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

(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

(4)

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

(7)

CMS Vision

Enhanced Data Provisioning

Nimble,

Flexible,

Analytic

Environment

Validated

State

Data

BI Tools

Databases

Data

Warehouses

Statistical

Tools

Integration

Tools

Uniform

Metadata

(8)

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 - MACPRO

T-MSIS

Etc.

MFP

WMS

PERM

MSIS

(12)

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

(13)

● 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

(14)

• 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?

(15)

Data Exchange Interoperability

MSIS

Flat File

T-MSIS

Flat File • Custom Format • Non Standards Based • Limited Adaptability • Limited Extensibility XML • Flexible Format • Standards Based • Adaptable • Extensible

Current State

Future State

(16)

T-MSIS Operational Framework

(17)

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

(18)

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

(19)

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

(21)

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