Information Technology in Support of Health Insurance Exchange, Integrated Eligibility System, and Health Information Exchange
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1 Information Technology in Support of Health Insurance Exchange, Integrated Eligibility System, and Health Information Exchange Manu Tandon EOHHS Secretariat Chief Information Officer Massachusetts State HIT Coordinator MESC, Boston 22 nd August 2012
2 Agenda MA HIX/IES project approach and update MA Reusability Scorecard Medicaid's Role in HIX, IES, and HIE HIX/IES possible expansion to other Health and Human Service Programs 2
3 Why are HIX and IES being done together? The Federal government has strongly encouraged states to integrate the eligibility functions and exchange systems A combined approach is cost and resource efficient. Customer centric streamlined view hard to achieve unless we closely coordinate. Competing program demands Tight implementation timelines 3
4 Massachusetts Progress to Date SI Vendor Procurement: Vendor selected and contract signed on 7/11/12 CGI/Deloitte is the selected System Integrator Procuring an IV&V: Finalizing vendor selection Significant Progress on Shared Services activities including security framework and MDM Requirements and process model development for E&E, Plan Management, Financial Management JAD sessions underway for Medicaid eligibility, QHP & SHOP plan selection Participating in collaborative efforts New England States Collaborative for Insurance Exchange Systems (NESCIES), Numerous presentations at conferences (e.g. NGA, MMIS, etc.) Enroll UX 2014 Project 4
5 MA HIX/IES Development Sequencing Components Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Code Drop 1 Code Drop 2 Code Drop 3 Address Validation, HIPAA X12, AIMS, HIX/IES App Framework AIMS, HIX/IES App Framework, Private Insurance, SHOP, Plan Management AIMS, HIX/IES App Framework, Subsidized Insurance, Medicaid Eligibility, Renewals, Navigator / Broker Portals, Fin Management 10/26/12 Code Drop 1 Complete 1/4/13 Code Drop 2 Complete 4/26/13 Code Drop 3 Complete 9/30/14 End of Operations & Maintenance 6/30/14 End of Stabilization 1/1/14 Fully Functioning Exchange 10/1/13 Open Enrollment Code Drop 4 Premium Billing, Notices, Business Intelligence/ DW, Other Interfaces, Customer Service Interface 7/29/13 Code Drop 4 Complete Design Build Test 5
6 Agenda MA HIX/IES project approach and update MA Reusability Scorecard Medicaid's Role in HIX, IES, and HIE HIX/IES possible expansion to other Health and Human Service Programs 6
7 Establishing Tiers of Reusability Tier 1 Share Documents, Process and Knowledge Tier 2 Share & Reuse Code, Library and Packages Tier 3 Jointly procure hardware/software and manage joint deployments States are exploring reusability and CMS is encouraging reuse and multi state collaborative 7
8 Massachusetts Reusability Scorecard Within the State (Attained Level 3) Leveraged combined Hardware Software purchasing power across initiatives Leveraging common cloud hosting environment for HIX/IES and HIE efforts (saving resources and time) Reuse of HIX/Medicaid E&E will dramatically reduce cost of standing up similar solution ground up for other EOHHS programs Reuse of shared services e.g. Identity Management, MDM, Address Validation Easier due to presence of coordinated governance and cross agency cooperation. Assisted by neutral convener. Amongst States (Attained Level 1, poised for limited Level 2) Leveraged other state RFPs, procurement templates, and other artifacts Saved countless man hours avoiding recreation of documentation Positioned to share COTS tool for HIX Shopping with other New England states at no additional procurement and no ongoing license costs Savings Multi million dollars of procurement and ongoing costs associated with typical ERPs Intend to reuse MAGI rules RI and VT as design partners with Massachusetts offer best chance of higher than Level 1 reusability. 8
9 MA Reusability Scorecard Contd. With the Federal Government (Attained Level 1) Leveraged Federally facilitated Exchange (FFE) artifacts to accelerate development Negotiated reusability credit with Systems Integrator leveraging federal artifacts Looking to share code with Federal Facilitated Exchange (FFE) Barriers to higher degree of reusability outside of state/agency boundaries Lack of cross state governance is a hurdle to inter state reuse As all state based exchanges march to the same end date, it is hard to remain passive until reusable solutions develop. No real out of the box solution available in the market, resulting in custom solutions with relatively higher degree of customization and configuration. 9
10 Agenda MA HIX/IES project approach and update MA Reusability Scorecard Medicaid's Role in HIX, IES, and HIE HIX/IES possible expansion to other Health and Human Service Programs 10
11 Medicaid s role in MA Health IT initiatives In Massachusetts three major Health IT related initiatives are being executed in parallel. Massachusetts Medicaid plays a key role in all of them. Statewide Health Information Exchange (HIE) phased in from ACA compliant Health Insurance Exchange (HIX) by 2014 Integrated Eligibility System (IES) at EOHHS by
12 Summary of Features HIX is about getting residents access to healthcare IES HIE is about getting residents access to comprehensive health and human services with effective data sharing amongst programs is about giving residents, care providers, and public agencies timely access to consented information needed to enhance quality and contain costs in the healthcare system. While each has its own mission, the three initiatives provide considerable cross leverage opportunities. Maximizing FFP, each project enhances coordination with federal agencies. They all leverage the MA Virtual Gateway providing a common face for these services. Built in cohesion, the incremental cost for each project is lower. They provide an opportunity to coordinate "transition of care" with "transition of coverage". Ability to share consented data across entities allows for coordinated care and an effective programmatic case management A linked provider directory and patient record locator services allows for effective handoff between clinical and administrative exchanges. Jointly they take us on a journey from episodic care to coordinated care to patient directed care. We're moving from fee for service to bundled payments/capitation. Our IT systems are evolving from segmented to integrated to community based. 12
13 Feb 2011 Start MA Health IT High Level Timeline 12/21/11 SI RFR Today July 12, 2012 Project Kick-Off Jan 2014 Oct 2013 Go Live Open Enrollment Feb Jun 2012 Inception(BPR, RFR) Jul Sep 2013 Design & Build Jan 2012 Jan 2013 Jan 2014 Health Insurance Exchange (HIX) Feb 2011 Mar 2014 Jun Aug 2012 IES Phase II Strategic Plan Project (10 Weeks) Feb Mar 2013 Inception(BPR, RFR) Apr Dec 2015 Phase II Design & Build Jan 2013 Jan 2014 Jan 2015 Integrated Eligibility System (IES) Jan 2012 Dec 2015 Dec 2012 Phase IB - Go Live July 9, 2012 Oct 2012 Project Kick-Off Phase IA - Go Live Oct Dec 2012 Phase I Jan Dec 2013 Phase II Jan Sep 2014 Phase III Jan 2012 Jan 2013 Jan 2014 Health Information Exchange (HIE) Jul 2011 Dec 2014 Jan 2012 Jan 2013 Jan 2014 Jan 2015 Jan 2011 As of Aug 20, 2012 Dec 2015
14 The HIX, IES and HIE connection Shared Services centric approach Leveraging shared services to drive down costs and accelerate development Common platform for clinical and administrative transactions Common cloud IaaS vendor Common identify management (Oracle IAM) Common master data management for client and provider (IBM Initiate) 14
15 Medicaid Shared Services Current State + HIE + HIX/IES MMIS & VG Users AIMS Provider Public Provider Online Service Center Claims Engine Eligibility Domain HIE Users Virtual Gateway Clinical HL7 Interface Gateway HIPAA HTS Interface X12 Gateway EDM Provider Directory MMIS Base Application MMIS HIX Domain HIX & Integrated Eligibility System CBHI (Children s Behavioral Health Initiative ) HIX & IES Users PKI Service MDM Services Shared Services HIE Direct Gateway Statewide HISP Medicaid plays a key role in MA's approach to HIX/IES and HIE. Alignment of clinical and administrative transactions shall be a key success factor for alternative payment models Immunization Syndromic Surveillance ELR Medicaid & Public Health Applications 15
16 Agenda MA HIX/IES project approach and update MA Reusability Scorecard Medicaid's Role in HIX, IES, and HIE HIX/IES possible expansion to other Health and Human Service Programs 16
17 2015 MA HIX and Integrated Eligibility System Eligibility Processes & Services Other EOHHS Programs Portal Related Portals Eligibility Hub Integrated Eligibility Rules Medicaid/CHIP/ Other EOHHS MDM programs Private/Subsidized Eligibility Integrated Eligibility Domain Other Health and Human Services Programs (TBD) Health Insurance Exchange Portal Plan Processes & Services Financial Processes & Services SHOP Processes & Services HIX Domain Federal Data Hub State Data Hub *Carrier Gateway Document Management Security Others Shared Services 17
18 IES Phase 2 Planning (example) High overlap of Data Elements across HHS programs Based on a survey of 20 eligibility programs, EOHHS identified 44 high level data elements collected by agencies. Data Elements Name, Gender, DOB, Contact Information, SSN, State Residency, Disability, Language Employment, Race, Ethnicity, Unearned Income, Earned Income, Military/Veteran, Medical Coverage, Household, Marital Status, Clinical Information, Education/Student, SSA, SSI # of programs (N=20) collecting data element Citizenship/Immigration Status, Residential Facility, LTC Facility, Authorized Representative, Special Assistance Requirement, Assets, Native American, Pregnancy, Other Benefits Received, Child Support, Assistance Requested Expenses, Voter Registration, Domestic Abuse, HIV, Work Requirement, Immunization, Convictions, Alternate Name, Accident/Lawsuit, Teen Parent, Interview Hardship, Expedited SNAP Questions
19 Integrated Eligibility Phase 2 (example) contd. Data Elements Analysis While there was a large amount of overlap among high level data elements, these elements are defined and captured differently across agencies and programs. An initial assessment of the complexity of harmonization revealed the following: Complexity of Harmonization # of data elements High (e.g. income, household, clinical information) 6 Medium (e.g. race and ethnicity, military/veteran status, state residency, and medical coverage) 18 Low (e.g. name, DOB, gender, contact information) 20 19
20 Integrated Service Delivery Journey 20
21 Contact: Manu Tandon Secretariat Chief Information Officer Massachusetts Executive Office of Health and Human Services 21
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