient File Transfers File Transfers File Transfers Management Security Security Security Plan & Provider Management Recipient Recipient Recipient Management Management Management Provider Plan & Provider Management Management 7 of 13
  8. 8. Dependencies Interfaces DB 3 DB 1 MMIS MMCS Applications Databases EHRs Eligibility DB 4 DB 2 The way it is… 8 of 13
  9. 9. The Promise of SOA Technical Services Forms Hub EDI Rules Workflow Mgmt Service Gateway Engine Mgmt Access DB MITA Enterprise Service Bus Database Services Mgmt Process Enroll Enroll Det Medical Claim Provider Recipient Eligibility History Business Services The way it should be… 9 of 13
  10. 10. Case Studies -Texas Eligibility (TIERS) – Ron Bennett, Deloitte -Indiana MMCS (EB) – Gary Garofalo, MAXIMUS 10 of 13
  11. 11. Texas Eligibility (TIERS) Ron Bennett, Deloitte Consulting Moderator: Paul Brannan, Alabama MMIS Coordinator Brannan 11 of 13
  12. 12. Texas Integrated Eligibility History 2000 – 2003 TIERS Texas Works • Integrate Cases/Programs • Medicaid Cascade 2003 – 2004 TIERS LTC HB 2292 Reorganization • Multi-Channel Access • Privatization Analysis Call Center Business Case 2004 – 2005 • SOA Technologies, IBM hl IE Pilot Stack, TIERS Integration 2006 – 2007 IEES Pilot • BPO Pilot ICE / HOP / HAND • Service Enablement 2007 – 2009 • Service Reuse End State 12 of 13
  13. 13. Texas Health and Human Services Commission Goals Data Collection From: Clients through Self Service Kiosks and Internet Application Community-based Organizations (e.g., Food Bank, Hospital, Faith-based) Optical Technologies for Imaged Documents and FAX Outsourced Business Operations Internal HHSC Employees Work Flow Automation Across: Programs P Systems St Workers Wk Food Stamps Eligibility TX Works TANF Document MEPD Management Medicaid Enrollment Vendor Integrate Communication Channels: Web Self Service Interactive Voice Response (IVR) 211 Call Center Document Imaging and FAX Web services open TIERS data collection and its eligibility engine to organizations that facilitate HHSC clients obtaining benefits while integrating the tools that automate eligibility/enrollment processes for more effective and efficient program administration. 13 of 13
  14. 14. 14 of 13
  15. 15. Business Architecture Business Process 1 Business Trigger Result 2 Logic Maturity Target Process Maturity 3 Model Process Steps Business Capabilities 4 Define Triggers, Logic & Results 1 2 3 4 5 5 Relate to Process Capabilities 15 of 13
  16. 16. Information Architecture Examine MITA Taxonomy y Extend to Eligibility Define Schemas Data In Motion Data at Rest Determine Information Exchange Methods Define Data Access Services Inquiry CRUD Analytical 16 of 13
  17. 17. Technical Architecture Channel Integration – Internet, Phone, Document, FAX, B2G/G2G Global Process Engine – Orchestration and Human Task Management Data Integration Services – Enterprise Service Bus (ESB) Data Transformation Services Extract/Transform/Load (ETL) Et t/T f /L d Unstructured Document Capture Decision Support Services – Analytical Data Mart Composite Services – Inquiry and Capture Eligibility Services – Business Rules Engine and Policy Decision Tables Inquiry Process Integration Services Service Communication Services Eligibility Data Integration Services Adapter Adapter Service Capture Service Common Services 17 of 13
  18. 18. Enhanced Eligibility Services Vision Self Trading IVR FAX/Mail Service Partners Call Face to Center Face Apply Collect EDBC Certify Issue Notify 18 of 13
  19. 19. Indiana MMCS (EB) Gary G G Garofalo, MAXIMUS fl Moderator: Paul Brannan, Alabama MMIS Coordinator Brannan 19 of 13
  20. 20. Indiana Enrollment Broker Project Overview HEALTH CARE TECHNOLOGY SERVICE PROGRAM Knowledge g Hoosier Outreach O h Management Healthwise and Education Telephony Care Helpline Select EDI Enrollment Healthy Broker Indiana Enrollment Applications Plan Pl 20 of 13
  21. 21. Project Goals •Bi Business Goals Gl 1. Maximize health plan choice selection to accommodate needs of individual members and their families 2. 2 Maximize enrollment into managed care health programs to provide families and their members quality health care at a more affordable cost 3. Facilitate better quality care and increased knowledge to promote choice and independence for beneficiaries • Technology Goals 1. Facilitate information sharing for the best customer experience 2. Reduce administrative overhead through operational efficiencies 2Rd d ii i h dh h i l ffi i i 3. Provide consumers with easy access through multiple touch points 21 of 13
  22. 22. Implementation Challenges 1. Tight timelines 2. Multiple program implementations including 1 new program 3. Legacy environment integration 3L i ti t ti 4. Reports 5. Data conversion 22 of 13
  23. 23. Approach • Use an MMCS SOA product to – Reduce cost of implementation through modular design and reusable components – Increase interoperability through standardized interfaces – Provide greater configurability of the application – Support greater use of commercial off-the-shelf products – Reduce maintenance costs through Simpler Maintenance footprint • Leverage standards to – Promote secure data exchange – Promote efficient data sharing • Maximize use of beneficiary centric applications 23 of 13
  24. 24. Business Architecture 24 of 13
  25. 25. Technical Architecture Enrollment Recipient Plan/Provider Management Management Management Workflow Correspondence Rules/Decision Data Management Management Engine Security IVR Outbound service bus Dialer Document Management Knowledge Database EDI Management Management Data Marts/ Warehouse 25 of 13
  26. 26. Future Enhancements • New Programs - Focus on enrolling new populations into managed care • Extend self service – Leverage online services and telephony component integration as implemented in other states • Further streamline EDI – Leverage COTS gateway software for improved security 26 of 13
  27. 27. John Lau, MAXIMUS 11419 Sunset Hills Road Reston, VA 20190 (703) 251-8610 JohnLau@Maximus com Ron Bennett, Deloitte Consulting 400 W 15th Street Suite 1700 Austin, TX 78701 (512) 226-4121 Gary Garofalo, MAXIMUS 11419 Sunset Hills Road Reston, VA 20190 (703) 251-8465