Opportunities for California to Leverage Medicaid Information Technology Architecture (MITA)

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1 Opportunities for California with Integration of DMH and ADP Functions into DHCS Opportunities for California to Leverage Medicaid Information Technology Architecture (MITA) From Both a Business and Technical Perspective April 15, 2015

2 Opportunities for California with Integration of DMH and ADP Functions into DHCS Ben Word Chief Enterprise Architect California Department of Health Care Services Enterprise Innovation Technology Services (EITS) Enterprise Architecture Office The Enterprise Architecture Office helps DHCS take charge of its own transformation. We assist in the creation of roadmaps to take DHCS from where it is today to where it wants to be tomorrow. We work to ensure that projects are aligned with the overall DHCS Strategic Plan, and we shed light on when and where things get off-track. April 15, 2015

3 Talking Points MITA Overview MITA Example (Short Doyle) MEDS Modernization Project Update (Medi-Cal Eligibility Data System) 3

4 MITA Overview MITA Framework MITA State Self-Assessment MITA Maturity Levels MITA Tools, Templates and Artifacts 4

5 Business-Driven Enterprise Transformation established principles that describe business transformation and a transition strategy to achieve that transformation. Commonalities and Differences defines processes, data, and technical solutions that are common to each state yet flexible enough to meet state-specific needs. Standards First promotes the use of data and technical standards. Built-in Security and Privacy includes security and privacy goals and capabilities throughout the architectures. Data Consistency Across the Enterprise ensures, to the greatest extent possible, that copies of data elements are minimal, synchronization of multiple copies (when necessary), and the official data of record is always available. 5

6 Medicaid Information Technology Architecture MITA is both an initiative and a framework Began with the concept of moving the design and development of Medicaid information systems away from the siloed, sub-system components that comprise a typical MMIS Consolidation of principles, models, and guidelines that combine to form a template for the States to use to develop their own enterprise solutions MITA supports Enterprise Architecture EA defines the business, the information necessary to operate the business of an organization, the technologies necessary to support the business operations, and the transitional processes necessary for implementing new technologies in response to the changing business needs. - CMS 6

7 Describes a structure for the Medicaid Enterprise that includes business operations, information exchange, and technological services. Includes: Business Architecture (BA) - Describes the current and future business operations of a state Medicaid enterprise Information Architecture (IA) - Describes the current and future data needs to support the business of a state Medicaid enterprise Technical Architecture (TA) - Defines a set of technical services and standards that can be used to plan and specify future systems 7

8 MITA State Self-Assessment The purpose of conducting the State Self-Assessment (SS-A) is to identify the As-Is operations and To-Be target environment across the Medicaid enterprise Enables DHCS to use defined levels of business maturity to help shape the future vision of the Medicaid program It is now required by CMS for all requests for enhanced federal funding (submitted with Advanced Planning Documents) Referenced in the CMS Seven Standard s and Conditions for enhanced federal funding Initial California SS-A completed in 2008, annual updates began in

9 MITA Maturity Levels Level 1 Level 2 Level 3 Level 4 Level 5 Labor intensive, manual, paper based Focus is on compliance State-specific standards Little collaboration Information is stored in disparate systems Mix of manual and automated processes HIPAA and state-specific standards Collaboration with other agencies Electronic Data Interchange (EDI) transactions Information is stored in disparate systems Standardized business rules definitions Automated to the fullest extent possible within the intrastate Intrastate exchange of information Collaboration with other intrastate agencies and entities Develop and share reusable business services Regional information exchange hubs Automation of information collection Automated decision making based on intrastate standardized business rules Clinical and interstate exchange of information Collaboration with other interstate agencies and entities Develop and share reusable processes including clinical information Information is available in near real time Processes that use clinical information result in immediate action, response, and results Interstate interoperability Automated decision making based on regionally standardized business rules National (and international) interoperability Information is available in real time. Most processes execute at the point of service Information exchange with national agencies Automated decision making based on nationally standardized business rules 9

10 MITA Tools, Templates and Artifacts 10

11 Talking Points Business Architecture Profile (Short Doyle Example) Information Architecture Profile (Short Doyle Example) Technical Architecture Profile (Short Doyle Example) Seven Standards and Conditions Profile Enterprise Concept of Operations Medi-Cal Gap Analysis Medi-Cal Roadmap 11

12 12

13 13

14 Defines the Medi-Cal Enterprise from a business perspective. All Medi-Cal business processes are mapped to MITA standard v3.0, accounting for any state specific processes. Each Medi-Cal business process is evaluated to determine current level of maturity. Business Process Templates (BPT) Business Capability Matrices (BCM) Target 5 year goals are set across all Medi-Cal business processes. 14

15 15

16 A graphical representation of the As-Is and To-Be ratings for the Medi-Cal business process across all six capability qualities. Based on the SS-A Companion Guide To-Be ratings become high level requirements for Medi- Cal business process. Process Short-Doyle Claim As-Is To-Be OVERALL 2 2 Timeliness of Process 2 2 Performance Measure 1 bus. day TBD Supporting Evidence Reference TBD Data Access and Accuracy 2 2 Performance Measure TBD TBD Supporting Evidence Reference TBD Cost Effectiveness 2 2 Performance Measure TBD TBD Supporting Evidence Reference TBD Effort to Perform: Efficiency 2 2 Performance Measure TBD TBD Supporting Evidence Reference TBD Accuracy of Process Results 2 2 Performance Measure TBD TBD Supporting Evidence Reference Utility or Value to Stakeholder TBD 2 2 Performance Measure TBD TBD Supporting Evidence Reference TBD 16

17 17

18 For each Medi-Cal business process: MITA Business Process Model Hierarchy: Shows the mapping to the MITA BPT. Organizational Owner: Identifies the organization within the DHCS that owns the Medi-Cal business process. Variations from the MITA Standard Definition Identifies business process steps that vary from the MITA definition. Used with the MITA BPT. Data and IT Systems : Lists the major data exchanges and systems used to support the Medi-Cal business process. Current As-Is View : Describes the current operations of the Medi-Cal business process in relation to the MITA Business Capability Matrix. Target To-Be View: Identifies the targeted maturity level for the Medi-Cal business process. This information is provided to assist in creating business process models. 18

19 Defines the Medi-Cal Enterprise from a information perspective. There are five components within the IA: Data Management Strategy (DMS) Conceptual Data Model (CDM) Logical Data Model (LDM) Data Standards Information Capability Matrices (ICM) Each Medi-Cal business area is evaluated to determine current level of maturity. Target 5 year goals are set across all Medi-Cal business areas. 19

20 Information Architecture Profile provides an illustration of the As-Is and To-Be capability levels as a result of the SS-A. Each Medi-Cal business area is profiled (based on the SS-A Companion Guide). 20

21 For each Medi-Cal business area: Current As-Is View : Describes the current maturity of the Medi-Cal business area in relation to the MITA Information Capability Matrix. Target To-Be View: Identifies the targeted maturity level for the Medi-Cal business area. 21

22 A graphical representation of the As-Is and To-Be ratings for the Medi-Cal business area across all five IA components. Based on the SS-A Companion Guide To-Be ratings become high level requirements for Medi- Cal business area. 22

23 Defines the Medi-Cal Enterprise from a business and technical services perspective. There are six components within the TA: Technical Management Strategy (TMS) Business Services (implements a business process at a specific capability level) Technical Services (piece of software that executes a generic IT capability) Application Architecture Technology Standards Technical Capability Matrix (TCM) Each Medi-Cal business area is evaluated to determine current level of maturity. Target 5 year goals are set across all Medi-Cal business areas. 23

24 Technical Architecture Profile provides an illustration of the As- Is and To-Be capability levels as a result of the SS-A. Each Medi-Cal business area is profiled (based on the SS-A Companion Guide). 24

25 Technical Service Areas (TSA) Access and Delivery Intermediary and Interface Integration and Utility Technical Service Classifications (TSC) Lower level classification comprised of one or more service standards. For each Medi-Cal business area: Current As-Is View : Describes the current maturity of the Medi-Cal business area in relation to the MITA Technical Capability Matrix. Target To-Be View: Identifies the targeted maturity level for the Medi-Cal business area. 25

26 A graphical representation of the As-Is and To-Be ratings for the Medi-Cal business area across all Technical Service Areas and Classifications. Based on the SS-A Companion Guide To-Be ratings become high level requirements for Medi- Cal business area. 26

27 Designed to aid the state in assessing their compliance with the Seven Standards and Conditions. Evaluate the As-Is and To-Be ratings for the Business, Information, and Technical Architectures as they relate to each of the Seven Standards and Conditions for each Medi-Cal business area. Seven Standards and Conditions Scorecard - Summarizes the State Medicaid Enterprise As-Is and To-Be adherence to funding requirements. 27

28 The Concept of Operations describes the Medi-Cal Enterprise from a business perspective and shows the transformation from the As-Is operations to the To-Be target environment at a high level. Each Medi-Cal business area is discussed. High Level COO As-Is and To- Be diagrams included. 28

29 The Medi-Cal Gap Analysis identifies the capability characteristics of the 5 year To- Be goals that are not present in the current As-Is environment. These targeted capabilities are the gap that exist between Medi-Cal s current operations and the future desired state. 29

30 The MITA Roadmap addresses the gaps and supports the target capability characteristics. It identifies initiatives and planned projects that facilitate the maturity progression over the next 5 years and creates the implementation plan to MITA maturity. It also identifies when maturity goals are not supported by any planned projects and action is required by the DHCS to ensure target capabilities are addressed appropriately. 30

31 Talking Points MEDS Modernization Business Case Approach Scope Schedule 31

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39 Time to hear from you! 39

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