Tackling Future CMS Requirements


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Tackling Future CMS Requirements—FDCCI, Shared Services, Big Data and Mobility by Tony Trenkle, Chief Information Officer and the Director of the Office of Information Services in the Centers for Medicare and Medicaid Services, Department of Health and Human Services

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Tackling Future CMS Requirements

  1. 1. Tackling Future CMS Requirements Tony Trenkle Chief Information Officer and Director, Office of Information Services
  2. 2. Topics for Today •  CMS Operations•  Shared Services•  Big Data•  Data Center Consolidation•  Mobility 2
  3. 3. CMS Operations 3
  4. 4. CMS Operations  •  More than 98 million beneficiaries (not counting additional potential 30+ million Americans that will be added through health care reform).•  CMS expends approximately 1 trillion dollars annually on Medicare, Medicaid, and CHIP programs.•  More than 900 million Medicare fee-for-service claims•  More than 1.6 billion claims for Medicaid beneficiaries•  More than 11 million home health assessment records•  More than 13 million nursing home assessment records 4
  5. 5. CMS IT •  Counting payments to the states the FY12 operating plan was $3.8 billion.•  If CMS were a separate agency, that would make us the third largest IT budget behind only DoD and DHS.•  CMS’s IT infrastructure is very decentralized and funded mostly on a programmatic basis. 5
  6. 6. Critical IT Challenges …CMS IT Transformation Goals CHALLENGES TRANSFORMATION GOALS•  Huge ACA IT Requirements •  Meet Legislative Mandates with Enterprise IT Shared Services•  Successful Health Reform depends on more and better data •  Create the Data Infrastructure to maximize CMS Data and Information•  IT funding from multiple budgets Product Use•  Complex and Old IT infrastructure •  Transform IT Portfolio Management and Governance•  Decentralized IT infrastructure •  Transform CMS IT Operations•  Rapid Technological change •  Improve CMS’ Information Security•  Heavy Contractor Presence/Aging and Privacy Posture Federal workforce •  Identify and Adopt Innovative Technologies •  Improve Organizational Effectiveness 6
  7. 7. Shared Services 7
  8. 8. Enterprise Shared Services•  What: Scalable, reusable business/technical solutions that serve multiple business processes•  Why: Tight budgets, need to leverage solutions across business lines and enhance interoperability•  Four initial “big hitters” selected to be implemented –  Enterprise Identity Management (EIDM) –  Enterprise Portal –  Master Data Management (MDM) –  Business Rules Engine 8
  9. 9. Stages of Shared Services FY2014 FY2013 Showing real ROI Supporting for major programs FY2012 programs Foundation work 9
  10. 10. CMS Enterprise Shared Services: EIDM Business Rules Enterprise Master Data Engine Service Portal Management Individuals will have a single identity for engaging in business with CMS that meets all federal security requirements Enterprise Remote Identity Proofing (RIDP) Identity User Identification, Verification and Authentication Management Enterprise Identity Management (EIDM) Shared Service Managing connections from user to a CMS application 10
  11. 11. What do we deliver to business?•  Reduce overall CMS access management costs by combining existing authentication and authorization systems –  Over 175 CMS applications with 135,000+ users currently using seven different access management systems•  Meet the requirements to support the ACA Health Insurance Exchange –  Exchanges will potentially add 30 – 50 million users –  Legislation requires a simple and clear path for customer experience•  Improved experience for external users that access multiple CMS systems (e.g., providers) that currently have different proofing•  Future: Ability to rely on other identity proofers (federated identity)•  Current Status –  Contracts have been awarded for remote ID proofing and enterprise ID management –  First application uses will begin to be implemented over the next several months 11
  12. 12. CMS Enterprise Shared Services: Portal Enterprise Master Data Business Rules Identity Management Engine Service Management A central preferred channel for beneficiaries, providers, organizations and States to receive CMS information, products, and services Secure access to Enterprise Portal enumeration, e-enrollment, e-Registration, status checking, and reporting Shared Service services Improved usability and higher customer satisfaction 12
  13. 13. What do we deliver to business?•  Consistent user interface design to support a “single face of CMS”•  Integrated access to multiple CMS websites/portals reduces need for users to access multiple URLs to access the information or applications they need•  Ability for users to customize/personalize their portal experience.•  Current Status –  Initial portal capability has been implemented. –  Additional portlets will be added in the next several months 13
  14. 14. CMS Enterprise Shared Services: MDM Enterprise Business Rules Enterprise Identity Engine Service Portal Management A suite of data records and services that will allow CMS to link and synchronize beneficiary, provider and organization data to multiple disparate sources Master Data Provider and beneficiary profiles (book of Management record) will be obtainable through a singe call to a trusted, authoritative data service Shared Service that is part of the MDM system Relationships between beneficiaries, providers and organizations can be tracked across all CMS programs 14
  15. 15. What do we deliver to business?•  Foundational, centralized source of reference data for Providers, Beneficiaries, Organizations/Plans, and Programs and relationships between these entities•  Integrated data from many disparate data sources (including Medicaid)•  Data services and BI tools that applications can consume to access the data•  Current Status: –  Initial support provider and beneficiary alignment/assignment for ACO SSP and Pioneer demos was implemented in May –  Other capabilities will be implemented in the next several months 15
  16. 16. CMS Enterprise Shared Services: BRES Enterprise Enterprise Master Data Identity Portal Management Management A software tool that can execute one or more business rules within CMS IT application code Establish business rules governance policies Business Rules for creating and enhancing business rules Engine Management of all enterprise rules, define the Shared Service relationships between different rules and relate some rules to the IT applications accessing the service 16
  17. 17. What do we deliver to business?•  “Rules engine” tool that supports rule development and translation to consumable code that applications can call•  Centralized repository of business rules that new applications can use as-is or modify•  Standardized complex logic currently embedded in many different systems (e.g., what is a dual eligible)•  Current Status: –  Support ACO Pioneer processing with beneficiary and provider cross-check rules 9/2012 –  Discussions underway to capture cross-program precedence rules for coordinated care programs 17
  18. 18. Medicare Provider Experience – Today at CMS Provider Enrolment National Plan and Chain and Provider Ownership System Enumeration (PECOS) System (NPPES) 18
  19. 19. Future State – Increased Automation and Self-Service Provider Portal Automated Provider Verification & Book of 1 Record Enumerate Screening Automated Data Capture, 2 Self Service Used by Enroll Updates A, B MACs 3 Register Demos, Medicaid PQRS, etc.. 1.  Iden(ty   7.  Tax  and  Business   2.  Licensure   8.  Provider  Death  No(ce   Program 3.  Legal   9.  Provider  Financial   Integrity 4.  Criminal   Informa(on   5.  Geo-­‐Spa(al   10.  State  Provider  Enrollment   6.  Exclusion  Data   &  Eligibility   ACOs 19
  20. 20. CMS and Big Data 20
  21. 21. What is “Big Data”? © 2012 NetApps Inc. All rights reserved“Big Data” refers to datasets whose volume, speed and complexityis beyond the ability of typical tools to capture, store, manage andanalyze. Complexity Coined by Francis Diebold, professor of economics at the University of PA in 2000, when “Big” meant Gigabytes / day1 Speed Volume 21
  22. 22. Data Trends World’s Data Kaiser’s Data 80% 90% STRUCTUREDSTRUCTURED UNSTRUCTURED DATA UUNSTRUCTURED NSTRUCTURED DATA DATA DDATA ATA Ø 80% of world’s data is unstructured (Rise of Ø 90% of Kaiser’s data is unstructured (80% Mobility devices, and machine generated data) of EHR and Image data) Ø 44x as much data over the coming decade (35 zettabytes by 2020) Ø 25x as much data over the coming decade. (One exabyte by 2020) Ø  Majority of data growth is driven by unstructured data (Active archives, Medical Ø  Majority of data growth is driven by images, Online movies and storage, Pictures) unstructured data (Medical Images, Videos, Text, Voice) Ø  Information is centric to new wave of opportunities (Retail, Financing, Insurance, Manufacturing, Healthcare,…) Ø  Information is centric to providing Real time Personalized Healthcare. (Requires Contextual – device, environment, spatial, Ø  Industry is employing Big Data Technologies Demographics, Social, and Behavioral for Information extraction. profiles in addition to medical information) Source:   Intel  Developers  Forum,  September  2012   Ø Kaiser is evaluating Big Data Co-­‐presenta(on  by  Rajiv  Synghal,  Principal,  Kaiser  Permanente;  “Big  Data   and  Analy(cs  in  Healthcare  and  Life  Sciences.”       Technologies… h[p://intelstudios.edgesuite.net/idf/2012/sf/aep/HLCS002/HLCS002.html   22
  23. 23. Big Data at CMS  •  Currently, we store and maintain: –  ½ a terabyte of data each month (roughly 1.7 million pieces of 8 1/2 x 11 paper) –  370 terabytes of Medicare data –  30 terabytes of Medicaid data –  10 terabytes of unstructured data –  Quality data –  Encounter data –  Other•  By the end of 2015: –  Medicare Claims Data will reach approximately 700 terabytes –  Medicaid Claims Data will reach approximately 100 terabytes 23
  24. 24. Payment Mechanisms are ShiftingRisk to Payor Current Future Risk to Provider Traditional Traditional Fee-For-Service Global Episodic BundlingFee-For-Service Capitation Shared Savings Payment Care Models Episodes of Clinical Service Accountable Care Patient Centered Care (CABG, Centers (Retail Organizations Medical Homes AMI etc.) Clinics etc..) IT and Data are the lynchpins 24
  25. 25. Data Warehousing VisionMaximize the full potential of CMS’ vast data resources to realize an enterprisedata warehouse environment that can support the internal and external analytics forCMS’s future business model and to help transform the national healthcare sector.•  Goal #1: Design a scalable, sustainable data warehouse environment that supports integration of new data sources such as encounter, quality and clinical data to the traditional claims, beneficiary, and provider data sources.•  Goal #2: Provide an easily accessible, efficient, and secure environment for analyzing and extracting the vast sums of CMS data.•  Goal #3: Enable business use of data without the need to understand underlying technologies, evolving to a self-service model.•  Goal #4: Provide CMS user communities with the tools and information required to make timely informed decisions and drive innovation (including but not limited to internal and external users, such as analysts, researchers, states, provider organizations, and Accountable Care Organizations). 25
  26. 26. Data Warehousing Business Drivers•  CMS’s role is changing from paying claims to defining quality of care, supporting multiple payment models, and driving national healthcare improvements. This will require quicker, easier answers to broader, more complex questions using more data.•  Legislative mandates require increased coordination with other agencies and with external parties, driving CMS to standardize data definitions and formats and to embrace industry best practices.•  CMS is becoming an information clearing house to support external researchers doing increasingly sophisticated analytics that will drive innovation in the national healthcare sector.•  Budget and operational pressures require CMS to improve efficiency, reduce costs, provide quicker time to market and to provide better return on investment. 26
  27. 27. The Current Environment 2011 Environment CMS Feedback Reports StatesRaw ResearchersData Multiple Data Repositories/ Public Use Files END USERStreams Analytics/ Plans Knowledge Creation 7000 DUAs / Data Cuts Providers Feedback Loop•  Mostly unidirectional communication•  Several differing points of entry into CMS Phone/Fax•  Multiple accounts for CMS customers for various programs eMail•  Corrections, Alterations, Clarifications take time•  Costly USPS END USER•  Cumbersome, yet manageable... For now. Help Desk 27
  28. 28. Near Future Environment If There is No Change 2013-2014 Environment If There is No Change Increasing Demands for CMS Information from: CMS • ACO Smart Reports • 10332 (Availability ofRaw Medicare Data for Perf. Measurement StatesData Multiple Data • 3002 (PQRS Improvements) • 6002 (Physician Sunshine ) Researchers Repositories/Streams Analytics/ • 3003 (Quality Resource Utilization Reports) END USER • 3007 (Physician Value Plans Knowledge Creation Modifier) • CBRs for Non-Physician, Non- Providers Hospital Providers • 10331 (Physician Compare) Will lead to: • Hundreds of thousands of new DUAs and data cuts • Large increase in feedback reports, public use files and DUAs • Increasingly inefficient transfer of data/knowledge • Increased costs 28
  29. 29. Desired Future CMS Data Environment States Researchers Dissemination Collection EXTERNAL Plans Data Enclave USER Providers Health 2.0 OrganizingProgram CMS marketplace dataData Streams Gateway Maximizing Use Contractors of Data Portal Fed Partners INTERNAL USER Operations Web Services CMS Data BENEFITS Products •  Improved business •  Easy, timely and secure •  Reduced cost of intelligence access to information operations 29
  30. 30. Key 2012 Activities•  Partnered with Oak Ridge National Laboratories to test new ways of faster and more efficient data management (Knowledge Discovery Infrastructure). Follow up activities will be conducted in Baltimore to test scalability and applicability.•  Created new office to focus on data management and analysis to partner with the Office of Information Services.•  Beginning analysis for data warehouse consolidation as part of DW strategy•  Virtual Data Center work will help with providing more flexible environments 30
  31. 31. Data Center Consolidation 31
  32. 32. Current CMS Data Center Environment Baltimore Data Center • MAPD AppsMixture of Development • HITECH EDC 1, Inefficient • Data WarehousesDirect and Contractors • Medicare FFS Claims use of • Public WebsitesIndirect Contracts • CWF Hosts computing resources EDC 2 Research Data Over 80 • Medicare FFS Claims Centers operational data • HITECH NLR • 1-800-Medicare- centers have been NDW identified by the Inconsistent OMB Data requirements Center IBM Boulder for security, MAC DataVarying pricing Centers Consolidation • HIGLAS architecture andand ownership Initiative Softwaremodels across Developmentdata centers Medicare Program Buccaneer Integrity • Quality Net Life Cycle • PSCs, RACs, & ZPICs • CCW (SDLC) UC San Diego • MIG Data Engine (Medicaid) 32
  33. 33. CMS Data Center Consolidation StrategyWill award a multi-billion dollar Virtual Data Center (VDC) IDIQcontract in 2012 that will:•  Support Federal and HHS data center consolidation strategies•  Consolidate the CMS data center footprint across 6-8 data centers.•  Reduce overall energy consumption by improving server virtualization, IT equipment utilization and environmental control devices• Eliminate redundant spending and solutions on software, infrastructure and operations• Leverages shared resources, reduces time to market for new initiatives and provides high availability to mission critical applications• Improve security, disaster recovery times, and effectively employ cloud and virtualization technologies. 33
  34. 34. VDC and Energy Use•  Partnered with the Department of Energy and Lawrence Berkeley Laboratories to have VDC Contractors to provide an Energy Conservation Measures Plan that will be evaluated as part of their overall technical solution which will include but not be limited to:•  Current Power Usage Effectiveness (PUE) of contractor owned and contractor operated VDC facilities.•  Minimum baseline for PUE improvement that will be monitored and reported periodically after the initial baseline report.•  Energy consumption as it relates to CMS system’s resources, both dedicated and shared.•  Technical solution alternatives that will improve PUE, adhere to security standards and achieve performance objectives.•  Return on investment, realized by CMS, over a specific task orders period of performance. 34
  35. 35. Mobility 35
  36. 36. HHS Mobility Strategy•  Identifying the user and business requirements for mobile technologies;•  Identifying the security and privacy requirements for mobile technologies;•  Developing configuration baselines for mobile technologies; and•  Providing recommendations on identified mobile technologies for implementation 36
  37. 37. CMS Strategy for Mobility Internal Users•  Work with HHS through the CTO Council and CIO Council to ensure that CMS policies and initiatives are in line with the overall Department approach and the Federal Digital Government Strategy•  CMS has engaged in an effort to continually investigate technologies that position us to deliver services via a more mobile and agile framework.•  The following technologies are being implemented to the CMS support population: –  Mobile Workforce – 100% mobile capability –currently being implemented, will complete early next year •  Windows 7/Office 2010 •  Dell 6320/HP 2760P Convertible Tablets •  Cisco Virtual Private Network for remote access •  67% work remotely on a consistent basis with as much as 85% working episodic •  100% Telework - 120 day pilot –  Mobile Device Management-being piloted for full implementation in the next 1-2 years •  Replace RIM devices with selection options for iOS and Android •  Deploy iPads – manage with MDM enterprise system •  Bring your own device 37
  38. 38. Unified Communications Anywhere, Anytime, Any Medium Voice Over IP Wi-Fi Softphone Converged Network Desktop InstantMessaging Unified Desktop VTC& Presence Enriched experience for CMS employees through integrated data, voice, video & services 38
  39. 39. Supporting Mobility Needs of Stakeholders•  Optimize websites for mobile users –  Engage with customers to identify at least two existing priority customer-facing services to optimize for mobile use. •  CMS has worked with Medicare beneficiaries and 1-800-MEDICARE customer service representatives (CSRs) to identify Medicare.gov top tasks. This feedback was incorporated into the redesign and drove the design of the Medicare.gov mobile sites navigation structure. –  Optimize at least two existing priority customer-facing services for mobile use and publish a plan for improving additional existing services. •  CMS has launched a redesign of the Medicare.gov website which uses responsive design. This means that the website fully supports access on smartphones and tablets •  Looking to mobile optimize other priority public websites within the next 12 months.•  Ensure that shared services support mobility
  40. 40. What Does it all mean?•  Creative tensions abound –  Rise of end user tools vs. centralized IT management –  Growing need for data and data analytics vs. maintaining appropriate security and privacy –  Budget controls vs. more diverse IT needs•  Policy/business requirements and technology solutions are becoming harder to align•  Skill set needs are becoming more complicated•  New and different partnerships will be needed 40