Medicaid Information Technology Architecture (MITA) A Citizen-Centric Approach

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Medicaid Information Technology Architecture
(MITA) A Citizen-Centric Approach
MITA
David Mix, PMP, MBA HIT/MITA Program
Manager Virginia Department of Medical Assistance
Services (DMAS) david.mix_at_dmas.virginia.gov
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Agenda

• Why Are We Here?
• MITA Overview
• MITA State Self Assessment (SS-A)
• MITA, Health Information Exchange, and Health
  Reform
• What is Virginias mITA Concept?
• Next Steps

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Why Are We Here?

• DMAS conducted a MITA State Self-Assessment
  (SS-A) in 2007
• Required by CMS to get funding
• Limited to DMAS
• Strategy is to repeat SS-A every two years to
  gauge progress and adjust plans
• Nothing significant had changed in early 2009 to
  warrant the effort 2010 became a very different
  story
• New Federal impetus for Health Reform
• American Recovery and Reinvestment Act (ARRA)
• Health Information Exchange
• Regional Extension Centers
• Provider Incentive Program
• Patient Protection and Affordable Care Act (ACA)
• Medicaid expansion in 2014
• Health Insurance Exchange
• Standardization of enrollment forms across all
  health human services programs
• Many other grants available
• New Virginia impetus for Reform executive level
  business sponsors
• HHR Secretary Hazel
• Secretary of Technology Duffey

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What Do We Hope to Accomplish?

• Shared vision
• All HHR Agencies
• Local government
• Understand the big picture
• Many interrelated efforts with a common
  denominator MITA
• Alignment of Virginias efforts to national
  direction
• Business
• Technology
• Planning
• Funding

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MITA Overview
MITA
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MITA OverviewWhat Is It?

• A Centers for Medicare and Medicaid
• Services (CMS) initiative to transform the
  Medicaid Management Information System (MMIS)
  into an enterprise-wide backbone architecture
  capable of addressing tomorrows Medicaid needs
• Bottom line
• It is a tool kit to help identify where we are,
  where we are going, and a means to measure
  progress

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MITA OverviewWhat Is the Vision?

• The Concept of Operations (COO) is a tool
• that describes current business operations
  and
• envisions future transformation.
• In the future, Medicaid agencies and other
  payers roles change from those of performing
  operations that require a large administrative
  staff (e.g., to manage paper flow, telephone,
  fax, EDI, and Web-based transmissions make
  decisions and respond to inquiries) to those of
  executive management and professional teams
  (e.g., to analyze program trends, needs, and
  gaps plan strategically monitor program
  objectives and health outcomes make performance
  based payments and participate in the nations
  healthcare goals.

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MITA Overview Framework A Business-Driven
Architecture
l
Vision, mission,
objectives come first
Architecture
l
responds to business
needs
MITA Business,
l
Information, Technical
Architecture models
are enablers to meet business needs
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MITA State Self Assessment (SS-A)

• A MITA Tool

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What Is an SS-A?

• The State Self-Assessment is a MITA
• process for States to measure their process
  maturity level against the Federal Baseline
  Model.
• It serves to align each States enterprise
  efforts towards the national vision.
• Business Architecture
• Information Architecture
• Technology Architecture

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What Is an SS-A?The MITA Maturity Model

• A maturity model measures the improvement and
  transformation of a business across two
  dimensions time and space
• Time marks progress from today to a realistic
  future i.e., 10years and
• Space dimension shows how the business looks at
  present and what its capabilities are likely to
  be as it matures.
• MITA Framework requires a maturity model to
  define boundaries and provide guidelines for the
  transformation of the Medicaid Enterprise from
  its As-Is level of maturity to progressively
  higher levels of performance.

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What Is an SS-A?The MITA Maturity Model with a
10 Year Horizon
Maturity
To-Be
Levels 4 and 5 Technology and policy under
development. Can not be certain of timeframe.
When available, will cause profound change and
improvements in business processes.
Levels 3-5 Years Healthcare industry begins to
use technology available in other business
sectors. Adopts policies to promote
collaboration, data sharing, consolidation of
business processes.
As-Is
Levels 1 and 2 All technology, policy, and
statutory enablers exist and are widely used.
Agency complies with baseline requirements.
Level 2 shows improved capabilities over Level 1.
Time
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What Is an SS-A?Definition of State Medicaid
Levels of Maturity
Level 1 Level 2 Level 3 Level 4 Level 5
Agency focuses on meeting compliance thresholds for State and Federal regulations, primarily targeting accurate enrollment of program eligibles and timely and accurate payment of claims for appropriate services. Agency focuses on cost management and improving quality of and access to care within structures designed to manage costs (e.g., managed care, catastrophic care management, and disease management). Focus on managing costs leads to program innovations. Agency focuses on adopting national standards, collaborating with other agencies in developing reusable business processes, and promoting one-stop-shop solutions for providers and consumers. Agency encourages intrastate data exchange. Agency benefits from widespread and secure access to clinical data and focuses on improvement of healthcare outcomes, empowering beneficiaries and provider stakeholders, measuring objectives quantitatively, and ensuring overall program improvement. Agency focuses on fine-tuning and optimizing program management, planning and evaluation since it has benefited from national (and international) interoperability and previously noted improvements that maximize automation of routine operations.
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MITA, Health Information Exchange, MMIS, and
Health Reform

• Converging Efforts

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mITA Technical ArchitectureLeveraging mITAs
Framework

• Can serve as the Central Nervous
• System for connecting HHS
• programs
• Allows easy access to and sharing of health
  information throughout the delivery of care
• Common denominator for
• Federal initiatives
• State initiatives
• Not just about Medicaid its about the common
  denominator
• IT Architecture as the enabler for business
  transformation

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COV-HIEFitting the HIT Puzzle Together
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Converging EffortsInteroperability Example
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What is Virginias mITA concept?
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Next Steps

• Complete SS-A
• Align business, technical, and solution
  architectures to MITA vision
• Business needs and priorities feed into planning
  and priorities
• HHR HIT/MITA Program Management Office
• Fund and oversee 25 projects to be completed by
  2013
• Known business priorities
• Citizen-centric portal (leverage existing state
  efforts)
• Connect COV-HIE to State health systems (DCLS
  VDH)
• To support meaningful use
• Full automation of member management processes
• To support Medicaid expansion and the
• Health Insurance Exchange
• Questions?

MITA
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