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CENTERS for MEDICARE & MEDICAID SERVICES
Medicaid Information Technology Architecture
May 19, 2003
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
The MITA InitiativeThe MITA Initiative
A National Framework Supporting Improved Systems Development and Health Care Management for
the Medicaid Enterprise
3
MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
MITA Initiative: MITA Initiative: zData SharingzReusable ComponentszModularityzOpen ArchitecturezStandardszCollaborationzSecurity
Key PrinciplesKey Principles
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
Driving Forces/ChallengesDriving Forces/Challenges
“Blue Books” Claims
Recipient TPL
LegislativeMandates Code
SetsUtilization
Review
ManagementReports
Recipient Provider
Claims
MMIS
Medicaid Program Changes
Rapid Changes in Technology
Resource Limitations
Specs for 6 Medicaid
Management Information
System Modules
Early ‘70s General Systems Design--
“Blue Books”
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
Today
WebAnalytics
Online AnalyticalProcessing
(OLAP)
World WideWeb
1995
MultidimensionalDatabases
EnterpriseInformation
Portals
Data Mining
Analytic Applications
MMIS Evolution and Trends—1970 to Today
MMIS Evolution and Trends—1970 to Today
Source: ified from Data Warehousing and E-Commerce, William J. Lewis
1990
Ad HocQuery Tools
DataWarehouses
RelationalDatabases
1985
Decision SupportSystems (DSS)
Executive Information
Systems (EIS)
1970
TransactionSystems
ExtractFiles
FinancialReportingSystems
ReportingSystems
(MARS +SURS)
mod
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
Conceptual Architecture—Past Evolving to PresentConceptual Architecture—Past Evolving to PresentTPL
SURSFraudDetect
PriorAuthorization
Enrollment
OutsourcedFunctions
WebPortal
DataWare-house
EVSAVRS
RxPOS
DD, DOA,DMH
Waivers
OtherState
Agencies
State,LocalPublicHealth
EligibilityDetermin-
ation
SCHIPEPSDTNEDSS
IZ
CMSCDC
SAMHSA
DOFStateBank
Clearing-house
ManagedCare
Contracts
ContractedBenefit
ManagementDrugs, Mental
HealthMMIS CoreSubsystems
CodeSets
UtilizationReview
ManagementReports
Recipient Provider
Claims
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
Conceptual Architecture—one state exampleLegacy architecture with some standards applied to facilitate data sharing
Conceptual Architecture—one state exampleLegacy architecture with some standards applied to facilitate data sharing
TPLSURSFraudDetect
DD, DOA,DMH
Waivers
PriorAuthorization
Enrollment
OutsourcedFunctions
OtherState
Agencies
State,LocalPublicHealth
EligibilityDetermin-
ation
SCHIPEPSDTNEDSS
IZ
CMSCDC
SAMHSA
DOFStateBank
Clearing-house
ManagedCare
Contracts
ContractedBenefit
ManagementDrugs, Mental
Health
WebPortal
DataWare-house
EVSAVRS
RxPOS
MMISSubsystems
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
OTHERAGENCIES
Conceptual Architecture—FutureConceptual Architecture—Future
TPLSURSFraudDetect
DD, DOA,DMH
Waivers
PriorAuthorization
Enrollment
OutsourcedFunctions
OtherState
Agencies
State,LocalPublicHealth
EligibilityDetermin-
ation
SCHIPEPSDTNEDSS
IZ
CMSCDC
SAMHSA
DOFStateBank
Clearing-house
ManagedCare
Contracts
ContractedBenefit
ManagementDrugs, Mental
Health
WebPortal
DataWare-house
EVSAVRS
RxPOS
MMISSubsystems
TPLSURSFraudDetect
DD, DOA,DMH
Waivers
PriorAuthorization
Enrollment
OutsourcedFunctions
OtherState
Agencies
State,LocalPublicHealth
EligibilityDetermin-
ation
SCHIPEPSDTNEDSS
IZ
CMSCDC
SAMHSA
DOFStateBank
Clearing-house
ManagedCare
Contracts
ContractedBenefit
ManagementDrugs, Mental
Health
WebPortal
DataWare-house
EVSAVRS
RxPOS
TPLSURSFraudDetect
DD, DOA,DMH
Waivers
PriorAuthorization
Enrollment
OutsourcedFunctions
OtherState
Agencies
State,LocalPublicHealth
EligibilityDetermin-
ation
SCHIPEPSDTNEDSS
IZ
CMSCDC
SAMHSA
DOFStateBank
Clearing-house
ManagedCare
Contracts
ContractedBenefit
ManagementDrugs, Mental
Health
WebPortal
DataWare-house
EVSAVRS
RxPOS
MMISSubsystems
State 1
OTHERSTAKEHOLDERS
WebPortal
DataWare-house
EVSAVRS
RxPOS
PriorAuthorization
Enrollment
EligibilityDetermin-
ation
MMISSubsystems
WebPortal
DataWare-house
EVSAVRS
RxPOS
PriorAuthorization
Enrollment
EligibilityDetermin-
ation
MMISSubsystems
State 3
TPLSURSFraudDetect
PriorAuthorization
Enrollment
OutsourcedFunctions
WebPortal
DataWare-house
EVSAVRS
RxPOS
EligibilityDetermin-
ation
SCHIPEPSDTNEDSS
IZ
CMSCDC
SAMHSA
MMISSubsystems
TPLSURSFraudDetect
PriorAuthorization
Enrollment
OutsourcedFunctions
WebPortal
DataWare-house
EVSAVRS
RxPOS
EligibilityDetermin-
ation
SCHIPEPSDTNEDSS
IZ
CMSCDC
SAMHSA
MMISSubsystems
State 2
DATA EXCHANGE
Access Policy
StandardsSecurity
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
The MITA Initiative: The MITA Initiative: Support
Transition
Develop Architectural Components
Establish Framework
MITA
A JourneyA Journey
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
The MITA Initiative: The MITA Initiative: z Awarded task order 9/02 (CSC-prime, Fox
Systems & FourThoughtGroup – subs) z Established MITA Technical Group (MTG)z Conduct interviews, surveys, focus
groupsz Presented MITA vision & strategy at 2003
National MMIS Conference—validated assumptions
z Ongoing data collection & requirements gathering
z Review possible changes to policiesz MITA conceptual architecture framework
document currently in 2nd release (in-house review) final deliverable date is 9/2003
z Communicate, publicize, and market our efforts
MITA
Establish Framework
A JourneyA Journey
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
The MITA Initiative: The MITA Initiative:
zMITA Model Focuses on:�Organization�Business�Data�Application�Technology�Interfaces�Security
MITA
Develop Architectural Components
A JourneyA Journey
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
The MITA Initiative: The MITA Initiative:
z Transition plan guidelinesz Technical assistancezOther tools and templates
MITASupport
Transition
A JourneyA Journey
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
MITA Initiative– Our Ongoing ApproachMITA Initiative– Our Ongoing Approach
zBuild partnershipszCollaborate with industryzCoordinate with other initiativeszListen to our partnerszLeverage work done to date
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
Conceptual Architecture ApproachConceptual Architecture Approach
SteeringCommittee
MTG
CMSCO/RO
States
S-TAG
PS-TG
OtherIndustryLeaders
OtherFederal
Agencies
StandardsSettingOrgs
MITATeam
Public Health Data Standards
Consortium
eGov, NHII, CHIand other initiatives
S-TAGMMIS Redesign
Workgroups
PS-TG PapersMedicaid Vendor
Community
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
Conceptual Architecture—The Process
Conceptual Architecture—The Process
Develop Business Cases and
Sequencing Plan
Sequencing Plan and
Transition Strategy
Projects
Business Cases
Develop Target Information Systems
Architecture
Data Architecture
Application Architecture
Technology Architecture
Develop Target Business
Architecture
Organizational Structure and
Roles
Business Processes
Facility Locations
Document Mission, Vision, Strategy,
Current Architecture
Mission Programmatic Requirements
Current Architecture
Vision, Strategy
Analysis and Design
Data Collection
Validation
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MedicaidInformationTechnologyArchitecture
MedicaidInformationTechnologyArchitecture CENTERS for MEDICARE & MEDICAID SERVICES
Why Is the MITA Initiative So Important? Why Is the MITA Initiative So Important?
MITA will enable:zImproved managing and monitoring of
programs through the sharing of data zEfficient use of scarce resources through
the development and sharing of reusable softwarezQuick response to changes in programszGreater access to high-quality data
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