1. Building the Foundation
NAMD Fall Conference
September 7, 2016
Susan Mosier, MD, MBA, FACS
Secretary, Kansas Department of Health and Environment
Build the Foundation: the IT infrastructure that will allow us to have a 360 degree view of the people we serve. We believe the IT infrastructure will be an accelerant for our delivery system and payment reform efforts.
Delivery system and payment reform
Good morning. It is great to have the opportunity to talk with you today about our Kansas Modular Medicaid System or KMMS Project.
We’re building a new foundation for our future delivery system and payment reform efforts.
What underlays the delivery system and payment reform efforts is the IT infrastructure

2. Roadmap Overview of Kansas Medicaid
Overview of Kansas Modular Medicaid System (KMMS)
Goals of KMMS
Modules and modularity
Foundation for future growth
Summary
End with a picture of where we are going. 2

3. KanCare Overview KanCare is a Medicaid Managed Care program
3 Managed Care Organizations (MCOs)
Operate statewide
Operate across the spectrum of health
Goals:
To improve quality/outcomes and
To reduce the rate of rise in cost growth
Through:
integrated, coordinated care and
an increased emphasis on health, wellness, prevention, earlier detection and intervention
I want to briefly talk about our Medicaid and CHIP managed care program. KanCare serves over 420,000 Kansans. Expenditures for calendar year 2015 were over $3.0 billion approved in December 2012 – allowed us to move essentially all populations and essentially all services into capitated risk-based managed care model with 3 Managed Care Organizations (MCOs). These MCOs operate statewide and operate across physical health, behavioral health and long term services and supports
The goals of KanCare are the goals of the triple aim:
Improves quality/outcomes while bending cost curve down
And to achieve this through:
better integration and coordination of care
And by moving up the health care continuum from where we have been in focusing largely on care to an increased emphasis on health, wellness, prevention, earlier detection and earlier intervention
Essentially all populations and services in capitated risk-based managed care
Silos between divisions and agencies remain
Silos of data remain

4. KMMS Overview
Recent RFP award for Kansas Modular Medicaid System (KMMS) to Hewlett Packard Enterprise (HPE) as the system integrator
Service oriented architecture with enterprise service bus in a virtual private cloud
HPE partners on KMMS include:
Cerner for population health management, data analytics, predictive modeling and enterprise data warehouse
SAS for program integrity functions
We recently awarded the contract for Kansas Modular Medicaid System (KMMS) to Hewlett Packard Enterprises (HPE). HPE serves as the system integrator to replace our existing MMIS
HPE has subcontracted with::
Cerner Corporation for population health management, data analytics, predictive modeling and enterprise data warehouse
SAS for program integrity and utilization review
KMMS is on a service oriented architecture platform with transactions brokered through an enterprise service bus operating in a virtual private cloud

5. Goals of KMMS
Provide a 360 degree view of a Medicaid beneficiary in order to meet that individual’s needs holistically
Facilitate increased and improved coordination and integration of services
Break down silos of: behavioral and physical health, agencies and organizations, data, funding
Provide skinny data
Need to focus on an individual’s needs holistically, not programmatically: 360 degree view, whole person care, plan of service. Provide tools for individual and pop health management
Need for coordination and integration across a broad array of organizations, jurisdictions and sectors, in part through more timely and accurate communication among patients, providers and payers
Need to break down silos
Need for the ability to share information accurately and timely
Provide skinny data – targeted, actionable information
Provide tools for better coordination of care across the health and healthcare systems
Personal Health Record – person
Electronic Health Record – provider/payer
Facilitate more timely and accurate communication between and among the people that are involved in a person’s health and care: patients, providers, payers, care coordinators/navigators, health coaches
Allow for expanded access to the health system whether it be through telehealth or by the people involved in the health care of a person having access to more data and more timely data
Provide tools for managing at an individual level or at various population levels – clinics, hospital systems, counties, state level, etc. 5

6. Utilization Management
Core System: 8 Modules
Module Overview
Program Integrity/
Utilization Management
SAS Fraud Framework
Investigative Case Management
HPE PI SURS Product
Customer Self Service
Portal (CSSP)
Claims/Encounter
Processing
Provider Management
HPE Provider Product,
K2 blackpearl
Workflow Management, InRule
Business Rules Engine
Microsoft Dynamics CRM,
Avaya Unified Communications,
Aspose Correspondence Management
HPE Business Policy
Administration
KMMS - Enterprise Service Bus
Financial Management
Managed Care Enrollment
Broker Services
Data Warehouse
and Analytics (DWA)
KEES Integration
Modernized Kansas Financials,
HPE TPL Product,
HPE Drug Rebate Product
HPE inSight Dashboard
Core system is 8 modules:
1. Customer Self Service Portal
2. Claims
3. Provider management
4. Program integrity and utilization review
Financial management (with dashboard, TPL)
Managed Care
Interface with the eligibility system
EDW
HPE Managed
Care Product
Modernized Kansas
Member Management
Cerner HealtheIntent
Data Warehouse Platform
= Product
= Modernized

7. Advantages of Modularity
Facilitates new and innovative collaborations
Encourages new entrants into the Medicaid marketplace
Improves ease of upgrades and replacement
Facilitates standardization
Provides a platform for expansion:
New modules within the Medicaid enterprise
Connect to modules in other agencies and beyond 7

8. Challenges of Modularity
A new IT infrastructure for the health care industry
Multi-vendor
Management
Issue resolution
Attracting new vendors to the public side of health IT
Higher dependence on strong governance structures
Not the first industry, but perhaps the most complex data-wise 8

9. Medicaid Enterprise New Module Web Service Business logic Data Stores
New Data Stores

10. Statewide SOA Framework
State Enterprise
Resolve conflictual ser
Statewide SOA Framework
All State agencies, programs, and supporting IT services
HHSE Enterprise
All Health, Human Service, and Environment agencies, programs, and supporting IT services ME
Modernized Medicaid Enterprise
HHSE PH example immunizations. Environment example: air quality monitor data
Statewide SOA - Eliminate redundancies,, resolve conflictual services, fill gaps. Develop a plan of service. Connect with Commerce around jobs training and employment, Education – early childhood initiatives, adverse childhood events. Children and Families – voc rehab, foster kids. Local and federal housing authorities and more
Whole data for whole person care:
Leverage public health expertise and programs
Expand to include human services data and applications
Provide expanded opportunities for job training, employment, education, housing and more
Continue to upgrade and harness advanced information technology. Employ advanced data analytics and predictive modeling for program improvement and MCO oversight. Expand use of telehealth.
With stakeholders, explore, design and implement alternative payment models tied to quality and outcomes

11. Let’s recap: What we currently have are silos of data and agencies
Let’s recap: What we currently have are silos of data and agencies. For Medicaid alone, we have over 20 data silos spread across 2 agencies.
What we’ve done in the past is improve our programs by…
As Is

12. Improved As Is Photo from Ed O’Neil
tricking out our silos, but they would still be silos. And CMS…
Now we connecting our silos while keeping our existing infrastructure….
Improved As Is
Photo from Ed O’Neil

13. We could try to build upon the existing structures, but we end up with a silod house.
What we need to do is build a new foundation for…. … a well-architected, well-constructed ,highly secure house. In the spirit of the season, Something like this one…
Improved As Is
Photo by: jordan hogenson. No changes.

14. … a well-architected, well-constructed ,highly secure house
… a well-architected, well-constructed ,highly secure house. Something like this one.
One with excellent security and one where there are rooms of data, not silos. One that essentially everyone should have access to some rooms in the house and if you have the right credentials, you can access the rooms of data easily so that we can make better decisions for the people we serve.
To Be