A Successful Step Towards CMS MITA Compliance. A Composer Solutions Overview

Transcription

1 A Successful Step Towards CMS MITA Compliance A Composer Solutions Overview

2 Overview The Medicaid and Medicare healthcare systems manage over 50 million patients and process several billion in benefit payments. The Center for Medicare & Medicaid Services (CMS) has rightfully requested that the 51 state agencies standardize systems and processes to improve patient care and reduce costs. One of CMS s initiatives was the creation of the Medicaid Information Technology Architecture (MITA). MITA was created as an architectural and development standard to foster system development that is easy to use, highly flexible and easily works with other systems across the Medicaid enterprise to improve the administration of the Medicaid program. To achieve the goal of a standardized system that is easy to maintain and reduces future costs, MITA objectives were developed to ensure systems are patient-centric, web-based, data-focused that are interoperable across states, promote reusability, and integrate well with all other health data. This overview provides a summary of MITA in terms of its goals and objectives, the MITA Maturity Model (MMM) structured approach and how the use of the Composer Advantage software will augment your organizations ability to achieve MITA s goals and objectives. MITA Goals and Objectives

3 MITA Current Challenge The desired outcome of MITA is to develop integrated systems using industry standard best practices technologies and programming methodologies that are easily maintained and changed with a patientcentric data focus that is available in an easy to access and understand manner. This is a fantastic vision. However, this vision is difficult to attain based on the challenges documented in a Medicaid s SOA whitepaper: When business rules, policies, or legislation change, any or all components of the system may be impacted, including applications, databases, and interfaces. Thus, it becomes increasingly difficult to manage this complex environment. It is also becoming exceedingly costly to maintain these systems, both from a financial perspective (state and federal), as well as from an intellectual property perspective. And as systems grow older, fewer and fewer resources are available that are familiar with these systems and know how to maintain or update them. The key challenges identified in Medicaid s SOA whitepaper are: Highly interconnected systems using point-to-point interfaces require pervasive modifications to accommodate changes to business requirements, making them difficult to change Users must navigate through multiple functional systems to perform a single task MMIS, to a large extent, is platform dependent, and does not communicate easily across functional or technical boundaries, which makes it difficult to share information or reuse functionality This creates a usual conundrum for current system owners to first understand what their systems do, how they are organized, how they operate and interact, and where the critical business functions are located. Given the size and age of many Medicaid systems today, plus the multiple technologies and methodologies that have been used to manage and maintain these systems, this is a daunting task. CMS clearly recognized the size and complexity of the Medicaid program and understood the Medicaid stakeholders would need a transitional roadmap and process to implement the goals and objectives of MITA. Therefore, CMS developed a MITA Maturity Model (MMM) which is structured phased timeline that allows stakeholders the ability to view Medicaid improvement and transformation in bit-sized chunks over time. The MMM was a 10-year time frame that outlined a roadmap for the transformation of the Medicaid enterprise from a current as is capability to a future to be state. This 10-year timeframe was divided in 5 progressive steps of maturity, referred to as levels, with each level having a distinct narrative description of the capabilities of the Medicaid enterprise at that level. The MMM shows a pathway of continuous business improvement leading to a realistic future state. Each new level incorporates the best practices of the prior level and introduces and adds new higher level capabilities. The five levels are: Level 1 - understanding of the current system, Level 2 - plan for potential short terms improvements, Level 3 - intermediate goals to facilitate moving to the next level, Level 4 - augment clinical data into existing process and Level 5 - make it interoperable across the nation. (See table below)

4 MITA Maturity Model (MMM) The transformation process outlined by CMS a decade ago was and still is a very good process. The challenge is that despite this transitional roadmap for the last 10 years, many of the states have yet to fully achieve Level 1 which is a full understanding of their current system in order to reduce the time and cost of making Medicaid program changes to the current system. This lack of progress over the last 10 years is a real challenge that is getting worse as the people who work on these systems are retiring and the systems themselves continue to age. The complexity and enormity of the challenge has made taking the first step difficult.

5 Taking the First Successful Step of Implementing MITA The fundamental principle of achieving Level 1 of the MMM is full understanding of the as is current Medicaid system. This as is knowledge and understanding is critical as the foundation of current system understanding, as without this knowledge it is difficult to have a cost effective maintenance plan in place. And attempting to develop a modernization strategy that aligns with the MMM Levels without understanding your current system is nearly impossible. The diagram at the left describes the benefits of having the as is knowledge and understanding of your current Medicaid system. The Composer Advantage software is specifically designed to collect, organize and visually present detailed legacy application knowledge that is easily accessible by business and technical users. Using the Advantage solution will allow your organization to rapidly create a foundation of knowledge as a critical first step towards MITA compliance. This foundation requires a complete understanding of the current system, which is typically in and of itself a daunting task, as most existing systems are decades old and have no useful documentation. Gaining this understanding is not easy as the Medicaid system is typically maintained by just a few technical resources who are already fully tasked with Medicaid maintenance and change requests. Composer Advantage programmatically generates a knowledge base (KB) of detailed application information by processing a copy of the application s source code creating a complete foundation of application knowledge. As not all application knowledge resides in the source code, Advantage has knowledge management capabilities that enables the collection of application knowledge that is in the minds of programmers and business users that are easily added as Knowledge Notes. Using the Composer Advantage Knowledge Base, the users can begin to understand and visually review the system s design and architecture including: Proper segregation and documentation of all applications that constitute the Medicaid system On-Demand Documentation provides a visual representation of the existing Medicaid system Understanding the detailed connectivity and interfaces including dependencies View program and business logic in an easy to use graphical and decision table based formats

6 Use pre-defined MITA compliant classification and naming conventions to add MITA terminology as a Business Vocabulary to Programs, Rules and Variables (Data Entities) Add Knowledge Notes to program logic elements to make them more MITA descriptive Quickly extract and annotate relevant business logic (representing core business rules that conduct Medicaid business functions) into human readable formats, augmented by autosuggest technology that assists in the assignment of relevancy and process classification codes Map systems, applications and business logic to relevant policies and aide codes with autosuggest capabilities to quickly achieve the required mapping Search, review and analyze the knowledge base to derive current and future decisions Accurately assess the impact of legislative or CMS mandated business changes business Refactor business rules into specific formats for industry leading business rule engines or generate program summary documentation to augment the creation of the Requirements Document for future modernization initiatives Having a centralized knowledge base repository with role based access ensures the application knowledge is preserved in an easy to use accessible format for on-demand searching, reviews and reporting Composer Advantage is a web-based cloud ready application knowledge platform that collects, preserves and enhances application knowledge in an easy to use knowledge base:

7 State Agency and Vendor Benefits State Agency benefits of using the Composer Advantage Knowledge Base Improve CMS Relationship and funding approvals by achieving the MMM Level I requirements which demonstrates progress towards MITA compliance Use Advantage s impact analysis capability to investigate the effect of CMS Change Requests Visually review the entire Medicaid system (including all subsystems and programs) Capture and preserve application knowledge and information as a department operating asset Add MITA process terminology to ensure standard review and analysis going forward Map legislative mandates (aka policies) to the Medicaid system and highlight any potential gaps Create accurate business requirement documents with MITA compliance for Vendor RFPs, exportable directly from Advantage knowledge base with MITA terminology Validate and manage Vendor project deliverables Maintenance or Replacement Vendor benefits of using the Composer Advantage Knowledge Base Summary Rapidly gain overall knowledge about State s current Medicaid application Fully understand business logic, data flows and interface details of the Medicaid system Generate useful artifacts like flowcharts, process flows and decision tables to develop modernization strategies that are fully aligned with MITA Generate human readable business rules for use in new modular systems If engaged as the M&O Vendor for the current Medicaid system, the application knowledge will significantly improve the maintenance team s application understanding, thereby decreasing the time and cost of implementing Change Requests The MITA goals and objectives are a well thought out architectural and development initiative. The challenge is the State Agencies have to work within financial and resource constraints and getting started is problematic. Composer Advantage provides a rapid path to achieve the basic Medicaid system understanding (MMM Level I) which will improve the implementation of CMS and legislative changes, decrease maintenance costs and enable the Agency to begin a long-term Medicaid system modernization that is aligned with CMS s vision. The programmer and analyst productivity gains and improved relationship with CMS ensure a high ROI using Composer Advantage.