DEFINING REQUIREMENTS FOR AN UNDEFINED FUTURE

Transcription

1 1 WYOMING DEPARTMENT OF HEALTH HEALTH INSURANCE ELIGIBILITY AND ENROLLMENT SYSTEM DEFINING REQUIREMENTS FOR AN UNDEFINED FUTURE Medicaid Enterprise Systems Conference August 22, 2012

2 2 Project Drivers

3 Project Drivers 3 The Perfect Storm ACA Integration of CHIP and Medicaid Move to Enterprise Architecture Antiquated System HIEES Lack of customer service options

4 4 Resulting Business Needs

5 Business Needs 5 New, flexible system to replace Medicaid component and integrate CHIP program Flexible system pla=orm (SOA) Robust business rules engine IntegraEon with the Health Insurance Exchange (HIX) Expanded customer service opeons through Customer Service Center (CSC) and Client Web Portal Workflow and document management (EDMS) ReporEng and quality monitoring

6 6 Result- The Health Insurance Eligibility and Enrollment System (HIEES) Health Insurance Exchange (HIX) Client Web Portal -Self-Screening -Online Application -Eligibility Determination -Self-service tools Application Portals (Client and Worker Portals) Benefit Mgmt System -Dashboard -Intake -Case maintenance -Workflow -Reports CSC Key HIEES Application In Scope: External Systems Future Scope: External Systems HIEES SOA Architecture Security Client Master Index Reporting Data Analytics Business Rules Engine Workflow Management EDMS Future State Systems Figure 1.0: HIEES Overview

7 Key Milestones to Meet 7 MILESTONE DATE IAPD to CMS September, 2011 Requirement Gathering December February 2012 RFP Release May 1, 2012 Proposals Received June 15, 2012 Oral Presentations July 11-13, 2012 Letter of Intent to Award July 20, 2012 ~CMS Contract Approval Date ~August 15, 2012 ~Implementation Start Date ~September, 2012 Operational Start Date October 1, 2013

8 8 Addressing Project Risks

9 The Risks 9 Aggressive milestones with ACA Resource constraints 2 dedicated FTEs to project Averaged 3-7 stakeholders in requirement gathering sessions Funding Large dollar systems in other states

10 Mitigation Strategies 10 Allow for flexibility Allow vendors to propose implementaeon strategies to meet predefined milestones Know your stakeholders and their knowledge sets Small can sell be comprehensive Make the contractor do the heavy lixing Build your budget around your objeceves SomeEmes, the Toyota is a bezer fit than the Cadillac

11 11 Defining Requirements

12 Step 1: Aligning Goals & 12 Objectives What does the State really need? What technology do we need to support that?

13 Step 2: Align Sessions with Business Needs 13 Over 35 sessions grouped by General, Phase- Specific, Business/FuncEonal and Technical Requirements Requirements war room for intensive 3- month period

14 Step 3: Draft Requirements and 14 Validate with SMEs Leverage sample RFPs and exiseng State requirements to provide firm basis for requirements Step 1 Step 2 Step 3 Step 4 Step 5 Developed calendar of sessions Sent draft requirements and agenda for State review Facilitated sessions to update/validate requirements Documented session results and distribute session report Reviewed session results and provided recommended edits Incorporated changes and redistributed results Session report completed Draft Requirements Draft Session Report Final Session Report Figure 2.0: Requirement Gathering Process

15 15 Food for thought: RFP/Requirement Development

16 Don t reinvent the wheel. 16 CMS Seven Conditions and Standards HIEES Requirement(s) Modularity Flexible platform (SOA) and modular approach to applications Open interfaces and exposed application programming interfaces MITA Condition Industry Standards Leverage Aligns with MITA business, architecture and data standards State and federal standards- including HIPAA, HITECH, NIEM, Section 508 of the Rehabilitation Act Emphasized COTS or leveraging existing products Business Results Technology to support business functions Enhanced customer service options Flexible business rules engine Reporting Interoperability Robust reporting and quality monitoring tools Future integration with other systems, Departments

17 Be transparent about the 17 unknowns. Service Delivery TransformaEon TransiEoning Medicaid service delivery from DFS field offices into centralized units under WDH Management of CSC State or contractor run? Future program integraeon with DFS ACA requirements

18 Develop proposal requirements early. 18 Consider corresponding proposal response queseons for each set of requirements Require proposal formats that clearly spell out the proposed solueon

19 19 The Results

20 The Results 20 Released RFP on May 1 st, on original Emeline Proposals received June 15 th, 2012 Oral presentaeons held July 11-13, 2012 NoEce of intent to award: July 20 th

21 Lessons Learned 21 Time permigng- release a drax RFP to the vendor community to flush out any areas of confusions or areas that needed further support Get Leadership buy- in for all aspects of the scope of work to avoid opeonal scope of work components Clearly communicate the award seleceon process in the RFP

22 22 Questions?