1	Medicaid IT Architecture Ohio’s Journey has Begun APHSA Conference August 16, 2004 Ravi Kumar, Sr. Project Manager Ohio Department of Job and Family Services
2	Medicaid IT System (MITS) Project MITS is to address… Business Process As-is to To-be analysis Business process Reengineering Cost Reduction and Efficiency People Succession Planning Knowledge Management Skill-set enhancement Technology Replace/Integrate ten systems supporting Ohio’s Medicaid Program (including MMIS) Embrace new technology – Web, CRM, Document Management
3	MITS Purpose Ohio Medicaid is… 6^th largest public health care purchaser 33% state expenditures 76% ODJFS expenditures $12 billion in SFY 2004 Value Purchaser 1 in 3 births 1 in 3 children 1 in 4 seniors over the age of 85 years 75% of long term care costs 3^rd oldest legacy system in the country Built by SME’s & served Medicaid well (in the past)
4	MITS - Why do this? Growing business pressures Regulatory Demands Rapid Change and Growth Cost management Pressures Medicaid Reform Commission Recommendations Nursing Home Study Council Recommendations Open OIG Audits
5	MITS - Why do this? It takes years to make major (and even some minor) changes to the Medicaid system HIPAA Third Party Liability – Cost Avoidance Direct Bill – Long Term Care Nursing Homes Eligibility De-link – Medicaid from Food Stamps and Cash Benefits Backlog of Software Change Requests and Projects Many people not even asking for system changes anymore
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7	MITA Early Adopter Project * Ohio is one of Early Adopter states Accomplishments Business Model Approach Gap Analysis Self Assessment Planning Advance Planning Document Hub architecture- Early Adopter Project Memorandum of Understanding with CMS
8	Ohio Business Model
9	MITA Business Model
10	CMS & Ohio Business Models – Comparison
11	Self-Assessment Process
12	Inputs – Self Assessment Inputs As-Is Analysis of Ohio’s Business Model Technical Gap Analysis Market Based Solutions MITA Capability Matrix: Business View MITA Capability Matrix: Technical View MITA Maturity Model and maturity level descriptions
13	Outputs Outputs As-Is Business process Maps Technical Gap Analysis ODJFS Market Based Solutions (EDS & CNSI) Business View Mapping Technical View Mapping
14	MITA Maturity Model
15	Business View Mapping– MITA Self-Assessment
16	Findings – Business View– MITA Self-Assessment (cont’d)
17	Business View Mapping – MITA Self-Assessment (cont’d)
18	Business View Mapping – MITA Self-Assessment (cont’d)
19	Technical View Mapping – MITA Self Assessment
20	Hub Architecture – Adaptor Project Purpose – To replace existing Medicare Buy in legacy system Background - Under an buy-in agreement with the Federal government, Ohio enrolls qualified people in the Supplementary Medical Under an buy-in agreement with the Federal government, Ohio enrolls qualified people in the Supplementary Medical Insurance Program (Medicare Part B) and, when qualified, in the Premium Hospital Insurance Program (Medicare Part A) and pays their premiums.
21	Blended IT Team Approach Retraining existing IT staff New technologies New techniques Not outsourced to a vendor Bring expertise in-house where needed Part of deliverable is training/mentoring state staff State staff from 3 IT sections working together
22	Buy-In Architecture
23	Technology Benefits Moving from COBOL to Java Scalable, flexible, extensible architecture Web front end New relational database Sharable for other alert states (plug and play with minimal customization) Seamless view of recipient: aggregating data from disparate legacy systems
24	MITA Next Steps Build a business based Medicaid IT architecture Develop a service migration strategy Develop detailed technical and business requirements for MITS Change Leadership Develop Hub-based architecture and complete initial strategic projects with newer technologies (web, document management etc.) Develop MITA compliant Implementation APD Develop MITA compliant MITS RFP
25	What it will take… “Incentives to take risks and complete IT projects according to goals do not normally exist in government. A successful IT implementation in government requires the hands-on involvement of senior management. Processes must be aligned to ensure accountability for success.”
26	Questions and Discussion