The One PI System

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The One PI System

• August 25, 2008

National Association for Medicaid Program
Integrity
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Agenda

• Background
• One Program Integrity (PI) overview
• One PI interviews
• One PI vision
• Current and future data environment
• One PI releases
• Use of One PI by states
• Collecting and accessing One PI data
• One PI Portal and analysis tools
• Assistance on using One PI
• Next steps

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Inception of One PI

• Bill Gould, along with program integrity staff,
  helped define Medicaid and Medicare fraud and
  abuse efforts
• Paul Miner, George Mills, CA officials and EDS
  developed concept of Medi-Medi and realized a
  comprehensive and integrated database was needed
• With the Medicare Modernization Act (MMA), ground
  work and funding was available to support
  development of an integrated database
• The One PI System was started

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One PI Overview

• One PI consists of a large Medicare and Medicaid
  data repository accessed through a secure portal,
  using a standard set of analytic tools to detect
  fraud, waste and abuse

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Interviews for One PI

• CMS conducted interviews at the beginning of the
  project
• The purpose of the interviews was to
• Understand the current data and system
  environment of potential One PI users
• Understand future needs of the PI community
• Understand business needs of the One PI system
  for requirements determination purposes

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Entities Interviewed for One PI Project
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Interview Results

• Most common requests included
• Access to comprehensive data
• Access to a variety of analytical tools
• Fast response time
• Data quality standards
• Adequate end user support
• Portal collaboration features
• Communication with users on project status

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One PI Vision

• Took interview results and other inputs and
  developed One PI vision

To Provide A Secure, Centralized Environment
Containing Current, Consistent, Relevant Medicare
And Medicaid Health Benefits Data, With Standard
Analytical Tools, For Use By Our State and PI
Partners Involved In Identifying and Combating
Fraud, Waste and Abuse
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Current Data Environment
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Future Data Environment with One PI
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One PI Releases

• Release 1.0 Portal (12/21/07)
• Release 1.1 Medicaid State 1 (02/14/08)
• Release 1.2 Medicaid State 2 and Prescription
  Drug Event (PDE) for State 1 and State 2 (PDE,
  Business Objects State 2 04/04/08 Advantage
  Suite State 2 07/09/08)
• Release 1.3 First DataBank (FDB), National
  Council for Prescription Drug Program (NCPDP),
  and Drug Enforcement Administration (DEA)
  (8/13/08)
• Release TBD - Medicaid State 3

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Use of One PI by States

• Each state can
• Access and analyze its data using data analysis
  tools (Advantage Suite, Business Objects and
  others)
• Access and analyze matched data. Note a
  Computer Matching Agreement (CMA) must be
  established
• Share documents or reports with specific One PI
  users
• Access standard reports and create ad-hoc reports
• Access national and regional norms

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Use of One PI by Medi-Medi ZPICs

• Zone Program Integrity Contractors (ZPICs),
  which will replace Program Safeguard Contractors
  (PSCs) for Medi-Medi programs, can
• Access your data without you having to send it to
  them
• Access and analyze Medicare and Medicaid data in
  their jurisdictions. Note CMAs must be
  established
• Share documents or reports with specific One PI
  users
• Access standard reports and create ad-hoc reports
• Access national and/or regional norms

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State Participation in PIDUG

• As a partner, states are invited to participate
  in the Program Integrity Data Users Group
  (PIDUG)
• The PIDUG is a forum for One PI data users to
  collaborate on analytical solutions, fraud
  schemes and improvements to the One PI system
• PIDUG meetings are every two weeks for an hour
• States are encouraged to provide feedback on the
  One PI system
• States are encouraged to test and assess if the
  system is working appropriately

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Collecting Data for One PI

• The Medicaid Integrity Group (MIG) at CMS will be
  expanding the existing MSIS data collection
  effort by adding elements to better detect fraud,
  waste and abuse (FWA)
• The existing MSIS elements and the new data FWA
  elements are called MSIS Plus elements
• MIG will eventually collect data from all 50 US
  states territories
• CMS wants to ease the states burden of supplying
  multiple data feeds to CMS
• CMS is considering whether it is feasible to use
  the MSIS Plus state data feed for all CMS
  activities that require Medicaid data

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Secure Access to Data in One PI

• All access to data is through role-based security
  where each user is restricted from accessing any
  information, tools or data that they are not
  authorized to use
• The One PI Portal is the gateway to the One PI
  system
• A state will access data and run reports in the
  One PI System by logging onto the Portal
• The Portal is also used to collaborate and share
  information

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• The One PI Portal

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One PI Portal - One PI Authentication Page
Single login method mitigates risk to CMS and
states with centralized access and role based
security.
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One PI Portal - One PI Home Page
The Portal Home Page will be used by state users
to communicate with PI partners. Tabs are
available to users in accordance with their role
based security access.
Content management portlets allow information to
be communicated to all users.
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One PI Portal - Analysis Tools Page
States will be able to access a variety of
analytical tools for use in Program Integrity
related work. This list will grow as the One PI
program grows.
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One PI Portal - PIDUG Home Page
The Program Integrity Data User Group (PIDUG)
will be a forum for One PI data users to
collaborate on analytical solutions, fraud
schemes and improvements to the One PI system.
States are encouraged to participate.
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One PI Portal - PIDUG Documents Page
The PIDUG document management portlet allows for
the sharing of pertinent documents for all
members to view. Role based access will determine
who can add and edit documents.
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Access to Data Analysis Tools

• States can use all data analysis tools in the One
  PI system
• Currently, One PI contains Business Objects and
  Advantage Suite
• Plans are to include more analysis tools in the
  future

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• Business Objects

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Business Objects - InfoView
Standard reports will be made available to all
users to allow for efficiency and
standardization. States can modify the standard
reports and suggest new standard reports.
Public folders are accessed via role based
security.
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Business Objects Example 1 - Standard Report
States can view the data elements contained
within the report.
States can slice dice the data results of a
query to develop multiple reports or views of the
data.
Results can be displayed graphically
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Business Objects Example 2 Ad-Hoc Report
States can create ad-hoc reports for non-routine
analysis. Web Intelligence is the version of
Business Objects the One PI will offer. This
does not require a client download to the users
desktop.
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Business Objects Ad-Hoc Report Build Query
Data elements are logically grouped into folders
which will allow states to easily access the
appropriate elements.
States can set filters to restrict results to
their specific business need.
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• Advantage Suite

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Advantage Suite - Pharmacy Profile Example
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Advantage Suite - Episodes
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Advantage Suite Drug Fraud and Abuse Example
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Advantage Suite Completion
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Assistance with using the One PI Portal
Analysis Tools

• In order for each state to become familiar with
  the modules in the One PI system, assistance is
  available
• Online help is accessible for all One PI modules
• Computer based training is offered for the Portal
  and each analysis tool in the system
• Classroom training will be offered to states on
  how to use the One PI Portal and analysis tools

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One PI Project Next Steps

• Complete Proof of Concept and move into
  operations in FY 2009
• Establish bullpen of states interested in One
  PI and/or Medi-Medi participation

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Points of Contact

• If you have questions about this presentation,
  please contact
• Randy Beardsley
• randy.beardsley_at_cms.hhs.gov
• 410-786-1606
• Laura Minassian-Kiefel
• laura.minassiankiefel_at_cms.hhs.gov
• 410-786-4641

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• Questions