NMEH Medicaid IT Architecture (MITA) Framework Sub-Workgroup Beyond Compliance: Highlights from the 2012 MITA State Self-Assessment Survey August 20, 2012
The MITA 2012 State Self-Assessment (SS-A) Survey Survey Summary o The MITA SS-A Survey was conducted on June 25 through July 3, 2012. o Representatives from 17 state Medicaid and 6 vendors and/or contractors participated. The limited number of responses (n=23) may not provide a complete picture of state MITA activities. Some valid observations can be made. A follow-up MITA SS-A survey is planned in March 2013. o 80% of the states surveyed have completed a MITA SS-A. 80% worked with a contractor. 37% of these MITA SS-As are over two years old. None have submitted an annual update to their initial MITA SS-A. 62% are waiting to include Member Eligibility and Enrollment business processes in their MITA 3.0 SS-A. 56% plan to conduct a FULL assessment of all MITA 3.0 areas. 44% plan to conduct a FOCUSED assessment. 1
Future SS-A Planning and Scope In the next 12 months, does your state plan to do one of the following? (#18) 16% Update an older SS-A 11% 5% 68% Update a partial SS-A Conduct the initial SS-A No Plan within the next 12 months 2
Governance Please select the option below that best describes your State's current MITA governance structure. (#15) No MITA Governance structure is currently in place 21% 11% We have dedicated staff to lead MITA 11% 26% We have Identified a MITA lead, but not dedicated full-time We have not identified a MITA Lead, but Steering Committee Lead and dedicated SME staff 32% Other (please specify) >100% due to rounding calculation Ø This is a multi-divisional effort within our department, with one office as the lead agency with limited but dedicated staff, along with collaboration with liaisons and leads in other offices. Ø a new PMO, Enterprise Architecture Team and CIO has been put in place that is developing governance processes for projects including the Replacement MMIS. 3
MITA s Role in the State Medicaid Enterprise Future State Does your state have a target (within the next 5 years) To-Be business capability assessment for the State Medicaid Enterprise? (#21) 28% Yes No 72% Ø The MITA framework will provide the foundation for our State Medicaid Agency's future. We are basing our enterprise architecture on MITA, and our department will be using MITA to move its business forward. Ø Development of the state s HIE has already layered onto the enterprise the benefits of integration and interoperability. Ø We are aiming at level 4 by increasing intrastate and regional exchange of information. Ø MITA is central strategy to address ARRA and PPACA requirements. 4
MITA s Role Beyond the Boundaries of the State Medicaid Enterprise Has your state applied the MITA guidelines and principles to other projects outside of the Medicaid program? (#23) 33% 67% No If Yes, which ones? Ø Principles outlined in MITA will be incorporated into systems outside of Medicaid. For example, the Health Benefit exchange will implement some MITA standards and conditions. Ø The State created business process templates and business capability matrices based on MITA 2.01 to complete a Behavioral Health SS-A. Ø HIT (HIE), Health Department system services, State Laboratory services, establishing a state enterprise architecture (business and technical infrastructure. 5
MITA s Role Beyond the Boundaries of the State Medicaid Enterprise Has your state broadened their SS-A to include areas outside of Medicaid? (#24) 39% 61% No If Yes, which ones? Ø [State] Benefits Management System. Ø The State completed an SS-A for Behavioral Health. Ø Foster Care, Department of Military Affairs and Public Safety, State Police, CHIP, Public Health, Office of Technology. Ø Behavioral Health, we are also looking at the draft National Human Services Interoperability Architecture. 6
MITA s Role Beyond the Boundaries of the State Medicaid Enterprise Do you think the MITA business, information and technical architectures provide a foundation that can be applied outside of the Medicaid program? (#25) 24% No If Yes, where? 77% >100% due to rounding calculation Ø The concepts of MITA are not new to how systems are designed and built. Shared services, integrated security, and re-use have been implemented in other industries for years. Ø Our Medicaid program is located within the [state health department] and many other [state health] programs such as maternal and child health, mental health, etc. serve the Medicaid population. Ø [State] is looking at MITA as the central enterprise vision for the State. 7
An Opportunity for Increased Education and Outreach Do you feel that your state business and technology staff have an understanding of the requirements of the Seven Conditions and Standards? (#31) 43% 57% Yes No Ø only a very general understanding. basic understanding. basic knowledge. Ø At this point a few staff have an understanding, as we move forward with the state self assessment more staff are gaining an understanding. Ø Technology staff have a greater understanding than the business staff. 8
An Opportunity for Increased Collaboration Is your state collaborating with other state and federal agencies to support IT Guidance? (#37) 38% No 63% If Yes, what activities are being done? >100% due to rounding calculation Ø We are cooperating with CMS on completing the Infrastructure assessment [and] look for opportunities to work with other states on new projects. Ø Collaboratives with other states re: cloud computing; governor's HIT forum; [state health information network]; MMIS multi-state collaborative. 9
Performance Standards will Enhance the MITA Framework Please select the option below that best describes your State's defined performance standards and measures for primary MITA business processes. (#38) 13% We currently have defined performance standards and 31% measures for primary MITA business processes We do not have defined performance standards and measures, but plan to adopt them Other (please specify) 56% Ø Our current processes are a mixed bag. We have some defined performance standards and measures. Ø As part of replacement MMIS there will be defined performance standards and measure, also will be part of MITA gap analysis. 10
Performance Standards will Enhance the MITA Framework Please select your top three (3) pressing MITA information needs from the list below. (#41) Please select your top three (3) pressing MITA information needs from the list below. 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% What is the minimum that has to be done for the SS-A? What skills are required to conduct a complete SS-A? What are the benefits of conducting the SS- A? How do we keep the SS-A current? What are the other uses for the SS-A? What is the level of effort to go from 2.0 to 3.0? Business rule development Business architecture Practical applications of the Seven Conditions and Performance Standards and Measures Examples of Performance Standards and 1. Examples of Performance Standards and Measures from other states (54%) 2. Performance Standards and Measures (44%) Business rule development (44%) What is the level of effort to go from 2.0 to 3.0? (44%) 3. How do we keep the SS-A current? (38%) 11
MITA Repositories Has your state utilized either of the following national MITA repositories? (#42) 16 14 12 10 8 6 7 10 Yes No 4 2 8 5 0 CMS: The Collaborative Application Lifecycle Tool (CALT) - https:// calt.hhs.gov/sf/sfmain/do/home Clemson & CMS MITA Repository - http://mita.clemson.edu/ar/ Comments for Repository Improvement Ø CMS identify what is the repository to be used. Multiple sites add confusion where to place and locate information. Ø Ease to get access to repository. Ø Expand the knowledge share of the repository. Include state level documents including APD, Assessments, Workflows, Business Plans, etc. Ø Timely updating, and announcements/notification that they have been updated, perhaps through NMEH listserv and other vehicles. 12
Discussion & Conclusions Leading states are managing MITA as a business process improvement program, not as an IT project or simply to achieve federal compliance. The MITA framework can be extended to other health and human services programs. Some states have completed mapping MITA 2.0, 2.01 to 3.0 and have concluded: ü Not significant level of effort increase ü Encouraged by the changes ü Extended mapping to HIX blueprint and across the healthcare enterprise A performance reference model for MITA is needed to establish a business case (beyond enhanced FFP) and ensure sustainability. A definitive national repository for MITA artifacts and multi-state collaboration is needed. NASHP s health reform site, http://www.statereforum.org/, is a good model. More education and outreach is needed to communicate the value of MITA to the HHS enterprise and other state agencies. ü Information sharing from states that have extended to other state agencies (i.e. State Police, Department of Military Affairs and Public Safety, Behavioral Health) 13
Contact NMEH MITA SWG Co-Chairs Patti Garofalo Client Executive Healthcare and Human Services CSG Government Solutions pgarofalo@csgdelivers.com Susan Ackley Director Standards Compliance Cognosante susan.ackley@cognosante.com Rick Howard Research Director Industry Research Public Sector Gartner rick.howard@gartner.com