April 22, 2015 Improving the Way California Delivers Health Care Services

Agenda Medi-Cal Overview Mission Kaizen PAVE MITA Driving Change 2

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Medi-Cal at a Glance 2015/16 Total Budget - $98 billion ($19B state funds) Total Budget - $98 billion ($19B state funds) Beneficiaries served – million Beneficiaries served – million Enrolled providers – 135,000 Enrolled providers – 135,000 Average weekly check-write – $382 million Average weekly check-write – $382 million Average monthly capitation payments - $3.3 billion Average monthly capitation payments - $3.3 billion 71% Managed Care, 29% Fee-For-Service (FFS) 71% Managed Care, 29% Fee-For-Service (FFS) 4

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PED Files 6

PAVE Business Rules 7

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TANYA HOMMAN, CHIEF PROVIDER ENROLLMENT DIVISION APRIL 22, 2015 PROVIDER APPLICATION AND VALIDATION FOR ENROLLMENT

Provider Enrollment Facts 140,000 ENROLLED PROVIDERS APPLICATIONS 70 PROVIDER TYPES 26 DIFFERENT APPLICATIONS 96 SUB FORMS 108 SUPPORTING Document Types EXTERNAL ENROLLMENTS 1200 TRANSMITTALS days PAPER/MANUAL 10

CHALLENGES Significant Effort Incomplete Submissions Long Wait Unknown Status Provider Dissatisfaction Difficult to Oversee Resource Need 11

Affordable Care Act (ACA) Additional Information Fee Collection Screening Levels Revalidation Monitoring 12

Target Improvement Measures EnrollmentScreening & Monitoring Application Submission Effort  40% Reduction for New Applications  60% Reduction for Added Locations  80% Reduction for Updates  80% Reduction in RTP Keeping Bad Providers Out  Increase detection (for cause denials)  200% increase in data accuracy Total Application Processing Times  Avg. 2-4 Weeks (from weeks)  Updates < 1 week  Real-time Status Tracking Monitoring Risk  Detect non-eligible, non- compliant providers within 90 days  Generate more audits, investigations based Enhanced Provider Tools  Linked Data, Documents and Communications Enhanced PED Capabilities  Collaboration with Program Integrity  Understanding of Provider Affiliations 13

PORTAL ENROLLMENTSCREENING MONITORING PAVE 14

PAVE PORTAL AT A GLANCE 15 Social Collaboration Context Based Intelligence Security Account Management Guided Preparation

HELPFUL TIPS COMMON VISION COMMON LANGUAGE CLOSE COLLABORATION COMMITTED RESOURCES 16

Linette T Scott, MD, MPH Chief Medical Information Officer, DHCS April 22, 2015 MITA Driving Change

DHCS Strategic Vision

DHCS Transforming and Innovating to Achieve its Commitments It begins with the DCHS Strategic Plan:  To the Public …  To the People We Serve …  To our Employees … 19

Built on the DHCS Quality Strategy 20 DHCS’s Three Linked Goals Improve the health of all Californians Enhance quality, including the patient care experience, in all DHCS programs Reduce the Department’s per capita health care program costs

DHCS Business Architecture 21 Vision Mission

Dynamic Workforce Focus on Core Values from our Strategic Plan:  Integrity  Service  Accountability  Innovation 22

23 Comparability – A Maturity Model Systems/Downloads/mitamm.pdf

As-Is Redundant Business Process Example 24 Provider Enrollment Process

To-Be Business Process Example Provider Enrollment Process 25

DHCS Information Architecture 26

Information Architecture Enterprise Data Strategy Conceptual Data Model Logical Data Model Standards 27

Conceptual Data Model 28

29 Supporting Business Process Transformation Advancing Maturity With National Standards & Frameworks

DHCS Technical Architecture 30

As-Is Technology Stack (partial list example) 31

32 Driving Quality … Technology Level 1 Process consists primarily of manual activity to accomplish tasks. Level 3 SMA automates process to full extent possible within state Health Information Exchange (HIE). Level 5 SMA fully automates process nationally to extent possible via Nationwide Health Information Network. MITA Maturity Levels: Connecting to HITECH Business Process Example: Manage Treatment Plans & Outcomes HITECH Act Creating the tipping point to transform health care

Medi-Cal EHR Incentive Payments as of March ELIGIBLE HOSPITALS Adopt/Implement Upgrade 255$377,484,695 Meaningful Use Payments 443$323,147,328 Eligible Professionals Adopt/Implement Upgrade15,133$319,833,797 Meaningful Use Payments 6,467$ 57,039,250 Totals Total EP / EH Payment Count21,600 Total EP / EH Payments Made $1,077,505,071

Medicare EHR Incentive Payments & Other Information (March 2015) Medicare Eligible Hospitals Meaningful Use Payments 724$914 Million Medicare Eligible Professionals Meaningful Use Payments 40,632$527 Million Medicare Advantage Providers 10,045$307 Million California EPs/EHs Receiving Incentive Payments 66,789 Total Incentive Payments Made$282 Million 34

Thank you!