Session #193, February 22, 2017 MEDICAID MODERNIZATION: RESHAPING LARGE REPLACEMENT PROJECTS

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1 Session #193, February 22, 2017 MEDICAID MODERNIZATION: RESHAPING LARGE REPLACEMENT PROJECTS Jessica Kahn/Anshuman Sharma, CMS Patricia MacTaggart, ONC 1

2 Session Facilitators Jessica P. Kahn Director, Medicaid Data and Systems, CMS Anshuman Sharma HHS Entrepreneur in Residence, CMS Patricia MacTaggart Senior Advisor- HIT, ONC 2

3 Conflict of Interest No conflicts to report 3

4 Agenda The state of the states on large, Medicaid IT replacements CMS says Opportunities and Challenges What does modularity mean in this context? Business-driven IT roadmaps Delivery reform examples 4

5 Learning Objectives Increase knowledge of the current state of IT in the single largest insurer in the US (Medicaid) Ability to identify current challenges and opportunities states and vendors are facing Precise understanding of what modularity means to states Increased awareness of healthcare business-outcome driven models for system modernization and how CMS and ONC are collaborating to offer technical assistance 5

6 State of the States Most states are in the process of modernizing their primary Medicaid IT infrastructure Long flight path but modular opportunities along the way Growing recognition of the value of user-centric design Increasing demand for use of standards and open APIs 6

7 CMS Guidance to States on System Modernization No more big bang $200m system replacements Take an incremental approach, driven by program needs Adopt either business process or component modularity User-centric design Mobile COTS, SaaS, Open Source, Reuse, 1: many partnerships Need strong PMOs, IV&V and possible tech advisors 7

8 Opportunities Failures = lessons Modularity opens the door to new entrants/new solutions Greater alignment of Medicaid s business with other payers Provider enrollment Claims processing Beneficiary cost-share management Data analytics Growing movement towards cloud and SaaS 8

9 Challenges Limited state resources (financial and staffing) Unfamiliarity with a vendor can be perceived as an inherent risk Public funding = greater accountability Lagging on Agile/iterative design & development internal capacity Boilerplate RFPs 9

10 Why? Cuts risk time and cost. Easier upgrade in the face of tech evolution, program needs, regs New vendors, increased competition, innovation and cost reduction Utilizing and developing capabilities across the state enterprise 10

11 Optimizing Health IT to Support State Integrated Service Delivery, Improved Population Health and Alternative Payments Actors: States Medicaid MCOs/ACOs Providers Goal: states have the opportunity to think through key health IT considerations as they plan their 1115 program and develop an optimized health IT ecosystem for advancing delivery system reform Approach: linking state priorities to plan/provider activities to information needs to required health IT considerations 11

12 State Waiver or SPA Priority Integrated Service Delivery Improved Population Health Alternative Payment Plan/Provider Activities Requiring Health IT Service Delivery that is Coordinated & Outcomes Focused Quality & Financial Measurement & Improvement Payment Methodology & Operations Data/ Information Source Financial / Claims Data Clinical Data Non-clinical Data (State/County/ Other Systems) Health IT Health IT Modular Infrastructure to Support Data/Information

13 Reporting Services Health IT functionalities that vary by prioritized activity Analytics Services Notification Services Exchange Services Consumer Tools Provider Tools Patient Attribution Core infrastructure for all health IT activities Data Extraction Identity Management Data Transformation Data Quality & Provenance Data Aggregation Provider Directories Foundational components for participant trust & value Security Mechanisms Rules of Engagement Financing Consent Management Policy/Legal Business Operations

14 Key 1115 Demonstration Program Design Questions Promoting and Funding Provider Health IT Adoption and Use 1. Does the demonstration provide direct provider incentives for EHR adoption or indirectly through MCO contract requirements? 2. Does the State support EHR adoption or HIE onboarding for ACOs, MCOs, LTSS providers, EPs, and other ineligible MU providers Do the activities described in the SMHP to help incentive eligible providers also support the 1115 efforts? 3. Is the State providing technical assistance to support health IT adoption amongst providers? The Use of Standards in Health Information Technology Procurement 4. As applicable, is the SMA directly promoting the use of federally certified health IT with providers through some mechanism or indirectly through provider network requirements in managed care contracts? 5. Is the State leveraging and advancing federally established health IT standards throughout State funded programs, procurements and IT systems? Specifically, is the state advancing federal standards as stated in both 45 CFR Vocabulary Standards for Representing Electronic Health Information and the ONC Interoperable Standards Advisory? 14

15 Key 1115 Demonstration Program Design Questions Advancing Use of Health IT to Support Quality Measurement 10. Is the State leveraging any of the CMS electronically specified clinical quality measures as part of the 1115 Demonstration quality strategy? 11. Is the State using any of the CMS electronically specified clinical quality measures part of the 1115 Demonstration payment or reimbursement methodology? 12. Is the State leveraging already established data standards for quality measure reporting requirements? Identity Management, Provider Directories and Attribution 13. Does the State have a strategy for accurately identifying individuals within their Medicaid enterprise? Is the State able to link individuals to providers and how does the State share these relationships with providers and their networks (i.e. how does the state plan to perform electronic attribution of people to providers?) Health IT and Service Delivery 14. Is health IT being used to improve services being delivered, such as through a PCMH, Traditional FFS, MCOs, ACOs, and/or tele-health model? 15

16 Translation into State 1115 Waiver Commitment: Washington State Example The state will use Health IT to link services and core providers across the continuum of care to the greatest extent possible. The state must have plans with achievable milestones for Health IT adoption for providers both eligible and ineligible for the Medicaid Electronic Health Records Incentive Programs and execute upon that plan. The state shall create a pathway, or a plan, for the exchange of clinical health information for Medicaid consumers statewide to support the demonstration s program objectives. The state shall require the electronic exchange of clinical health information, utilizing the Consolidated Clinical Document Architecture, with all members of the interdisciplinary care. 16

17 Translation into State 1115 Waiver Commitment: Washington State Example The state shall advance the standards identified in the Interoperability Standards Advisory Best Available Standards and Implementation Specifications (ISA) in developing and implementing state policies and in all applicable state procurements (e.g. including managed care contracts). The state shall ensure a comprehensive Medicaid enterprise master patient index, provider directory strategy, and health IT-enabled quality measurement strategy that supports the programmatic objectives of the demonstration. The state will pursue improved coordination and integration between Behavioral Health, Physical Health, Home and Community Based Providers and community-level collaborators for Improved Care Coordination (as applicable) through the adoption of provider-level Health IT infrastructure and software 17

18 Contact Info Jessica Kahn Director, Medicaid Data & Systems, CMS Anshuman Sharma HHS Entrepreneur in Residence, CMS Patricia MacTaggart Senior Advisor HIT, ONC 18