ISM Conference MITA (Tom Baden)

8/8/2019 ISM Conference MITA (Tom Baden)

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MITAMedicaid Information Technology Architecture

Minnesota Department of

Human Services


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Minnesota Health Care Programs

6 Billion in Expenditures

700,000 Minnesotans

44,000 Providers

87 Counties

46,000,000 Transactions


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Minnesotas Path to MITA

Historical Context


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Why MITA Now?

Medical Errors - 98,000 avoidable deaths due to medical error

Health Care Waste - 300 Billion spent annually on treatments with no health yield

Knowledge Diffusion - 17 years of medical evidence to be integrated into practice

Consumer Empowerment - Patients minimally involved in their health decisions

Health Privacy - Public concern

Health Preparedness - Surveillance is fragmented and untimely


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Partners

E-Gov Federal Enterprise Architecture

Office of the National Coordinator for Health InformationTechnology (ONCHIT).

The Centers for Medicare and Medicaid Management (CMS)

National Health Infrastructure Initiative (NHII).

MITA is intended to foster integrated business and IT transformationacross the Medicaid enterprise to improve the administration of the

Medicaid program. It is a common business and technology vision forstate Medicaid organizations. MITA is conceived in the context of:


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Medicaid Information Technology Architecture

Resetting the Medicaid Focus

Establish a national framework of enabling technologiesand processes that support improved programadministration for the Medicaid enterprise and

stakeholders dedicated to improving healthcareoutcomes for Medicaid beneficiaries.

MITA

Share the VisionChart the Course

Shape the Future


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MITA Goals

Develop seamless integrated systems that effectively communicatethrough interoperability and standards.

Provide an environment that supports flexibility, adaptability, and rapid

response to changes in programs and technology.

Promote an enterprise view that supports enabling technologiesaligned with Medicaid business processes and technologies.

Provide information that is timely, accurate, usable, and accessible tosupport decision making for health care management and program

administration.

Provide performance management measurement for accountabilityand planning.

Coordinate with Public Health and integrate health outcomes with theMedicaid community.


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MITA Objectives

Promote reusable components through modularity

Adapt data and industry standards

Promote secure data exchange

Promote efficient data sharing

Beneficiary centric focus

Promote programmatic practices (CMM)

Integration of clinical and administrative data to enable better decisionmaking

Breakdown artificial barriers between systems, geography, and fundingwithin the Title XIX program


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MITA Framework

Business Architecture

Information Architecture

Technical Architecture


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Concept of Operations

Maturity Model

Business Process Model

Business Capability Matrix

State Self-Assessment


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Concept of Operations

The Concept of Operations is a methodology used to describe currentbusiness operations and to envision a future transformation that

meets the needs of stakeholders.

Definition of As-Is operations Identification of current and future stakeholders

Identification of major business and data exchanges between stakeholders

Description of To-Be operations

Listing of key enablers required to meet the To-Be transformation



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Maturity Model

The MITA Maturity Model is derived from industries

that use such models to illustrate how a business

can mature over time.

As-Is Now

2 3 Years

5 Years

7 8 Years

To-Be

10 Years

1

2

3

4

5



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Business Process Model

The Business Process Model is a repository ofbusiness processes common to most Medicaidprograms. The BPM consists of a hierarchy of

business areas and component business areasthat lead to individual business processes.

BusinessRelationshipManagement

OperationsManagementMemberManagement

Medicaid BusinessProcessModel

ProgramIntegrity

Management

CareManagement

ProgramManagement

ContractorManagementProviderManagement



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Business Capability Matrix


Applying the maturity model to each business process

yields the Business Capability Matrix, which shows

how business process matures over time.

Busi ss iliti s

1 2 3 4 5

Tri r

Busi ss r ss

si ssic

s lt

Busi ss iliti s

1 2 3 4 5

Busi ss iliti s

1 2 3 4 51 2 3 4 5

Tri r

Busi ss r ss

si ssic

s ltTri r

Busi ss r ss

si ssic

s lt


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State Self Assessment

The State Self Assessment is used to determine

states current business capabilities anddocument their plans for transformation toachieve a higher level of business prowess



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Strategy & Governance

Prioritize business capability needs

Formal plan for implementing capabilities

Establish technical standards

Solidify strategic approach

Governance

Capa

city

Competency

Capital


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Process Innovation

Governance process & portfolio management

Best practices requirements gathering, project

management, architecture and software development.

Technically enabled business acumen.


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MITA Framework





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The MITA Information Architecture describes a logical architecturefor the Medicaid enterprise. It provides a description of the

information strategy, architecture, and data to a sufficient levelthat it may be used to define the data needs that will enable the

future business processes of their Medicaid enterprise.


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Data Management Strategy

Conceptual Data Model

Logical Data Model


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Data Management Strategy

Provide a structure that facilitates the development of information/datathat can be effectively shared across a States Medicaid enterpriseboundaries to improve mission performance.

Provides a mechanism for the agency to better understand our data andhow it fits in the total realm of Medicaid information.

Addresses fundamental areas necessary to enable information sharingopportunities and to position the Medicaid agency to operate in anenvironment of global information.



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Key Components to Strategy

Data Governance defines the governance processes for

making enterprise-wide decisions regarding MITAsinformation holdings.

Data Architecture establishes standard data-management

procedures for the MITA data models.

Data-Sharing Architecture describes technology

considerations for Medicaid enterprises to participate in

information-sharing communities.


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Conceptual Data ModelInformation Architecture

The conceptual data model is used

primarily as a communication tool

between the business user and IT

architect to obtain agreement on

the overall description of entities

and their relationships in business

terms. It also represents thebeginnings of an overall logical

structure of the data.


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Logical Data ModelInformation Architecture

Derived from the conceptual data model, the logical

data model defines aspects of business broken down

into data classes and attributes associated with each

business process.

The model identifies all of the data elements that are

in motion within the system or shared throughout the

Medicaid enterprise. It also shows relationships

between aspects of business.

The logical data model is the foundation for creating

a physical data model.


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MITA Framework





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The MITA technical architecture includes

Data architectureApplication architecture

Technology architecture

Collectively, they define a set of technical services and standardsthat a can be used to plan and specify future systems.


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Technical Architecture Defined

The adoption and use of common (industry and MMIS) standards

Identification of common vs. state specific processes, data andtechnical solutions

Business Driven Design of MMIS processes Built in security and delivery of data

Scalability, interoperability and extendibility of MMIS components

Performance metrics common to the various MMIS operations



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MITA Technical Principles

Technical principles shape MITAs definition and the Statesimplementation of the Medicaid Enterprise Architecture.

MITA is a business driven, implementation neutral, platform

independent and is adaptable, extendible and scalable.

The technical architecture is based on current and provenopen technology. Security, privacy, interoperability andreliance on quality data are built-in.



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MITA Technical Principles II

Guiding principles support flexibility, adaptability rapidresponse and will promote an enterprise view.

The technical architecture must also support performancemeasurement, effective communication and promote flexibility,

adaptability, and rapid response. The result should be leesduplication while providing timely, accurate and usable data.

Provide for the adoption of data and technical industrystandards and the promotion of reusable components(modularity), data sharing and secure data.



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Making the Connection


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Standards Advantage


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Service

Oriented

Architecture

Defined


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Strategic Advantage

E-prescribe, MTM, Part D, PA

Electronic Health Records

Linking the Health Community

Business Agility

Consumer Empowerment

Improved Health of Minnesotans


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Change theWayWe Think

Public private collaborations

Dynamic synergy with theDepartment of Health

Beneficiary centric focus


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Changing theWayWe lead

Strategic Accountability

Performance Accountability

Operational Excellence

Emergent Strategic Flexibility


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Change theWayWe Govern

Business Based Priority Setting

Govern Based on Facts

Goal & Objective Based Decisions

Execution Based Upon Value Proposition


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Change theWayWe Enable

With Technology

Requirements Best Practices

Project Management Disciplines

Solution Architecture

Development Best Practices

Testing & Quality Assurance


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Change theWayWeWork

Learning & Growth

Organize Around Strategy

Align to Create Synergy

Promote Process Innovation

Mission Based Motivation


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Meet Our Mission

Establish a national framework of enabling technologies

and processes that support improved program

administration for the Medicaid enterprise and

stakeholders dedicated to improving healthcare

outcomes for Medicaid beneficiaries.

Thinking Globally (National, State, Public/Private, Inter-governmental)

Acting Dynamically (Leadership, Processes , Systems)

Focus on the individual (Beneficiary)


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Continued Dialog

Thomas A. Baden Jr.MITA Architect

Minnesota Department of Human ServicesPhone: (651) 431-3109

[email protected]

Documents

ISM Conference MITA (Tom Baden)