MITA Enterprise Transformation California Department of Health Care Services Using the SS A to Initiate Enterprise Change
History of MITA at DHCS Initial Medi Cal SS A completed in 2008 based on MITA v2.0 Target business To Be goals used in development of MMIS replacement RFP Momentum from SS A decreased as priorities shifted and proposed MITA positions were not funded. Second Medi Cal SS A initiated after release of MITA v3.0 Completed in August 2013 Included Concept of Operations and initial Roadmap Coincided with release of the new DHCS Strategic Plan (Summer of 2013) 2
Results of Medi-Cal SS-A Results show very little maturity progression over 10 years 3 Medi-Cal Business Area 2008 2013 As-Is To-Be (2013) As-Is To-Be (2018) Business Relationship Management 1 1 1 1 Care Management 1 2 1,2 2 Contractor Management 1 1,2 1 1 Financial Management Operations Management TPL 1 3 1 2 Accounting 1 2 1 2 Dental 1 2 1 1 Medi Cal FFS (CA MMIS) 1 2 2 2 Dental 1 2 2 2 IHSS 1 2 1 1 Supplemental Services (SNFD) 1 2 1 1 Capitation 1 2 2 2 Performance Management (Program Integrity) 1 3 1 2 Plan Management 1 1,2 1 1,2 Provider Eligibility and Enrollment Management 1 2 1 3 Provider Management 1 2 1 1,2,3 Member Eligibility and Enrollment Management Member Management 1 2,3 On Hold
MITA Maturity Defined As Is Near Future To Be 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 CMS expects state agencies to be at an appropriate level based on federal initiative deadlines. Federal initiatives are directing the State Medicaid Agency to achieve Level 3 or, in some processes, Level 4 and 5 maturity. 4
DHCS Strategic Vision Aligned with MITA MITA Maturity Capabilities DHCS Commitments Level 3 Level 4 Level 5 To The People We Serve Improve the consumer experience Treat the whole person by integrating care Improve prevention and early intervention Develop effective, efficient and sustainable delivery systems Single point of entry Intrastate information exchanges Beneficiary focus with shared member business services National data standards for comparing outcomes Coordination / collaboration across health care programs Access to clinical information (EHR) Regional data exchange Beneficiary/patient centric Medicaid Enterprise Enterprise Master Patient Index Beneficiaries and providers empowered to make decisions affecting outcomes Master data management Interoperability and national data exchange Providers access vital clinical information to coordinate care Beneficiary focus objective Compare outcomes across a broad spectrum of other agencies and states To The Public Ensure a viable health care safety net Effectively engage the public and our partners Hold ourselves accountable for performance Be prudent, responsible fiscal stewards Intrastate agencies collaborate on common benefit plans Nationally recognized information exchange standards Shared business services SLA for intrastate data sharing Use of performance measurements Adopts enterprise architecture Seamless integration with clinical and administrative systems, health information exchanges, and EHR systems Real time decision making Implementation of performance measurements/ accountability Pay for performance / patient satisfaction measurement ONC Nationwide Health Information Network (NwHIN) National interoperability (SLA) Master data management Performance measurements based on performance information shared with other intrastate, interstate, and federal agencies To Our Employees Foster a healthy, positive work environment Focus on communication, teamwork and effective decisions Recognize and appreciate excellence Provide opportunities for learning and growth Statewide input to the policy setting process. Central, up todate and accurate. Stakeholder satisfaction at 90% Use of survey or questionnaires for information collection. Staff free from administrative data processing and focus on their primary functions. Regional input into the policy setting process Processes that use clinical information result in immediate action, response, and results. Stakeholder satisfaction at 95% or higher. National input into the policy setting process. Policy changes are distributed in near real time. Stakeholder satisfaction at 98% or higher. 5
Why Hasn t DHCS Advanced? DHCS is organized around programs and large operational systems Projects are based upon program specific needs, not enterprise wide solutions to support business capability advancement Technology/IT Solutions have historically aligned with organizational structure Level 3 requires use of national standards while local codes and state specific standards continue to be used across the Medi Cal enterprise 6
7 Medi Cal Provider Management As Is
Medi Cal Operations Management As Is Provider Community Multiple Entry Points Claims Processing Decentralized Communication Specific to Program e e Paper & Electronic Paper & Electronic Paper & Electronice e Paper & Electronic Electronic e SD/MC Portal e Paper Paper Paper Paper Various Online Claim Attachment Programs Dental Medi Cal FFS Managed Care Short Doyle Supplemental IHSS Manual Manual CD MMIS FAME CA MMIS Claims Processing CAPMAN FAME CA MMIS CHDP Subsystem Short Doyle FAME USLF SMART FAME CMIPS FAME Encounters Paid Claims CA MMIS Provider Subsystem FAME CA MMIS Recipient Subsystem Capitation Payments Paid Claims Paid Claims Encounters Paid Claims Various Reference Files Provider Master File Procedure Code File PCES Paid Claims and Indicates support of some HIPAA compliant transactions FAME 8 MIS/DSS
How Does DHCS Advance? Focus on the foundation of the MITA initiative the Business Business process consolidation, integration and standardization is required to advance along the capability maturity scale Use Enterprise Architecture (EA) principles to support business capabilities CMS recommends development of a state EA program to support transition planning and define projects needed to implement target capabilities. 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 http://www.medicaid.gov/medicaid CHIP Program Information/By Topics/Data and Systems/Downloads/mitaplan.pdf 9
How Does DHCS Advance? MITA maturity promotes Business Process Management Business processes are strategic assets enabled through technology and supported by information The Role of Business Maturity MITA represents a business driven enterprise transformation Business process maturity is the driver for overall MITA maturity Information and Technical capabilities enable business goals MITA Enterprise Change Roles Business Owner Information Owner Technical Capabilities Owner 10
Business Process Ownership Med QUEST To Be Vision Planning 11
Medi Cal Provider Management As Is Provider Department Mgmt Department Department of Aging of Aging of Aging Provider Department Mgmt of Department Social Svc. of Department Social Svc. of Social Svc. 12
Medi Cal Provider Management To Be. Business Owner Business Department Rules of Aging Department of Aging Business Department Rules of Social Svc. Department of Social Svc. 13
Recommended Actions 1. Establish a new governance process Monitor implementation of Roadmap and target To Be goals Alignment to strategic vision of DHCS Ensure projects have foundation based upon improved business capabilities Approve, direct, and influence enterprise IT approaches Decision making body holds relevant enterprise authority Made up of business, information and technical owners 2. Establish a new executive role Associate Director, Chief Business Architect Responsible for increasing MITA maturity across MITA business processes 3. Appoint business process owners 4. Staff a business architecture team 5. Look for opportunities to organize around MITA business processes 14
MITA Enterprise Change Presentation to Directorate Wednesday, June 26 th 2013 Office of HIPAA Compliance
Contact Info Carrie Moore Hubbert Systems Consulting, Inc. www.hubbertsystems.com Email: cmoore@hubbertsystems.com 16