Oregon HIX-IT Strategies and Status

Transcription

1 Oregon HIX-IT Strategies and Status Oregon Health Insurance Exchange IT Project Presented at the Medicaid Enterprise Systems Conference August 22, 2012 Oregon Health Insurance Exchange Corporation 1

2 Oregon HIX IT Project Local Partnership and Support Oregon's HIX IT project is within the Oregon Health Authority, the state's Medicaid agency Oregon s integrated HIX IT vision is supported by collaboration across all relevant state bodies Building an integrated eligibility and enrollment marketplace for both Medicaid, CHIP and tax credit eligible (and those without assistance) HIX IT is a collaboration by OHA, the Oregon Health Insurance Exchange Corporation, the Department of Human Services, and the Oregon Insurance Division Oregon's legislature has been very supportive, even prior to ACA 2

3 Oregon HIX IT Project Implementation Approach Oregon's Health Insurance Exchange Information Technology (HIX-IT) platform will become the system of record for all Medicaid And CHIP (MAC) eligibility One automated eligibility system for both Qualified Health Plans (QHPs) and MAC (MAGI in Phase I) Enrollment in MAC will be accomplished by integration with legacy MMIS and commercial carrier systems Oregon's HIX-IT project has a complementary human service modernization project implementing "horizontally" integrated HHS eligibility and case management The project teams use a shared service approach and are implementing on the same technology platform 3 3

4 Oregon HIX IT Project Vision Of Shared Logic and Data Applicants for medical coverage (Medicaid, CHIP, tax credits and self-pay commercial) can use either: Exchange Portal DHS Portal (or field office) Exchange DHS Professional Exchange will let likely eligibles know how to access other social services and "flag" DHS workers if applicant indicates interest DHS will determine eligibility for all programs (in a phased approach) and refer commercial inquiries to Exchange and its partners for shopping assistance 4

5 Oregon HIX IT Project Technology Strategy Using Commercial Off The Shelf Products Oracle Solution Stack Less time to construct Easier to reuse Better ability to evolve Hosted in Oracle s Cloud Using HP ALM for Application Life Cycle Mgt. 5

6 Leveraging DHS and HIX-IT Projects as Spring-board to Transform All Services Goal is to migrate all core HHS services in phases over 5 years 6

7 Leveraging DHS and HIX-IT Projects to Transform IT Enterprise COTS tools will be used as enterprise technology platform 7

8 Oregon HIX IT Project Current Status Oregon HIX IT Timeline Inception Requirements Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec High Level Business Requirements & Process Modeling Architecture Architecture Strategy, Modeling & Governance Infrastructure Hardware & Software Setup Elaboration Functional Areas Preliminary JADS 60 day HIX Corp Requirements JADs & Use Case Documentation OPA OPA Rules Workshops Interfaces Carrier JADS Construction Functional Areas Functional Prototype Monthly Iterative Builds Lite Scope Full Capacity Builds Interfaces CMS Test Interface Development: SI Vendor OPA OPA Rules Development Iterative Testing Transition Testing Iteravite Unit Testing Iterative Unit, System & Integration Testing Functional, Performance & UAT Testing Training Training & Business Transition Production MTP Move to Production Performance Management Ops & Maintenance Measure Performance Success Support & Emergency Bug Fix 8

9 Oregon HIX IT Project HIX Impacts on Oregon's Medicaid Transformation Huge Business Change for State Workers Create and Implement New Policies and Processes New system for Medicaid intake and eligibility determination Define and enable self service processes Configure and Implement New Technologies Exciting new capabilities, but one more big tool to use Challenge to effectively re train workforce and adapt to new system's limitations & opportunities Collaborate with New Partners Common platform for private and public health plans means some policy and operations areas are shared across insurance, health, human service, and HIX entities 9

10 Oregon HIX IT Project HIX Impacts on Oregon's Medicaid Transformation Vastly improved capabilities for citizens Citizens will be empowered to independently browse, search, compare, and enroll in both public and private health plans in one experience Users will have advanced capabilities such as real time verifications, automated eligibility determinations, online plan query capabilities, and a client portal Online user interface will automatically guide citizens to appropriate plans and subsidies Medical eligibility determinations will be consistent Single experience will help people to transition as they become ineligible for public programs 10

11 Oregon HIX IT Project HIX Impacts on Oregon's Medicaid Transformation Relevant HIX Technology Features: Flexible rules engine Citizen Portal and Professional Worker Portals Identity Proofing and Client Master Online Verifications (Federal Hub, State and Commercial Systems) HHS Legacy Integration (MMIS, Eligibility, Client, etc.) Carrier and SERF Integration Limited Case Management Re Usable Technology Platform 11

12 HIX and Public Benefit Areas have Profound Interdependencies but Different Perspectives "Heterogeneous" families encompass multiple benefit areas Changes in eligibility ("swirl") move individuals across benefit areas Service delivery and support services often span multiple benefit areas Lesson Learned: a System Built for One Area Will Profoundly Affect Service Delivery Systems in the Other Areas 12

13 HIX and Public Benefit Areas have Profound Interdependencies but Different Perspectives Multiple agencies must work together to achieve the right balance of integrated experience versus specialization 13

14 Contact: Rusell Hargrave, Senior Health and Human Service Technology Advisor Oregon Health Authority and Human Services, Office of Information Services

15 Appendix - Re-Use 15

16 Oregon HIX IT Project Strategy for Sharing With Other States What Will Oregon Share? Gate Artifacts: Project Charter; PMO Plans; Schedules; Strategies Requirements Set : BRD, FRD, UI Mock ups, Process Diagrams, Use Cases, OPA Rules, Policy Decisions Code Repository and Corresponding Technical, Functional, Architectural, and Design Documents How Will Oregon Share? CALT; SERVIS; CALLS: EI LC, Monthly CCIIO, other; Conference Participation; Direct Collaboration and Partnering Contact Tracey Humphreys, Manager State & Federal Collaboration and Reuse (tracey.j.humphreys@state.or.us) 16

17 Oregon HHS Technical Model SOA Integration Layer Citizen Portals HIX: Medical Eligibility, Enrollment Enterprise Business Services Business Rules Enterprise Technical Services Business Rules DHS: All Benefits Eligibility, Enrollment DHS & OHA: Customer Service Eligibility Benefits Client / Case Mgt Master Data Mgt. Privacy & Security Workflow DHS & OHA Content Websites Alerts and Notifications Workflow Content Mgt. Finance Collaboration Licensing Laboratory Business Services Vital Statistics Immunization Mobility Services HIE Services Electronic Health Records SOA Integration Layer Page: 17

18 Oregon HHS Technical Model WebCenter Portal & Content Mgt. Citizen Portals HIX: Medical Eligibility, Enrollment DHS: All Benefits Eligibility, Enrollment DHS & OHA: Customer Service DHS & OHA Content Websites MS Sharepoint Content Mgt. Alerts and Notifications Vital Statistics Mobility Services Siebel Mobility Module Enterprise Business Services Business Rules Oracle Policy Automation Eligibility Sieblel Benefits Client / Case Sieblel Mgt Workflow Sieblel Finance Collaboration HIE Services SOA Integration Oracle SOA SuiteLayer Sieblel WebCenter content mgt. and Content Mgt. Document Capture People Soft MS Sharepoint, Outlook, etc. Enterprise Technical Services Business Rules Oracle Business Rules Engine Master Data Mgt. Oracle Master Data Mgt. Oracle ID Mgt, DB Vault, Advance Privacy & Security Security Option, Active Directory Workflow SOA Licensing Custom Laboratory Orchard LIMS HP Wisconsin Transfer Immunization Electronic Health Records Open Source & NetSmart SOA Integration Oracle SOA Layer Suite Business Services Enterprise Integration Mgt. WebCenter; Siebel Partner Portal Page: 18