MARYLAND DEPARTMENT OF HEALTH Maryland Medicaid Information Technology Architecture (MITA) State Self-Assessment (SS-A) Review July 16, 2018
MD MITA SS-A Review MITA SS-A Approach The MDH MITA team completed • information gathering and analysis for the MITA SS-A through 2017 and 2018 MITA visioning has been developed • through ongoing weekly and monthly meetings with MDH Medicaid Leadership To assess the As-Is business • environment, the team met with over fifty (50) Subject Matter Experts (SMEs) representing the various programs across the MDH enterprise To assess the As-Is Information and • Technical environment, the team met with over twenty (20) MDH Technical staff to review key system and data capabilities across the MDH enterprise The MITA Roadmap, Concept of • Operations, TMS, and DMS have all been updated periodically to reflect key leadership decisions 2
MD MITA SS-A Review MITA Maturity Levels Aspirational Optimized and Adaptive Data and Outcome National Level 5 Standardized, Driven Average • National Integrated, Level 4 I nteroperability Automated Governed • Program and Minimally • Widespread Optimization Managed Access to Compliant Level 3 • Maximize Secure and Automation of Clinical data • Adopting Efficient Level 2 Routine • Improved National Health Operations Standards • Increased Outcomes • Intrastate • Program Level 1 Automation • I nterstate Exchange Strategy and • Increased Date • Coordinating • Meeting Standards Planning Exchange with other Regulations • Cost Optimization • Quantitative Agencies and statutes Management • Optimizing Measures • Reusable • Manual • Improving Evaluation • Shared • Paper-based Quality Processes Services Activities 3
MD MITA SS-A Review MITA Business Architecture Assessm ent Sum m ary MDH is seeking MML 2 with focus on standards and automation to best meet the needs of • the state (represented in orange). MML 3 requires complex and costly adoption of National Standards. MDH will evaluate • the benefits of this approach in future strategy updates (represented in gold). Business Area Level Maturity Assessment Results MITA Maturity Level 0 1 2 3 4 5 Business Relationship Management Care Management Contractor Management Eligibility and Enrollment Management Target As Is Level Financial Management 5-Year To Be Member Management Future To Be Operations Management Performance Management Plan Management Provider Management 4
MD MITA SS-A Review Program Developm ent Roadm ap Est. Contract $$ 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 Low/High $85.0 $105.0 Module T1: Pharmacy Claims Processing Data Warehouse (DW) / Decision Support $10.0 $20.0 Module T2: System (DSS) Module T3: National Correct Coding $7.0 $15.0 Module T4: Case Management $10.0 $15.0 Module T5: Long Term Services & Support (LTSS) $164.0 $164.0 Module T6: Provider Re-Enrollment (ePrep) $56.0 $56.0 Module T7: Provider Management $5.0 $15.0 $6.0 $10.0 Module T8: Financial Management $150.0 $250.0 Module T9: Core MMIS MD THINK: Enterprise Service Bus (ESB) $1.0 $5.0 Module T10: Integration MD THINK: Master Data Management $1.0 $5.0 Module T11: Integration Module T12: MD THINK: Customer Portal Integration $1.0 $5.0 Module T13: $0.0 $0.0 Surveillance Utilization Review System (SURS) Electronic Data Interchange Transaction Module T14: $0.0 $0.0 Processing System (EDITPS) Module T15: MD Think: Member Eligibility $1.0 $5.0 Integration Module RM1: Project Management Office (PMO) $28.0 $38.0 $15.0 $25.0 Module RM2: Independent Verification & Validation Module RM3: System Engineering, Architecture, and $15.0 $35.0 Integration $25.0 $40.0 Module G1: State Project Management/SMEs $0.0 $0.0 Module G2: Internal/Organic System Intergration $580.0 $808.0 Key Modules (Systems) Pre-Procurement DDI Base Operations Pause Project Support (People) T-Modules Technical Solution/SaaS $ Procurement Agile DDI Option Years Millions RM-Modules Risk Management G-Modules Govervance 5
MD MITA SS-A Review MDH Enterprise Module Strategy Diagram Program Development Roadmap MDH Enterprise Module Strategy Diagram Module① : Pharmacy Benefits Management (PBM) Module② : Data Warehouse/Decision Support Legend Module③ : Business Rules Engine/NCCI Module④ : Case Management New Enterprise Module or Component Module⑤ : Long-Term Services & Support (LTSS) These components are implemented as part of the project initiatives Module⑥ : Provider Re-Enrollment Module⑦ : Provider Management Existing Enterprise Module or Component Module⑧ : Financial Management New modules will integrate to these existing assets Module⑨ : Core MMIS Module⑩ : MD THINK ESB Module⑪ : MD THINK Master Data Management Module⑫ : MD THINK Customer Portal Business Areas/Service Domains External Member Agency Staff Module⑬ : OIG SURS Provider These represent process and data domains Stakeholders Stakeholders (State) Module⑭ : Electronic Data Interchange Transaction Stakeholders Processing System (EDITPS) Service Request Service Request Module⑮ : MD THINK Member Eligibility Integration Service Request Service Request Presentation Layer Access Identity Management Self-Service Portal Management Service Platform API Enterprise Service Bus Business Services Business Services Business Services Business Services Business Services Business Services Business Services Business Services Business Services Business Services Business Services Provider Management E&E Management Member Management Care Management Performance Management Operations Management Financial Management Financial Management Plan Management Contractor Management Business Relationship Business Service • • • • • • • Manage Contractor Information • ②⑦⑭ Manage Provider • ⑮ Determine Member Eligibility ⑪⑫ Manage Member Information ⑤⑫ Establish Case ⑬ Establish Compliance Incident ⑨ Generate Remittance Advice ⑧⑨ Manage AR Collection ①⑧⑨ Manage Drug Rebate • ② Develop Agency Goals and Management • • • • • • • • Inquire Contractor Information • Establish Business Relationship Information ⑮ Enroll Member ⑪ Manage Applicant and Member ⑤ Manage Case Information ⑬ Prepare REOMB ⑨⑭ Inquire Payment Status ⑧⑨ Prepare Member Premium ⑧⑨ Manage Cost Settlement Objectives • • • Manage Contractor Communication • Manage Business Relationship ①⑦⑫ Manage Provider • • • • • ② Manage Performance Measures ⑮ Disenroll Member Communication ①⑤ Authorize Service ⑬ Manage Compliance Incident ⑨ Prepare Provider Payment Invoice ⑧⑨ Manage AP Disbursement • Produce Solicitation • • • Information Communication • ⑫⑮ Inquire Member Eligibility ⑫ Perform Population and Member • ⑤ Manage Treatment Plan and Information • ⑨ Process Encounter ⑧⑨ Manage Contractor Payment • ⑧⑨⑫ Manage 1099 ② Manage Health Plan Layer • Award Contract • Manage Business Relationship • ①⑦⑫ Manage Provider Grievance • Outreach • ①⑬ Identify Utilization Anomalies • • ⑧⑨ Manage Member Premium • Information ⑥⑦⑫ Inquire Provider Eligibility Outcomes ①③⑨ Process Claim ⑧⑨ Manage TPL Recovery • Manage Contract Communication and Appeal • ⑫ Manage Member Grievance and • • • ⑫ Maintain Program Policy • ⑤ Authorize Referral ⑬ Determine Adverse Action • Payment • • Manage Contractor Grievance and • Terminate Business Relationship ⑥ Determine Provider Eligibility ⑨ Calculate Spend Down Amount ⑧⑨ Manage Capitation Payment • • • ①⑦⑫ Perform Provider Outreach Appeal • ⑧⑨ Formulate Budget ② Manage Health Benefit • ⑤ Authorize Treatment Plan • ①⑨ Apply Mass Adjustment • ⑧⑨ Manage Provider Recoupment Appeal • ⑥⑦ Enroll Provider ⑦ Terminate Provider • • • • • ②⑧⑨ Manage Budget Information • Information ⑫ Perform Contractor Outreach ⑦ Disenroll Provider ⑤ Management Population Health ①③⑨ Manage Data ⑧⑨ Manage AR Information • • ② Manage Rate Setting • Closeout Contract Outreach • ⑧⑨ Manage Fund • ①⑨ Submit Electronic Attachment ⑧⑨ Manage Incentive Payment • • • ⑤ Manage Registry ②⑧⑨ Generate Financial Report ⑫ Maintain State Plan • ⑧⑨ Manage AP Information • • • ② Manage Reference Information ⑤ Perform Screening and ⑧⑨ Manage Estate Recovery Assessment Case Management Data FORTIS CRISP PI Data Rules Engine MHBE Financial Data Repository Module IT Infrastructure Layer Health Record Data Financial Management Case Management Member Data Module Module PBM Member Data Financial Data Master Module Member Data Member Pharmacy Member Data Member Data Claims Data Business Rules Repository Data HIPAA Transactions Data Warehouse/ Decision Support System Provider Management Module Provider Data Performance Data Master Data Provider Data Management Core MMIS LTSS FMIS Master Claims/Encounter Data Provider Repository Provider Data Member Data Provider Data Provider Eligibility and Enrollment Member Care Performance Operations Contractor Business Relationship Management Management Management Management Management Management Financial Management Plan Management Management Management Stakeholder Management Group Transaction Management Group Planning and Control Group 6
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