HIE Lessons for MMIS Implementations November 7, 2016 Jim Younkin, MBA Chief Technology Officer CedarBridge Group jim@cedarbridgegroup.com The session is scheduled for Monday, November 7, from 4:15 – 5:45 p.m. ET. Slides are optional, though if you intend to use them, please try to get your presentations to our event coordinators or me by November 3. We anticipate roughly 125 attendees for the session. We will aim to have presentations wrapped up within 50 minutes to an hour, and reserve the remaining time for moderated discussion and audience questions. MMIS MODULARITY: MAKING DISRUPTION EFFECTIVE Session Overview: A program as large and complex as Medicaid requires significant investment in information systems and technology to effectively manage it. New thinking, inspired by software-as-a-service approaches in other tech sectors, is paving the way for Medicaid systems to become leaner, with their constituent components managed by smaller and more specialized vendors. In this session, we will explore this new world of modular Medicaid systems, learn the lay of the land in the tech sector for meeting Medicaid’s specialized systems needs, and hear how to cultivate the change needed to successfully create the nimble, modular Medicaid systems of the future.

HIE Lessons for MMIS Modularity Procurement Barriers Data Governance

HIE Lessons for MMIS ONC Interop Roadmap: “Services should be modular, secure and standards-based wherever possible” HIE Lessons for MMIS Modularity Data Governance Procurement Barriers

Health IT Modular Functions Roadmap Guiding Principle: Maintain modularity. A large, nationwide set of complex, scalable systems are more resilient to change when they are divided into independent components that can be connected together. Because medicine and technology will change over time, stakeholders must preserve systems’ abilities to evolve and take advantage of the best of technology and health care delivery. Modularity creates flexibility that allows innovation and adoption of new, more efficient approaches over time without overhauling entire systems. Source: ONC “Health IT enabled Quality Measures (HITeQM) Architecture Track”, ONC SIM state meeting- August 31 – September 1, 2016

State / HIE Intersection Provider tools (e.g., patient look-up) Direct Secure Messaging Results Delivery Public Health Reporting / Registries Population Health De-identification/Re-identification Reporting services Analytics services Notification services Exchange services Consumer tools Patient attribution Data Extraction, Transformation, and Aggregation Data Quality & Provenance Identity Management Security Mechanisms Provider Directories Consent Management Care Coordination Tools Provider Directory MMIS Eligibility/Enrollment Regulatory/Licensing Credentialing Benefits Management State registries: Vital information Disease reporting Immunization Drug, alcohol, HIV Behavioral health Child welfare Veterans Dept. of Corrections Gateway / Interface Engine State Services HIE Services Patient / Client Directory

HIE Takeaways for MMIS Which services are independent? Which core components can be shared? Is there an order? What about contracting and maintenance? What about staffing?

HIE Lessons for MMIS Modularity Data Governance Procurement Hire the right vendors at the best value, and hold them accountable for their performance. * CMS is pushing for reuse of components. Most in the room don’t own or run HIEs Reuse components for multiple systems: MPI/MPD: HIE APCD MMIS Eligibility and enrollment Credentialing Even if the State does not run the Statewide HIE public/private partnership 501(c)(3) Trusted resources: MPI, Provider Directory (credentialing), Interface Engine(?) Barriers * Source: http://www.sco.ca.gov/files-eo/0813_it_task_force_recommendations.pdf

Large IT Procurements Challenges Recommendations Pre-Solicitation Leadership & Governance State Staffing Procurement Process Proposal Evaluation Cultural Factors Vendor Management Recommendations Challenges Source: http://www.sco.ca.gov/files-eo/0813_it_task_force_recommendations.pdf

HIE Takeaways for MMIS It takes… Leadership and Vision Governance to build Trust Administrative action Certified Systems and Standards Vendor Management 90/10 funding to grow

HIE Lessons for MMIS Modularity Data Governance Procurement * Cross-cutting challenges: Limited demand for HIE Sustainability HIE integration into provider workflow Barriers Source: https://www.healthit.gov/sites/default/files/state_hie_evaluation_stakeholder_discussions.pdf

Common HIE Barriers / Enablers Limited demand for HIE Sustainability HIE integration into provider workflow Enablers Effective use of legislation Effective use of policy levers Strategic leveraging of existing investments in HIE Barriers Limited demand for HIE Sustainability HIE integration into provider workflow Enablers Effective use of legislation Effective use of policy levers Strategic leveraging of existing investments in HIE

Impact of External Data Source: https://oncprojectracking.healthit.gov/wiki/download/attachments/14582965/Day1_11_The_Chain_of_Trust%26ItsPotentialto%20TransformHealthcare_IBM.pdf?version=2&modificationDate=1474664001000&api=v2

HIE Takeaways for MMIS Understand state and federal privacy laws and regulations Understand drivers for non-state participants What about the “social” determinants of health?

HIE Lessons for MMIS Modularity Data Governance Procurement Barriers

Finding the duplicates Data Governance Finding the duplicates It’s almost a match When records merge Go to the source An ounce of prevention

HIE Takeaways for MMIS Data Governance Policies that work Data Entry Policies and Processes* Registrar/ Front Office Staff Training/ Certification* Managing Duplicate Records* Consumer Involvement* Data Governance Policies that work * PATIENT IDENTIFICATION AND MATCHING FINAL REPORT, Ai, 2014 (pp. 34-39)

Additional considerations… HIE Lessons for MMIS Additional considerations… Modularity Data Governance Procurement Next steps for you… Questions to ask: Of patient and provider file, how much are we sharing among our systems? How can we share information with our HIE? How do we ensure cleaner data for everyone of use? How much does it cost to maintain all our systems? How much of this ties back to patient/provider CedarBridge pitch of the states we’re working with… Barriers

Jim Younkin, MBA CTO, CedarBridge jim@cedarbridgegroup.com