CMS. Medicaid and CHIP Business Information Solutions (MACBIS) Transforming Medicaid and CHIP Data Collection

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(1)

CMS

Medicaid and CHIP Business Information Solutions

(MACBIS)

Transforming Medicaid and CHIP Data

Collection

(2)

Charles– a Medicaid Beneficiary

Charles lives

independently

and now has a

full time job at

Long John

Silver’s in

(3)

Medicaid and CHIP today

$400B annually

60M beneficiaries

~3M providers

500B medical services annually

Medicaid and CHIP Tomorrow

$500B

80M beneficiaries

3M++ providers

600B medical services annually

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The Need for Change

Resources are shrinking

and data driven decisions need to be made to ensure value in health care services

1.

Medicaid and CHIP state Data set is incomplete and it is not current

2.

Multiple data collections

3.

We and States are unhappy with results

1.

Reports are questionable and subject to

interpretation

2.

Difficulties in determining the cost, integrity or value of the purchased service

3.

Decisions are not data driven

1.

Multiple databases on multiple platforms

2.

A lot of manual operations in data

collection and validation

3.

Expensive, proprietary, contractor centric

Today’s Results

Today’s Technology

(5)

Operations

Data

(Cost, Encounters/ Claims, Providers and Beneficiaries) Business Process Performance Data (Timeliness and Accuracy of Business Functions)

Program

Data

(Benefits, Eligibility, Payment)

Quality Data

(Adult and children’s measures, MU measures)

Actionable Business Intelligence

Integrated

View of How We are

Doing:

Performance

Indicators and

Analytic Capacity

(6)

“High Performing Medicaid & CHIP Programs”

1.

Medicaid and CHIP state data set complete and current

2.

Federal and States are happy with LOE and results

3.

Decisions can be made based on

facts/information

Resources are shrinking

and data driven decisions need to be made to ensure value in health care services

Tomorrow’s Technology

Tomorrow’s Vision

Tomorrow’s Results

1.

Federal and state reports are the same, correct and current

2.

We can readily determine the cost, integrity or value of the purchased service

3.

Decisions are data driven

1.

A scalable, responsive, flexible, multi-user, and sustainable platform

2.

Multiple database interconnectivity

3.

Affordable, open source to extent possible

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CMS Vision

Enhanced Data Provisioning

Nimble,

Flexible,

Analytic

Environment

Validated

State

Data

BI Tools

Databases

Data

Warehouses

Statistical

Tools

Integration

Tools

Uniform

Metadata

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CMS ANALYTIC ENVIRONMENT / DATA LABS Data Integration Data Dissemination Reporting Analytics

CMS Vision

(9)

CMS Vision

Direct Access Mechanisms

End User

Communities

Medicaid.gov/

CMS Apps/

CMS Portal

Web

Services/

Portlets/BI

Interfaces

Medicaid &

CHIP

Systems &

Databases

Operational Reporting Operational Querying Analytical Reporting Analytical Querying Exec Info Briefing Books

Dashboards Scorecards Data Mining

(10)

Business

Analytics

and Data

Quality

Support

Data

Quality

Assurance

Data

Request

Manager

User

Adoption

and

Training

Adhoc

Workspace

Data

Analytics

Data and

Document

Mgmt

CMS Vision

(11)

TODAY ISSUES Incomplete Data Custom Data Validation Limited Analytics Data Silo’ed Limited State Integration TOMORROW SOLUTIONS Robust Data Up-to-Date Data Validation/Rule Engine Business Intelligence/ Reporting Data Integration Comprehensive State Integration

Establish

Plan

Execute

Transition

DEMONSTRATE!!

Enterprise Medicaid

and CHIP

Realizing the Vision

Medicaid and CHIP Business Information Solutions (MACBIS

)

Legacy Medicaid

and CHIP

Future

Future

Future - MACPRO

T-MSIS

Etc.

MFP

WMS

PERM

MSIS

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Addressing Today’s Medicaid & CHIP Data Issues

(Operations Data: T-MSIS)

Timeliness

Move from quarterly data submissions to monthly

Automate data quality checks at state and CMS; provide real-time

feedback to states

Reliability

Define required data elements with all data users

Define criteria, in collaboration with states, for successful submission

Implement automated receipt, control and tracking of state submissions

Implement ongoing data quality control through automation, reporting

and building analytics expertise

Robustness

Define data across operational areas: beneficiaries, providers, claims

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What does it take to get the data out of state systems into the T-MSIS format?

Complex analytical task; multi-phased project for each state

Requires technical assistance for states

State information technology work funded by CMS at 90% - expedited APD available

Do we have the right data to meet business needs?

Consulted with states and external stakeholders

Expanded MSIS structure of 200 data elements to over 600 data elements in T-MSIS

Created a standard data dictionary for authoritative state data submissions

Added additional files: Provider, Third Party Liability, Managed Care Plan file

Created analytics and reports required by CMS stakeholders using the T-MSIS data elements

Where should the data “live” at CMS?

Improve efficiency of operational data submission and response to states on submission

Scalability to handle larger volumes of data (assumption T-MSIS will handle data from all

states)

o

Scalability to run static and ad-hoc reports/analytics

T-MSIS Pilot: Key Questions

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Fewer Data Requests

T-MSIS will be

the

source for granular CMS

Medicaid

operational data needs vastly reducing

the number of ad hoc data requests;

More Frequent Data Refreshes

Monthly, not quarterly;

Enhanced Fraud, Waste & Abuse

Capabilities

With expanded, more

timely data, CMS and the states will be

better able to detect and recover/prevent

losses due to fraud, waste & abuse;

Fewer Reports Required from States

All Medicaid reports will be derived by CMS

based upon the T-MSIS data, eliminating several tasks and decreasing the burden for

states;

Expanded Access to Data

In time, states will be able to see high-level

data from adjoining states, cross walked with Medicare, program, quality, and

What Makes T-MSIS Better?

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Data Exchange Interoperability

MSIS

Flat File

T-MSIS

Flat FileCustom FormatNon Standards BasedLimited AdaptabilityLimited Extensibility XMLFlexible FormatStandards BasedAdaptableExtensible

Current State

Future State

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T-MSIS Operational Framework

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Readiness for Production

Successfully submitting via EFT

Meet data population

requirements

Meet business rules validation

Up- to-date with historical data

Defined operational schedule for

all files

2 consecutive submissions using

EFT software

Sustaining Quality and Timely

Submissions

Maintaining timeliness

-current on monthly

submissions

Maintaining data quality

standards per business rules

Maintaining release schedules

for future changes – advancing

data quality

Maintaining communications

with CMS for outstanding

issues

Success Criteria

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T-MSIS – National Roll Out

Accomplishments

Issued State Specification documentation – April 30, 2013

Revised T-MSIS data dictionary

File processing specification

State Data Quality business rules

State Collaboration/Support Site

Created State T-MSIS Collaboration Workgroup

10 participating States comprising varying levels of T-MSIS progress

- AZ, FL, GA, ME, PA, SC, TN, TX, VA, WA

T-MSIS State Progress

3 States participating in “Beta testing” - AZ, TN, VA

Technical assistance ongoing with all States

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T-MSIS – National Roll Out

Upcoming Activities

Project communication to States via webinars on relevant

project status

Schedule monthly meetings with State T-MSIS Collaboration

Workgroup

CMS review and approval of State source-to-target mappings

Roll out testing environment for state file processing and

operational readiness testing

Historical Data migration – conversion routines to maintain

downstream systems

(20)

As of mid-August:

6 states - Design/Development Phase

- 3 of these states are BETA testing with CMS

20 states - Requirements/Design Phase

(Source-to-target mapping)

10 states – Planning Phase

15 states - Re-plan/Project Startup

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TIMELINE: T-MSIS PROJECT

July 2014

Re-Plan Execute

Onboard Plan Execute

12 Pilot States

T

-MSIS National

Go-Live

States Project Evaluation Jan 2014 Jan 2013 July 2013 Oct 2013 Nov 2013 Dec 2013

Beta Testing

State File Testing w/ CMS

State Operational Readiness Testing – CMS Approval Source-to-Target Mapping

Review/Approval

MSIS Data migration

4/30 issue DD, Rules, Tech specs 8/29 Revised DD updates 11/1 Final Error Messages CMS production 2/1/2014 Go-Live 9/30 8/15 10/1 12/1 1/2 11/15 State Operational Readiness Checklist Apr 2014 April 2013

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Actionable Business Intelligence Transformation

Data Timeliness Quarterly Submission Latent data from states

Data Robustness

Limited set of MSIS elements

Lack of data integration Manual program data

Data Completeness Data Quality

Limiting data analytics Minimal end user access

Lack of stakeholder adoption for data use Data submitted incomplete

Limited data quality rules applied at state

Data Accessibility and Usability

Monthly Submission Edit rejections at record

level

Robust set T-MSIS elements Data integration

Robust analytics Data Labs

Stakeholder adoption of enterprise data

Data Validation at state level Tier 2+ at CMS level Improved error processing

Future

Core principles

Current

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2014

T-MSIS National cutover

Migration of MSIS historical data – since 1999

Limited analytic tools available

2015

T-MSIS continuous data quality improvement

Integrated Medicaid & CHIP Data Environment

Subset of targeted legacy systems integrated into data environment – e.g.

EPSDT

Continued maturity of Business Analytics and Data Quality Support Team

2016

Targeted legacy systems integrated into data environment

Achieve Integrated Data Environment that supports robust data

analytics

(24)

State T-MSIS Q &A Panel

State experience to date

Dos and don’ts for T-MSIS progress

Considerations for success

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QUESTIONS

Figure

Updating...

References

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