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Introduction. BackgroundOpportunityBusiness Problem and CausesSolutionSharingQuestions. . 8/16/2011. 2. Background. K-MED started over 2 years ago as a grant request/award.1st year
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1. Kansas Medical Eligibility Determination System (KMED) Darin D. Bodenhamer, MMIS
Director, Medicaid/CHIP Eligibility
Kansas Department of Health and Environment
Division of Health Care Finance
2. Introduction Background
Opportunity
Business Problem and Causes
Solution
Sharing
Questions 8/16/2011 2
3. Background K-MED started over 2 years ago as a grant request/award.
1st year—built team, completed and released RFP.
2nd year—evaluated responses, awarded contract.
3rd—just getting underway—execution.
In the process
ACA passed.
Administration transition—KHPA rolled into KDHE.
Will accommodate other human services.
8/16/2011 3
4. Opportunity CMS/CMCS enhanced funding regs
90/10 available through 2015
75/25 for ongoing ops
Must meet certain conditions, e.g., integration with HIX
CMS/CCIIO grants and awards
Planning grant
Early Innovator Award
Establishment grants
Late breaking news—SMD letter on cost allocation released 8/10/2011
Temporary waiver of OMB regulations requiring cost allocation across all programs
Exchange/CHIP/Medicaid can pay for base system
Other federal programs pay for incremental costs to add those programs
Federal commitment to quick turnaround 8/16/2011 4
5. Business Problem It takes too long to process applications.
Increase in applications results in backlog and poor customer service.
Policy changes take a long time to implement.
Information to support policy and process decisions difficult or impossible to obtain.
Customers frustrated by cumbersome processes.
Customers don’t have ready access to information about their benefits.
Error rates too high.
Health care delivery for Medicaid/CHIP fragmented. 8/16/2011 5
6. Business Problem (cont.) Impossible to implement and apply policies consistently.
Policy subject to each person’s interpretation and willingness to apply it.
Manual processes result in keying errors.
Impossible to measure impact of policies and whether desired outcomes are reached.
Siloed usage—no reuse potential.
No additional capacity for volumes to triple or quadruple by 2014.
Large investment in staff training—a long time prior to having a productive employee.
8/16/2011 6
7. Causes of Problems Manual, antiquated processes.
Everything paper based.
Business rules must reside in people’s heads.
What’s not hard coded is not coded at all.
What is hard coded is largely out of date and requires work-arounds.
24 year old eligibility system is coded in antiquated languages.
Difficult to change code.
Becoming more difficult to find resources who know how to change the system.
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8. Causes of Problems (cont.) Staffing levels have not increased at the rate of program growth.
Current eligibility system does not capture the information needed for decision support.
Fragmented technology architecture—information resides in multiple systems.
8/16/2011 8
9. Solution New eligibility system.
Web based.
Rules engine.
Business Process Management tool.
Master Data Management.
Business Intelligence Services (includes data warehouse).
Java based.
Relational database (sounds odd, but current system is not).
Electronic notification capabilities.
Integration with imaging and content management system.
Seamless determination of eligibility for all publicly funded or subsidized medical coverage.
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10. Solution (cont.) Online portal.
Online application, feeds directly into eligibility and allows for real time adjudication of eligibility.
Online presumptive eligibility tool.
Customer self-service.
Reporting changes.
Completing application forms and reviews.
Looking up information.
Integration with claims and assignment information.
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11. Solution (cont.) Service Oriented Architecture
Allows for data sharing and reuse across multiple agencies.
Will become the beneficiary component to MMIS.
Will house all MEDICAID/CHIP beneficiary information instead of being spread across multiple systems.
Potential reuse for HIT/HIE.
Integration with HIX process. 8/16/2011 11
12. Conceptual SOA Platform 8/16/2011 12
13. Changing Needs 8/16/2011 13
14. Horizontal and Vertical Integration 8/16/2011 14
15. Future Possibilities—Sharing Within the State 8/16/2011 15
16. Sharing With Other States RFP and supporting documents available at:
http://www.kdheks.gov/hcf/healthwave/Procurements.html
Artifacts will be available by request and other means.
Potential transfer solution.
Kansas may offer as a Software as a Service (SaaS) solution.
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17. How Would SaaS Work? 8/16/2011 17
18. Configuration 8/16/2011 18
19. Pros/Cons to SaaS Pros Quicker implementation
Quicker procurement
Shared costs
More standardized and reusability across states
More delivered functionality—focus only on the configurable items
More purchasing/negotiating power Cons Less flexible than local ownership
More complicated vendor management and governance
Potential riskier implementation 8/16/2011 19
20. Questions 8/16/2011 20