1. HIE Lessons for MMIS Implementations November 7, 2016
Jim Younkin, MBA
Chief Technology Officer
CedarBridge Group
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.

2. HIE Lessons for MMIS
Modularity
Procurement
Barriers
Data Governance

3. 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

4. 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

5. 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

6. 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?

7. 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:

8. Large IT Procurements Challenges Recommendations
Pre-Solicitation
Leadership & Governance
State Staffing
Procurement Process
Proposal Evaluation
Cultural Factors
Vendor Management
Recommendations
Challenges
Source:

9. 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

10. HIE Lessons for MMIS Modularity Data Governance Procurement
* Cross-cutting challenges:
Limited demand for HIE
Sustainability
HIE integration into provider workflow
Barriers
Source:

11. 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

12. Impact of External Data
Source:

13. 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?

14. HIE Lessons for MMIS
Modularity
Data Governance
Procurement
Barriers

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

16. 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 )

17. 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

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