Medicaid and PHA - Partnership in using the Data Warehouse

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Medicaid and PHA -Partnership in using the Data
Warehouse

• Cynthia Green-Edwards
• Director, Office of Medicaid Health Information
  Technology
• Michigan Department of Community Health (MDCH)

2
Overview

• Enterprise Data Warehouse (statewide)
• MDCH Data Warehouse
• Data Warehouse In Action!

3
Nations Longest-Standing, Most Sophisticated,
and Highly Utilized State Government Data
Warehouse
Users
Data Sources
1994

• Medicaid

• 50
• Medicaid

• Department of Community Health
• Department of Human Services
• Department of Corrections
• State Police
• State Court Administrative Office
• Department of Natural Resources
• Department of Energy, Labor Economic
  Growth
• Secretary of State
• Department of Treasury
• Federal IRS, SSA, Census Bureau

• 9000
• All major departments
• External (providers,
• PIHPs, CMHs, etc.)

2010
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Enterprise Data Warehouse Data Sets

• Department of Human Services
• Public Assistance Eligibility History
• Public Assistance Payment History
• Child Day Care Payment History
• Electronic Benefit Transfer
• Child Family Services
• Services Provider
• Foster Care Adoption
• Child Adult Protective Services
• Adoption Subsidy
• Child Support
• Department of Corrections
• Prisoner, Probationer, Parolee demographics
• State Police
• Personal Protection Orders
• State Court Administrative Office
• (Circuit, District, Probate, Criminal,
  Juvenile,
• Civil Traffic Courts)
• Demographics

• Department of Natural Resources
• Hunting License
• Campground Reservations
• Department of Energy, Labor Economic Growth
• Workers Compensation
• Unemployment
• Quarterly Wages
• MI State Housing Authority Clients
• Professional License
• Secretary of State
• Drivers License
• Department of Treasury
• New Hire
• MI Federal Individual Tax
• MI Federal Business Tax
• Federal
• SSI and RSDI Claims Payments
• Census
• Federal Case Registry (Child Support)

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Data sharing across state agencies

• Community Health (MDCH)
• Data sources
• MDHS (geo codes)
• CSES (court ordered medical support)
• DELEG (MI State Housing Auth clients)
• Business Examples
• Paternity Recoveries
• Homeless Project
• Duplicate ID
• Human Services (MDHS)
• Data Sources
• MDCH (well-child visits)
• CSES (support orders)
• Corrections (demographics)
• DLEG (unemployment/quarterly wages)
• Treasury (new hires)
• Business Examples
• Income Validation
• Foster Care/Well Child

• Child Support Enforcement (CSES)
• Data Sources
• MDCH (TPL, paternity)
• MDHS (beneficiary address)
• DLEG (unemployment/quarterly wages)
• MDNR (hunting license, campground)
• Treasury (new hires)
• Business examples
• Parent Locator
• Identify parent insurance
• Michigan Courts
• Data sources
• MDCH (death records)
• Corrections (parole, probation, prisoner)
• Department of State (drivers license)
• CSES (address)
• Business examples
• Cancel warrants
• Cancel collections

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Overview

• Enterprise Data Warehouse (statewide)
• MDCH Data Warehouse
• Data Warehouse In Action!

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MDCH Data Warehouse Data Sets

• Medicaid Provider
• Eligibility
• License
• Network
• DEA/CLIA
• MIChild
• MIHP (Maternal and Infant Health Program)
• MMA (Medicare Enrollment)
• Pharmacy
• Claims
• NDC
• MAC
• CMS rebate
• Substance Abuse
• Third Party Liability
• Vital Records - Death/Birth/Paternity
• Women Infants and Children

• Community Mental Health
• Childrens Special Health Care Services
• EPSDT
• Habilitation Support Waiver
• HIV/AIDS (structure only data deleted)
• Home Help Payments
• Lead Screening
• Long Term Care
• Home Care
• Nursing Home
• OASIS
• Michigan Care Improvement Registry
• Medicaid Fee-for-Service
• Medicaid Beneficiary Eligibility
• Medicaid Managed Care
• Payments
• Encounters
• Provider Networks
• Medicaid MI Choice Minimum Data Set

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MDCH Data Warehouse Applications/Exchanges

• Reports
• Federal Reporting
• MARS
• Nursing Home Assessment (MDS)
• Production Reporting
• Statewide Homeless Assistance Data Online
  Warehouse
• TPL Recovery Systems
• Health
• Paternity
• UCI (Unique Client Identifier)

• CHAMPS (MMIS)
• Habilitation Support Waiver
• Michigan Care Improvement Registry
• MMA
• MSIS
• Pharmacy Price Finder Website
• Program Integrity
• SURS
• Audit

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Data Integration Program Actions and Results
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MDCH Data Warehouse Unique Client Identifier
(UCI)

• Links person-level records from one programs
  database to others (includes Medicaid, WIC,
  Lead Screening, MCIR, Vital Records, LTC,
  MIChild, DSS, CSES, Paternity, Unemployment,
  SHADoW)
• Evaluates an individuals name, address, and
  other identifying data across programs to
  determine matches
• Assigns a unique ID, or UCI, to be used in all
  Data Warehouse databases for each individual
• Allows for administrative data extraction from
  distinctly different program databases
• Once person-level records are linked, they remain
  linked unless manual intervention introduced
• Gives a comprehensive view of individuals in
  multiple programs
• making it possible to effectively assess and
  analyze healthcare program data, make better and
  faster decisions, manage and measure programs,
  reduce costs, and improve outcomes

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MDCH Data Warehouse Benefits

• Improving the administration of healthcare
  services
• Conducting advanced healthcare analysis to
  determine patterns
• Assessing which programs are most effective
• Detecting and reducing fraud, waste, and abuse
• Improving and interpreting disease management and
  epidemiological patterns
• Improving health care outcomes
• Streamlining operations and improving
  efficiencies
• Supporting Health Information Exchange (HIE)

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Overview

• Enterprise Data Warehouse (statewide)
• MDCH Data Warehouse
• Data Warehouse in Action!

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MDCH Data Warehouse - Examples of Success

• Financial benefits from state healthcare programs
• 200 million annually since 2005 (800 million
  total)
• 97 million in fraud recoveries alone during this
  period
• Reduced cases of child lead poisoning
• Reduced number of cases by 35 from 2003-2007
• Medicaid-enrolled 3-year-olds screened for lead
  increased
• from lt50 in 2003 to 72 in 2009
• Identified 14 Michigan communities that represent
  80 of all child lead poisoning cases
• targeting prevention efforts in those
  communities
• Medicaid children at risk of flu complications
• Identified 59,000 during 2006-07 flu season
• Focus on those with asthma
• When a record is accessed in Michigan Care
  Improvement Registry (MCIR) for a child with
  high-risk condition, a reminder appears for
  physicians to evaluate the child for influenza
  vaccination
• Healthcare analysis and outreach in partnership
  with Michigan State University
• Newborn metabolic and hearing screening (linking
  screening records to Medicaid beneficiaries)
• Epidemiological analysis to determine impact of
  chronic disease (diabetes, asthma, cancer,
  cardiovascular disease, etc.) on Medicaid
  population of Michigan comparison with other
  states

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The Power of Linking and Sharing Information
Newborn Screening
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The Power of Linking and Sharing Information
Child Immunizations
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Member Level Historic Data Project -Helping
Health Plans Address New Member Needs

• Monthly data extracts to Medicaid Health Plans
• One year history of fee-for-service claims,
  pharmacy claims and encounters data for new
  enrollees
• Advantages
• Identify opportunities for care coordination and
  preventive care
• Baseline of information on new members
• Identify prior treatment, impact, and indications
  for future care
• (e.g., drug step therapy)
• Identify members for case and disease management
  prior to trigger episode as plan member
• Identify fraud and abuse (expensive DME)
• Auto populate Electronic Health Records (EHRs)
• Auto report members meeting criteria based upon
  pre-established algorithms

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Coordination of Care Project

• Monthly exchange of service level data
• Prepaid Inpatient Health Plan receives pharmacy
  and physical health data
• Medicaid Health Plan receives mental health
  encounters
• Includes data for one year prior to current month
• Goal is to provide coordination of care by
  multiple organizations managing a patients
  mental and physical health

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Michigan Care Improvement Registry (MCIR)

• Warehouse data integrated into online
  application
• Lead results
• High Risk Indicator identifies children at risk
  for flu complications
• Well-child visits and EPSDT services indicator
  (up-to-date or due/overdue)

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HIV

• Registry
• Services
• Coordination of HIV programs

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Maternal Infant Health Program (MIHP)

• Currently captures Maternal Screener data
• Will eventually include Infant Screener and
  Discharge Summary data
• Goals
• Assess outcomes
• Evaluate effectiveness of program
• Determine impact of interventions

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Health Information Exchange /Electronic Health
Records

• Meaningful use objectives and measures
• Improve quality, safety, efficiency
• Engage patients and families
• Improve care coordination
• Improve population and public health
• Ensure privacy and security protections
• Data mining to create a new Continuity of Care
  Document (CCD) based on HL7 standards
• Clinical quality measures
• Verifying provider reporting and tracking
  compliance
• Connected to SOM HIE

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Division of Genomics, Perinatal Health and
Chronic Disease Epidemiology Staff

• How data warehouse is currently used
• Ideas for future use
• Potential expansion of data sources

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Data Warehouse Resources

• Process for requesting data warehouse access
• Data warehouse Help Desk
• User Group Meetings