Commonwealth of Virginia

1. Commonwealth of Virginia Puzzle: To clarify or solve (something confusing) by reasoning or study David E. Mix, PMP, MBA HIT/MITA Program Manager Department of Medical Assistance Services Commonwealth of Virginia David.mix@dmas.virginia.gov

2. Puzzle Pieces • American Recovery and Reinvestment Act (ARRA) • HITECH: Health Information Exchange (HIE), certified Electronic Health Record (EHR), Provider Incentive Program, meaningful use looking for better outcomes and coordination of care • Patient Protection and Affordable Care Act (PPACA) • Health Benefit Exchange (HBE/HBX), Eligibility Systems, Medicaid expansion looking for better user experience and coordination of services • DHHS efforts towards simplified enrollment standards and Federal verification service with IRS, DHS, SSA • Enhanced funding for eligibility systems to support HBE/HBX • Other factors • X12 5010/NCPDP D.0, ICD10, NCCI, Provider screening regulation • State mandates • State budget challenges • State assets (as-is) • Executive support • Multi-Secretariat collaboration championed by Dr. Bill Hazel, Secretary of Health and Human Services • Secretary of Technology, Jim Duffey and the Virginia IT Agency (VITA) • HIT Advisory Commission, Health Reform initiative, and HIT Standards Advisory Committee • Virginia Department of Motor Vehicles technology modernization efforts • State Agency legacy system silos

3. Puzzle Picture • To assemble a complex puzzle, a picture of the completed puzzle is helpful • Medicaid IT Architecture (MITA) V2.0 Concept of Operations (COO) document provides a picture of the assembled puzzle • Includes HIE, EHR, and eligibility systems (basis for HBE/HBX) • While focus is on Medicaid/CHIP it does reflect interoperability with other social service programs • Technology base is program agnostic • Business case: one of cost avoidance

4. Virginia’s Strategy • Leverage MITA as core strategy to address both ARRA and PPACA requirements • Adopt MITA vision (self-directed services) • Look at requirements from an enterprise perspective • Use MITA State Self Assessment process to align efforts to Federal direction • Maximize Federal funding assistance • Leverage Virginia’s existing assets • VITA provides enterprise infrastructure • Governance, standards, competency centers (new), hosting, disaster recovery, strategic planning, help desk, cost allocation/rate setting, IT procurement/project approval, project management • Strategic planning at Secretariat level with State Agency alignment begins to reflect migration path to enterprise interoperability • Legacy systems can interoperate on the enterprise using standards-based services/interfaces • Enterprise technical infrastructure becomes an enabler of business transformation

5. Work In ProgressFederal funding approved • Establishing HIT/MITA program office • Secretariat level • Fund and manage multiple HIT/MITA projects • Data sharing/trust initiative • IT strategic planning initiative • Establishing a common physical technical architecture • Compliant with MITA Technical Architecture Standard • Pay-for-use environment – available to all Federal/State/local programs • Foundation for HIE and HBE/HBX interoperability with State systems • Includes a Master Data Management (MDM) product for person/organization information • Targeting significant improvement to Medicaid enrollment accuracy • Establish Service Oriented Architecture (SOA) and MDM competency centers • Establish authentication service • Tied to MDM product • Used for public facing portals (HIE & HBE/HBX etc) • Developed by Virginia Department of Motor Vehicles

6. Planning In Progress • Federal funding requested for interfacing Health Department and State Lab systems to the enterprise for access by HIE • Planning for replacement of multiple eligibility systems with an integrated solution • Reflected in MITA Transition Plan • Meets CMS seven conditions and standards for funding

7. References • MITA • http://www.cms.gov/MedicaidInfoTechArch/ • Virginia MITA transition plan • http://dmasva.dmas.virginia.gov/Content_pgs/mita.aspx • Virginia HIE Strategic and Operations Plan • http://www.hits.virginia.gov/ • Virginia State Medicaid HIT Plan • http://dmasva.dmas.virginia.gov/Content_pgs/pr-arra.aspx • Virginia IT Agency (VITA) Enterprise standards • http://www.vita.virginia.gov/oversight/dm/default.aspx?id=10344