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State of Vermont/Wakely
Consulting
Health Insurance
Exchange AssistanceIT Gap Analysis Report
Julyne302325, 2012
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Table of Contents
Executive Summary ................................................................................................................... 4Introduction ................................................................................................................................ 7Methodology .............................................................................................................................10Current State IT Systems Environment .....................................................................................11Gap Analysis Summary .............................................................................................................15
Appendices ...............................................................................................................................30Appendix A: IT Systems Current State Details ....................................................................31Appendix B: Functional and Technical Components............................................................48Appendix C: IT Assets Assessment Functional Component Worksheet (Detailed View) .....81Appendix D: IT Assets Assessment Technical Component Worksheet (Detailed View) .....118
Executive Summary ..................................................................................................................44Introduction ...............................................................................................................................77Methodology ...........................................................................................................................109Current State IT Systems Environment .................................................................................1110
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List of Tables
Table 1: Gap Analysis Approach Steps .....................................................................................10Table 2: IT Gap Analysis Initial Systems Review ....................................................................12Table 3: Vermont Systems Summary ........................................................................................14Table 4: Current IT Assets ........................................................................................................15Table 5: IT Assets Assessment Rating Scale ................................
............................................16Table 6: System Fit-Gap Rating Scale ......................................................................................19Table 7: Functional Component Fit-Gap Rating ........................................................................20Table 8: Technical Component Fit-Gap Rating..........................................................................24Table 1: Gap Analysis Approach Steps ...................................................................................109Table 2: IT Gap Analysis Initial Systems Review ................................................................1211Table 3: Vermont Systems Summary ....................................................................................1312Table 4: Current IT Assets ....................................................................................................1413Table 5: IT Assets Assessment Rating Scale ........................................................................1514Table 6: System Fit-Gap Rating Scale ..................................................................................1716Table 7: Functional Component Fit-Gap Rating ....................................................................1817Table 8: Technical Component Fit-Gap Rating......................................................................2221
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List of Figures
Figure 1: Gap Analysis Approach Summary ..............................................................................10Figure 2: IT Assets Assessment Functional Component Worksheet .........................................17Figure 3: IT Assets Assessment Technical Component Worksheet...........................................17Figure 4: Total Function Percentage by System (for Functional Components) ..........................21Figure 5: Functional and Technical Capabilities Summary ..............
..........................................29Figure 1: Gap Analysis Approach Summary ............................................................................109Figure 2: IT Assets Assessment Functional Component Worksheet .....................................1615Figure 3: IT Assets Assessment Technical Component Worksheet.......................................1615Figure 4: Total Function Percentage by System (for Functional Components) ...................... 1918Figure 5: Functional and Technical Capabilities Summary ....................................................2625
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Executive Summary
The State of Vermont (the State, Vermont) engaged Wakely Consulting to conduct a limited
Information Technology (IT) gap analysis to support the States planning for an integratedHealth Insurance Benefits Exchange (HIXHBE) and modernized eligibility system. The gap
analysis work should better help the State understand the IT implications of the business model
options it is considering for Exchange and modernized eligibility system implementation.
The objective of the analysis described in this report is to assess the functional and technical
gaps between the IT systems requirements for the full Exchange and modernized eligibility
system implementation and existing systems that are candidates for reuse. The IT systems
requirements for an integrated Exchange and modernized eligibility reference model are defined
by the Center for Medicare and Medicaid Services (CMS) Exchange Reference Architecture
(ERA) and Medicaid Information Technology Architecture (MITA) 3.0, with extensions
developed to address business areas not yet fully defined by CMS1.
Gap Analysis Process
The Wakely Consulting team worked with select State staff to gather the data required to
perform the gap analysis between the States current physical system capabilities and future
system requirements of the HIXHBE, using the requirements detailed in the integrated reference
model. State stakeholders selected four legacy systems for full gap analysis based on their
potential to meet some or all of the functional and technical requirements of the HIXHBE. TheWakely team analyzed these selected systems in further detail and entered the resultant data
into our Gap Analysis Tool. We designed this Gap Analysis Tool to help identify which current
physical systems show potential for reuse, including systems that may benefit from
t ti ith f ti l t h i l t b i l d d i V t HIXHBE
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Major Observations and Recommendations
General
The four systems considered for their reuse potential were ACCESS, Vermonts custom-built
human and health services eligibility and enrollment system; the Central Source for
Measurements and Evaluation (CSME), a custom-built analytics tool; OnBase, a commercial
records and document management system; and Event Replicator (EVR), a commercial add-onto ACCESS to enhance access to eligibility and enrollment data. Of these systems, ACCESS
displayed limited ERA/MITA 3.0 functionality, and only the commercial product OnBase
demonstrated good potential for reuse.
In the observations below, we discuss the difference between the needs of an integrated
Exchange and modernized eligibility system (i.e., its requirements) and those that existing
State systems provide.
Key Observations
Observation One. Only ACCESS has any of the functional capability required by the
ERA.The ACCESS system provides moderate support of less than 25% of the functions
required by the Financial Management, Eligibility & Enrollment Operations, and Customer
Service & Account Management components. Many of the functions required by these
components are not supported, and those that are, are moderately supported by ACCESS.
ACCESS technology is over three decades old and limits the prospects of enhancements to
meet ERA/MITA requirements. We recommend that the State of Vermont not consider ACCESSfor further reuse. There will more than likely need to be better exposure methods to ACCESS
data and processes
Recommendation One. Recommend further investigation into the reuse of data managed by
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interoperability point will be required for some time and may have to be enhanced through
EVR or other.
CSME is intended to be a data warehouse (DW) but has little DW capability and as built
limits the prospect of improvements. The CSME system provides no ERA/MITA functionality
and has poor technical functionality. CSME should not be considered for reuse. Agreed
100% Leveraging the BI side of this may be an option for reuse as it is a COT BI product
suite (SAP Business Objects) that has some footing in SOV
OnBase is however a modular commercial content management system, used by the State
for records and document management. Its current functionality can be enhanced through
purchasing additional modules to fill functional gaps found as a result of this IT Gap
Analysis.
RecommendationTwo. Further investigate OnBase for potential reuse as the Records and
Document Management component of the Information Management business support
component.Agreed. The deployment and scale of the existing infrastructure that support the
current onbase and lack of record schedule implications (full life cycle retention) will all need tobe address and governed better.
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Introduction
Project Context
The Patient Protection and Affordable Care Act (PPACA) was signed into law in March 2010.
The Stated aim of the health reform legislation is making health insurance more affordable and
more accessible to small businesses and individuals. As defined by the legislation, States are
required to make available a HIXHBEwhere individuals or small businesses will be able to
compare and purchase health insurance by October 2013.
The passing of this legislation has placed a significant burden on States to implement robust
programmatic and technical infrastructure in a very limited time- frame. Most prominent among
these requirements is the implementation of the HIXHBE. If the State is to take advantage of the
opportunity to implement its own State-based Health Benefits Exchangethat will beoperated by
the existing Department for Vermont Health Access (as opposed to allowing the Federal
government to operate an Exchange on the States behalf, or establishing a new state agency)
much work needs to be accomplished. The State needsto demonstrate substantial progress
by January 1, 2013 so that the Federal government will allow the implementation of an
operational Exchange by October 2013.
Project Objective
The federal government has made available to States Federal Health InsuranceExchangeHealth Benefits ExchangeEstablishment Grants to set up a HIXHBE. These
Establishment Grants are available in two types: a Level One grant, which provides one-year
funding to complete planning efforts and to consider how to establish the Exchange; and a Level
T t hi h id lti f di i t ifi d l t l t t bli h
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3. Identify various implementation scenarios given the information for Exchange demand,
provided specifically for this review by the State of Vermont.
4. Identify the desired operating levels of service and supporting systems.
Organization of this Report
This report addresses items one and two, the identification of potential gaps between the ITsystems selected for the gap analysis and the target operating model selected by the State of
Vermont.
We worked closely with the State to help identify their needs for implementing and operating a
State HIXHBE. This information highlighted the functional and technical requirements for their
target operating model for the Exchange, leveraged to assess a number of systems identified by
the State for potential reuse. This report includes a number of summary diagrams and
observations depicting the ability of existing systems to meet the functional and technical needs
identified by the State. Conversely, the gaps identified and illustrated are of functional and
technical areas where the IT systems have minimal or no coverage of Exchange requirementsas defined by CMS for the integrated ERA/MITA 3.0 model.
The next sections provide information on the approach and analysis in detail. In particular:
Description of the gap analysis methodology.
Discussion on the current IT system environment, and provides descriptions of the State of
Vermont systems assessed for potential reuse.
Results from our gap analysis, with clearly identified observations and results.
Following the report narrative are four appendices with additional detail about the gap analysis,
including the following:
Appendix A: IT Systems Current State Details
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Important Notes about this Report
The purpose of this report is to document observations that came to our attention during our
work and to offer our observations and recommendations for the States consideration. Our
procedures consisted of inquiry, observation, and analysis of provided information. Such work
does not constitute an audit or attestation. Accordingly, we express no opinion on financial
results, processes, other information, or internal controls. The State of Vermont is responsible
for the decisions to implement any recommendations and for considering their impact. This
report is meant solely for the use of the State management and is not to be reproduced or
shared with any third party without Wakely Consultings written consent except as may be
allowed by the terms of our Contract agreement.
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Methodology
The Vermont IT systems assessed in this report are in place, or are now being implemented,
and support current health insurance and human service programs. The purpose of the gapanalysis is to determine which, if any, of the IT systems have the potential for reuse to support
the Vermont HIXHBE. The State will use the results of this analysis as support for the planning
its HIXHBE.
Our team followed a four-step approach to conduct the gap analysis, as illustrated in
Figure 1Figure 1Figure 1.
Figure 1: Gap Analysis Approach Summary
Table 1Table 1Table 1describes each of the steps in the gap analysis approach.
Step Objective Outputs
Step 1 ReviewTechnical &FunctionalComponents
Validate the technical and functionalcomponents to help ensure that each isapplicable to Vermont
Identify missing components
List of technical and functionalcomponents required to support thetarget operating model
Step 1Review Technical &
FunctionalComponents
Step 2
Identify RelevantCurrent IT Assets
Step 3
Assess Current ITAssets
Step 4
Conduct Fit-GapAnalysis
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Table 2: IT Gap Analysis Initial Systems Review
Vermont Health Enterprise Systems
Vermont is in the midst of many initiatives to modernize not only its technology (systems,
hardware, software, etc.) but also its business processes. The single State Medicaid Agency,the Agency of Human Services (AHS) is currently involved in a modernization effort to integrate
AHS s systems and make them more flexible, integrated, and better positioned to support AHS
service integration and improved client outcomes. AHS is also seeking to improve and further
develop local partnerships, so that the breadth of human services can be provided in a
seamless fashion, addressing the full range of client and community needs leveraging shared
services, common technology, and detailed information. CMSs MITA 3.0 guideline will help
provide the framework to allow the State the ability to meet the goals of increasing electronic
commerce and transitioning to a digital enterprise2.
Solutions
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EVR EVR replicates real-time data from ACCESSto an SQL database.
Supports Healthcare, TANF, SNAP, LIHEAP,GA, EP, SSI, Lifeline, Crisis Fuel, PSE, andIV-D.
IBM Z9mainframe
z/OS 1.11mainframeoperating system
Windows Server2003 Enterprise(64 bit)
Table 3: Vermont Systems Summary
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Gap Analysis Summary
Step 1 Review Technical and Functional Components
The Wakely team reviewed the technical & functional components with Vermont. Given that the
State of Vermont asked Wakely Consulting to plan for a fully functional Exchange, all of the
functional and technical components are required in the target architecture for the States
Exchange.
Step 2 Identify Relevant Current IT Assets
The team assessed nine Vermont IT systems as part of the Gap Analysis. Based on the
understanding gained from the review of the HIXHBELogical Component Model, we worked
with State stakeholders to help to comprise and refine a list of potential systems for further
evaluation. Of the five systems the team identified, OnBase is the only system that appears to
have significant potential for reuse in the Exchange.
Current IT Systems System Description
OnBase Hyland Software commercial records and document management system supporting
Step 1Review Technical &
FunctionalComponents
Step 2Identify RelevantCurrent IT Assets
Step 3Assess Current IT
Assets
Step 4Conduct Fit-Gap
Analysis
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Being potential candidates for the future State Health Insurance ExchangeHealth Benefits
Exchange, we then assessed each of these systems for their level of fit for performing the duties
of the functional and technical components defined by the CMS ERA/MITA 3.0 guidelines.
Step 3 Assess Current IT Assets
The Wakely Consulting team, along with Vermont staff, sought to gauge each systems
capability in performing functions for the various functional and technical components defined byERA/MITA 3.0.
We then assessed each system as to whether or not it performs the functions of each
component and to what degree it performed the functions within the component. In seeking to
assess whether or not the system performed the function, we assigned the subject system a
value of yes, no, or unknown unknown indicating that further investigation was required prior
to determining a yes or no value.
If a system performed a function, we assessed the system as High, Medium, or Low to
indicate the extent to which a system performs all of the functions within a component. We
assessed the system N/A should it not perform the function and Unknown if the value of the
systems ability to perform the function was not known. In order to use this assessment
approach for calculating a systems potential support for a component, we employed the
following schema (seeTable 5Table 5Table 5)to score the ratings provided to each function of
each component:
Value Rating Implication
High The system provides 100% of the required functions for the component.
Medium The system provides 50% of the required functions for the component.
Low The system provides 10% of the required functions for the component.
N/A Th t d t id th i d f ti f th t th ti i d i 0%
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Figure 2Figure 2Figure 2depicts an extract of the worksheet used to record this information
during our system(functional)assessment efforts.
Figure 2: IT Assets Assessment Functional Component Worksheet
Appendix C: IT Assets Assessment Functional Component Worksheet (Detailed View) displays
the detailed version of the IT Assets Assessment Functional Component WorksheetFigure 3
depicts an extract of the worksheet used to record information during our system (technical)
assessment efforts.
Functional Component Service Performed by Component
Current Physical Systems
System 1 System 2
Performs
Function?
Function
Implementation
CommentsPerforms
Function?
Function
Implementation
Comments
Plan Certif ication & Risk Management 0 Yes NoPlan Certif ication & Risk Management Plan Certification
Plan Certif ication & Risk Management Manage Plan Submission Process Yes Med No N/APlan Certif ication & Risk Management Certify / Recertify / Decertify Plan Yes Med No N/APlan Certif ication & Risk Management Form QHP Agreement with Issuer Yes Low No N/APlan Certif ication & Risk Management Manage Issuer and Plan Information No N/A No N/APlan Certif ication & Risk Management Report Issuer and Plan Information No N/A No N/APlan Certif ication & Risk Management Assign Plan Quality Rating Yes Hi No N/APlan Certif ication & Risk Management Process Change in Plan Enrollment Availability Yes Hi No N/A
Functional Components
Service capability indicator
Service capability measure
Explanatory comment
Current IT Systems
Technical Component
Performs
Function?
Function
ImplementationComments
Performs
Function?
Function
ImplementationComments
Information Management
Yes Low
Custom reporting through use
of Natural programs. No N/A
Master Person Index
Yes Low
Internal identifier used among
all programs No N/A
Knowledge Management No N/A No N/A
Financial Transaction Procesing No N/A No N/A
InRHODES Rite Share
Technical Components
Service capability indicator
Service capability measure
Explanatory comment
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Step 4 Conduct Fit-Gap Analysis
We created a Gap Analysis Tool that used the input from Step 3 to calculate the reuse potential
of the State assets evaluated. We translated the assessment data provided in Step 3 into
scores, which were then used to rate each systems ability to perform the functions and to help
determine the level of reuse to recommend. Those levels of reuse included reuse with no
changes, reuse with system augmentation, or no reuse. We only assessed the systems against
those components they were intended to support.
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The Gap Analysis Tool provided three outputs to summarize the analysis.
1. A matrix of system ratings against individual functional or technical components
The system-ratings matrix illustrates the scoring of each subject IT system against each
functional component.Table 6Table 6Table 6describes the colors used in the matrix.
Color Description
Green The functions that this system supports for this component average a rating of High.
Yellow The functions that this system supports for this component average a rating of Medium.
Red The functions that this system supports for this component average a rating of Low.
Grey The functions that this system supports for this component average a rating of Unknown.
White The system was not designed to provide this functionality.
Table 6: System Fit-Gap Rating Scale
The percentage within each cell indicates how much of the components required
functionality the system provides. For example, a system component with a color of red
and a percentage of 50% provides low functionality to one-half (50%) of its rated
components. This same system could also receive a color of yellow for another component
with a percentage of 50%, meaning that this component provides medium functionality to
one-half of its rated components.
2. A rating of each system against overall functional or technical requirements
A graph illustrating the score of the IT assets components against all reference functionaland technical components. As an example, an IT asset that scores high in each of the
components against which it is assessed would have a corresponding high rating on the
graph.
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Functional Observations
Table 7Table 7Table 7summarizes the ability of each system to meet the requirements for each
of the functional components defined by ERA for an Exchange. As can be seen in Table 8, all of
the systems assessed are capable of supporting only a small amount of component
functionality.
Table 7: Functional Component Fit-Gap Rating
Figure 4Figure 4Figure 4illustrates how much functionality each of the above systems provides
relative to the requirements of the functional components covered by the system. It indicates a
l i i f h ff i i i h ll f i l i
ACCESS CSME OnBase EVR
IT Management 0% 0% 0% 0%
Financial Accounting & Reporting 0% 0% 0% 0%
Asset Management 0% 0% 0% 0%
Human Resource Management 0% 0% 0% 0%
Procurement Management 0% 0% 0% 0%
Business Agreement Management 0% 0% 0% 0%
Policy & Oversight 0% 0% 0% 0%
Plan Management 0% 0% 0% 0%
Financial Management 23% 0% 0% 0%
Eligibility & Enrollment Operations 22% 0% 0% 0%
Care Management 0% 0% 0% 0%
Claims Management 0% 0% 0% 0%
Broker/Navigator Rel'n Mgmt 0% 0% 0% 0%
Marketing & Outreach 0% 0% 0% 0%
Customer Service & Account Management 22% 0% 0% 0%
Functional ComponentCurrent IT Systems
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Figure 4: Total Function Percentage by System (for Functional Components)
Plan Management
This component includes the processes to assess the actuarial value, benefit design, and
quality of the plan to facilitate certification and quality rating of plans. In addition, this function
includes management of the plan and carrier relationship.
Observation: None of the systems assessed provide Plan Management functionality.
Financial Management
This component includes the processes to manage the risk adjustment processes as well as
premium and tax credit processing.
Observation: ACCESS provides limited financial management capabilities (e.g., premium
AP/basic AR) covering less than 25% of the required functions, with moderate support of those
supported functions.
Eligibility and Enrollment Operations
This component includes the processes to support insurance plan comparison-shopping,
eligibility assessment, enrollment processing, and appeals management.
Observation: Only ACCESS supports Eligibility and Enrollment Operations providing coverage
to less than 25% of the required functions with moderate support of those supported functions.
Broker/Navigator Relationship Management
Broker/Navigator Relationship Management includes the processes necessary to manage the
relationship between the Exchange and brokers and navigators through a portal, connect
Navigators to consumers, measure Navigator performance, facilitate broker quoting of
insurance plans and provide broker incentive compensation capability
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Customer Service and Account Management
This function includes member, provider, and contractor management processes, broker
relationship management processes, and related support processes.
Observation: Only ACCESS supports Customer Service and Account Management, providing
coverage to less than 25% of the required functions with moderate support of those supported
functions.
IT Management
This function includes application management, IT operations management, technical
management, and service desk management.
Observation: None of the systems reviewed provide the required functionality for the
Information Technology Management component.
Financial Accounting and Reporting
The Financial Accounting & Reporting component enables generation of financial reports and
publishes these reports to stakeholders. It supports accounting of all financial transactions and
all assets and liabilities.
Observation: None of the systems reviewed provide the required functionality for the Financial
Accounting and Reporting Management component.
Asset Management
The Asset Management component enables and supports the tracking and maintenance of allvaluable HHS agency resources. This may include things such as laptops, smart phones,
servers, software, etc.
Observation: None of the systems reviewed provide the required functionality for the Asset
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independent of the Exchange implementation and eligibility modernization. VISION was not
reviewed or assessed for reuse.
Observation: VISION may be a candidate for business reuse.
Financial Accoun ting and Reporting
The Financial Accounting & Reporting component enables generation of financial reports and
publishes these reports to stakeholders. It supports accounting of all State financial transactions
and all assets and liabilities.
Observation: VISION may be a candidate forlimitedbusiness reuse.3
Asset Management
The Asset Management component enables and supports the tracking and maintenance of all
valuable State assets.
Observation: VISION may be a candidate for limited business reuse.4
HR Management
The HR Management component supports the management of the State human resources. The
type of functionality within this component supports functional areas like payroll, employee
relations, recruitment, training and development, employee benefits and performance
appraisals.
Observation: VISION may be a candidate for limited business reuse.5
Procurement Management
The Procurement Management components supportsthe management of State services and
product procurement.
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3.0 for the Vermont Health Insurance ExchangeHealth Benefits Exchange. In addition, the
State should consider outsourcing, or using a different solution than VISION, such as
PeopleSoft AP and AR, for the premium billing and collection functionality of the Exchange
Financial Management component.
Technical Observations
Similar to the functional observations, we created a table to summarize the ability of eachsystem to meet the technical requirements for each of the technical components for the
Vermont HIXHBE. Table 8 shows tThis summaryis shown inTable 8Table 8Table 8.The same
scoring mechanism is used as the one described earlier; however, many of the technical
components are considered to be building blocks for providing basic capabilities that other
components access. The technical components were rated as either being provided or not
provided and therefore we report no functional support for the specific component.
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OnBase provides a small degree of the Information Management functionality and implements it
well. Both ACCESS and CSME provide limited Information Management functionality, but
implement it poorly.Agreed.
Observation: The OnBase low score is partially attributable to the CMS allocation of function
between Information Management and Knowledge Management. The combined score suggests
it may be a strong candidate for reuse, and further exploration is warranted. ACCESS and
CSME do not provide the necessary functionality for this component.Agreed.
Knowledge Management
The Knowledge Management component supports the management of content on various
electronic media and associated metadata to support content classification and retrieval
(e.g., videos and presentations for marketing and training purposes).
OnBase provides a large degree of the Knowledge Management functionality and implements it
well. Both ACCESS and CSME provide limited Information Management functionality, but
implement it poorly.
Observation: The OnBase high score is partially attributable to the CMS allocation of function
between Knowledge Management and Information Management. The combined score suggests
it is a strong candidate for reuse, and further exploration is warranted.
Workflow and Rules Management
Workflow and Rules Management component supports the design, configuration, and execution
of system workflows such as screening, intake, assessment, application processing, and
eligibility determination, among other tasks. It also serves as a documented repository ofbusiness logic as well as being an executable part of the overall architecture in the application
of those rules within the architecture.
Both ACCESS and OnBase provide a limited amount of workflow and business rules
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ACCESS provides all of the Master Person Registry functionality, but is technically poor.It
does not have self service functionality nor logic. I agree strongly the ACCESS 1 or 2 tables that
makeup the 700k records depicting people may be used as a data source for MDM solution but
that is it.
Observation: None of the systems have the necessary capabilities to satisfy the requirementsfor the Master Person Registry component.Agreed
Financial Transaction Processing
The Financial Accounting & Reporting component enablesgeneration of financial reports
(e.g., monthly summary reports, annual report) and publishes these reports to stakeholders. It
supports accounting of all financial transactions and all assets and liabilities.
ACCESS provides a small amount of financial transaction processing functionality, but is
technically weak.
Observation: None of the systems have the necessary capabilities to satisfy the requirements
for the Financial Transaction Processing component.
Identity and Access Management
The Identity and Access Management component manages user identity and access privileges.
All systems provide some form of identity and access management functionality. ACCESS uses
a combination of RACF (Resource Access Control Facility) plus homegrown user
authentication. CSME security is poor and users have access to database tables.I am not surethat is the case as tables should be abstracted through Business Object universes but I guess it
is irrelevant as CSME needs to go away. OnBase provides strong identity and access
management, but this is limited to OnBase access.
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Confidentiality management varies from system to system. The State of Vermont believes
ACCESS to be HIPAA compliant and is IRS (Internal Revenue Services) safeguard compliant.
Observation: None of the systems have the necessary capability to satisfy the requirements for
the Confidentiality Management component.
Data Management
The Data Management component performs data indexing, storage, retrieval and
transformation.
Both CSME and EVR provide much of the required component functionality but implement it
insufficiently. Hence they do not satisfy the requirements for Data Management.
Observation: None of the systems surveyed provide the technical components needed to
satisfy the Data Management (Indexing & Storage, Retrieval, and Transformation) component
requirements of the Exchange.
Unified Communications
This component provides access to the HHS AHS agency programs and services via
telecommunication services such as Interactive Voice Response, E-Mail, Fax, and Text
Messaging.
Observation: None of the systems surveyed provide the technical components needed to
satisfy the Unified Communications component requirements of the Exchange.
HHS Portal
The HHS portal is a single point of access Web application user interface that allows all users to
access theAHHS (Agency of Human Services) agency programs and services. It has multiple
views available for Employer, Employee, Consumer, Carrier, Broker and Customer Service Rep
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Technical Observation Summary
The Wakley team evaluated the four IT systems against the sixteen technical components
defined by the ERA/MITA 3.0 guidelines and foundonly OnBase to be a suitable candidate for
reuse. The team recommends further exploration of OnBases suitability.
Gap Analysis Summary
The degree of functional and technical capability of each system is summarized in the bubble
chart (Figure 5Figure 5Figure 5). Systems in the top right quadrant (high functional and
technical capability) are candidates for reuse. Systems in the bottom left quadrant (low
functional and technical alignment) are not candidates for reuse by the HIXHBEand may be
candidates for retirement in a legacy renewal initiative. Systems in the top left quadrant have
strong functional alignment but poor technical alignment; to be reusable, some improvement of
the technical platform would be required. Systems in the bottom right quadrant have strong
technical alignment but poor functional alignment. The technical elements of these systems
might be reusable as a base from which to build out more aligned functionality.
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Figure 5: Functional and Technical Capabilities Summary
OnBase appears in the lower right quadrant, indicating that it is a good technical reuse
candidate in a Vermont Exchange. It can be considered for reuse for the records and document
management component of Information Management. The State may however need to
purchase additional modules to fill the current functional gapsand. Ssome redesign and
redeployment may also be required.Modules, redesign/deployment will more than likely be
required. Agreed it is the best suited product that exists of all reviewed for reuse/expansion.
ACCESS appears in the upper left quadrant indicating that it provides moderate
Exchange/MITA functionality but is technically unsuitable. ACCESS data should be considered
for reuse.I would assume that ACCESS data and service exposure is more important and
required than leveraging it for application solution.
EVR system is a commercial add-on to ACCESS and it appears in the lower right quadrant
indicating that it provides no ERA/MITA functionality and is only useful if ACCESS is retained
and the EVR approach of exposing ACCESS data is determined to be appropriate. Access will
be around but unclear the exact requirements other than for data consolidation, MDM andother. EVR is still possibly the wrong approach to exposing this data.
The CSME system appears in the bottom left quadrant indicating that no ERA/MITA functionality
and has poor technical functionality. CSME should not be considered for reuse.
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Appendix A: IT Systems Current State Detai ls
Understanding Appendix A
Appendix A contains the IT System Asset Sheets for some VT IT systems collected to inform
the teams gap analysis work. The team collected these responses directly from the system
owners or their designees. We did not modify the information provided prior to incorporating it
into this report.
The key terms described below were used in the IT System Asset Sheets artifact.
A systems Create, Read, Update, and Delete (CRUD) operations show those functions that
perform some combination of four distinct operations on the systems data. The letters
components have the following meaning:
Abb reviat ion Name Descript ion
C Create The system functions produce information within the specified subject area(i.e., the business process needs to have the ability to create/store suchinformation in a repository).
R Read The system functions require use of the information from the specified subjectarea. Common usage for information being read is for display and analyticalpurposes.
U Update The system function revises information within the specified subject area(i.e., updates an existing record).
D Delete The business process erases information within the specified subject area.Information about entities in the indicated subject area is permanently removedfrom the repository
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Maintenance and Upgrades
Current/In-Progress
Future Plans Will be replaced by VIEWS. Supported programs will be removed in phases.
Scalability Poor. The mainframe can be upgraded as necessary to accommodate work. However,
additional work often results in the breakdown of Event Replicator, which cant keep up.Breakdowns of Event Replicator result in extended high-load ACCESS batch processesthat counter any performance advantages realized by mainframe upgrades.
Serviceability Very poor. Numerous kludges and spaghetti code solutions often result in breaking oneprocess to fix another process.
Extensibility Very poor. System was originally designed on a business model developed 30 yearsago. Subsequent changes to that model were accommodated with kludges and spaghetticode. Recent attempts to radically change the business model have been severelyrestricted by the extensibility limitations of ACCESS.
Reliability Fair. The mainframe lies off the main network, which allows ACCESS to remain onlinewhen network issues take other systems offline. ACCESS requires downtime of a fewhours per night and several hours per weekend for routine batch jobs and systemmaintenance.
Standards (met and how met)
Security (i.e., HIPAA, FIPS, Role-based,data in mo tion, and at-rest, etc.)
Role-based security model. HIPAA (Health Insurance Portability andAccountability Act) compliant to the best of our knowledge. IRSSafeguards compliant.
Other (i .e., Section 508, NIEM, HL7, etc.) N/A
Central Source for Measurements and Evaluation
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Open Architecture
VPN No
Web Access Yes
FTP No
ETL
API No
Adap ters I dont really know what you mean, but Tthere are adapters to convert and load the datainto different relational database management systems. Currently we are only configuredto use MS SQL servers adapter.
User Access and AuthenticationServices
Access to the data replicated is handled at the server level, and provided toa combination of end users and program administrators. Access toadministrative tools for the system itself is limited to AHS DBA staff.
User Interaction Services(i.e., 3270, 3270 emulati on, Webfront-end)
The replicated data is accessed by users via a combination of Webapplications, and generated reports (again at the server level). Developersand administrators generally have direct (read-only) access to the SQLtables themselves.
Data Access (i.e., databaseadapters)
Access to the replicated data in the SQL server environment is strictly readonly for all users, with the sole exception being the Event Replicator TargetAdapter (commonly referred to as ART), which receives the replicateddata from EntireX (middleware), and applies it to the SQL Server database.The process begins by loading up the SQL Server database with datarecords, read directly from the source Adabas database, then alltransactions occurring on the source database are replicated, converted to
equivalent SQL Statements, and applied to the target database. Thuskeeping the data in the target SQL Server database in sync with the sourceAdabas database.This approach adds much more processing and storagecapacity and system overhead as compared to leveraging the data at restthrough a different mechanism. I remember when AHS moved forward with
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Interfaces and Inputs
Source/DestinationType (point-to-point, Web
servi ces, etc.) Format (XML, flat fil e, etc.)
transaction
Outputs Single EntireX Broker Point-to-point XML units of work
Core Business Functions
Function Description
N/A Core businessfunctions of determiningeligibility and issuingbenefits all handled on themainframe, independent ofEVR
Core Technology Components
Offered Supporting Technology
Portal N/A
Client RelationshipManagement (CRM)
N/A
Case Management N/A
Records/DocumentManagement
N/A
Business WorkflowM t
N/A
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Core Technology Components
Offered Supporting Technology
EVR itself is not used for reporting.
Master Person Indexing N/A
Calculators N/A
Maintenance and Upgrades
Current/In-Progress Our current version of the EVR server is 3.2.1. We are currently in the process ofupgrading ART from version 2.6.1 to 2.7
Future Plans EVR server has an approximate projected upgrade date of third quarter 2013.
Scalability The scalability of EVR is limited by the resources that can be made available to it. Rightnow we replicate about half of all mainframe transactions in ACCESS, but areapproximately at the capacity that we can handle with our current configuration.Replication of the transactions incurred during our month end processing consumesalmost 100% of the mainframe CPU for about 12 hours any more and wed be unableto prevent this from running into the work day and impeding ACCESS users.
Serviceability Serviceability of the EVR server is relatively limited. Partially because the functionalitymakes use of so many different Software AG products, in debugging replication youoften get passed from support team to support team and they often have a great deal ofdifficulty in identifying root cause. Additionally, EVR is a relatively new product (5plusyears old)and although it is based on Adabas functional architecture, there are fewvendor support personnel with even as much experience with it as our in house DBA
staff. However, once root causes can be narrowed down to either the source Adabasdatabase, or the EntireX messaging system, serviceability becomes extremely good asthe vendor has support personnel with decades of experience.
Extensibility EVRs extensibility is primarily dictated by its installation and use rather than its
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Reliability Overall, replication is very reliable. Once a set of subscriptions has been implementedand the systems are left alone, things are very stable. Properly set up replicationsubscriptions virtually never get out of sync, and the persistence in the messagingsystem insures that no messages are ever missed. However, the system isnt without itspitfalls. One major source of problems is the fact that replication depends on so manydifferent pieces all working in unison, (WAIT UNTIL THE TRUE SOA MODEL ISESTABLISHED )100% of the time. Any network or server maintenance can disrupt theflow of replicated data and unless the DBAs catch the problem it can cause backups ofreplicated data on the mainframe that cause EntireX to use so much memory it causes
huge problems. Also since the current version of ART needs to be run as an application(not a service), someone always needs to maintain a connection to the server runningART; so, even getting a session ended by someone trying to log on to a server can resultin huge problems. The best way to ensure stability is by good communication. With nohuman interference, the reliability would be excellent. But in the real world Id say thatreplication is disrupted about once every month or two.
Standards (met and how met)
Security (i.e., HIPAA, FIPS, Role-based,data in moti on and at-rest, etc.)
Other (i .e., Section 508, NIEM, HL7, etc.)
Other Information
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Functional Component Service Performed
Core Busi ness Claims Management Suspend encounters
Core Busi ness Claims Management Reject, suspend, or purge attachment information
Core Busi ness Claims Management Receive attachment information
Core Busi ness Claims Management Validate attachment and application
Service Delivery
Service Delivery Brok er/Navigator Relationshi p Management
Service Delivery Brok er/Navigator Relationshi p Management Self-service broker/navigator Portal
Service Delivery Brok er/Navigator Relationshi p Management Online training
Service Delivery Brok er/Navigator Relationshi p Management Record/modify training
Service Delivery Brok er/Navigator Relationshi p Management Record/modify certification
Service Delivery Brok er/Navigator Relationshi p Management Record/modify compliance
Service Delivery Brok er/Navigator Relationshi p Management Manage broker/navigator monthly targets
Service Delivery Brok er/Navigator Relationshi p Management Manage compensation
Service Delivery Brok er/Navigator Relationshi p Management Testing of incentive returns
Service Delivery Brok er/Navigator Relationshi p Management Broker/Navigator evaluation
Service Delivery Brok er/Navigator Relationshi p Management Produce monthly paper/e-statements
Service Delivery Brok er/Navigator Relationshi p Management Manage broker inquiries
Service Delivery Brok er/Navigator Relationshi p Management File dispute
Service Delivery Brok er/Navigator Relationshi p Management Manage dispute
Service Delivery Marketing & Outreach
Service Delivery Marketing & Outreach Determine mode of communication
Service Delivery Marketing & Outreach Generate communication
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Functional Component Service Performed
Service Delivery Marketing & Outreach Prepare communication content
Service Delivery Marketing & Outreach Receive request for information, appointments, and assistance
Service Delivery Marketing & Outreach Review and approve communication
Service Delivery Marketing & Outreach Validate information
Service Delivery Marketing & Outreach Create new health plan/benefit offering
Service Delivery Marketing & Outreach Identify target groups
Service Delivery Marketing & Outreach Manage enrollment campaigns
Service Delivery Marketing & Outreach Modify existing health plan/benefit offering
Service Delivery Marketing & Outreach Notify new/modified health plan/benefit offering to stakeholders.
Service Delivery Marketing & Outreach Perform enrollment campaigns
Service Delivery Marketing & Outreach Receive population information and statistics from SMA
Service Delivery Marketing & Outreach Create/Update/Delete standard notification
Service Delivery Marketing & Outreach Generate communication
Service Delivery Marketing & Outreach Identify target population
Service Delivery Marketing & Outreach Prepare content for the communication
Service Delivery Marketing & Outreach Review and Approve communication
Service Delivery Marketing & Outreach Approve, deny, or modify decisions to develop outreach communications
Service Delivery Marketing & Outreach Determine content and method of communication and performance measures
Service Delivery Marketing & Outreach Generate communication
Service Delivery Marketing & Outreach Analyzing information, performance measures, feedback from community, andpolicy directives
Service Delivery Marketing & Outreach Log communication message
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Functional Component Service Performed
Service Delivery Marketing & Outreach Review and approve communication
Service Delivery Customer Service & Account Management
Service Delivery Customer Service & Account Management Assign unique account identifier
Service Delivery Customer Service & Account Management Prepare verification request response
Service Delivery Customer Service & Account Management Receive contract verification request
Service Delivery Customer Service & Account Management Send contract verification response
Service Delivery Customer Service & Account Management Generate claim status response
Service Delivery Customer Service & Account Management Inquire payment status info
Service Delivery Customer Service & Account Management Provide/send claim status response via HCISN (Hospital Cultural Interpreter
Services Network)
Service Delivery Customer Service & Account Management Receive and log claim status request
Service Delivery Customer Service & Account Management Validate requester authorization
Service Delivery Customer Service & Account Management Prepare/provide provider information
Service Delivery Customer Service & Account Management Receive request for provider information
Service Delivery Customer Service & Account Management Send inquiry response
Service Delivery Customer Service & Account Management Determine provider/member eligibility status
Service Delivery Customer Service & Account Management Notify provider/member of eligibility status
Service Delivery Customer Service & Account Management Validate request for provider/member eligibility
Service Delivery Customer Service & Account Management Notify modification in insurance affordability program to HIX
Service Delivery Customer Service & Account Management Receive request to modify contractor i nformation
Service Delivery Customer Service & Account Management Request modification in contractor information
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Functional Component Service Performed
Service Delivery Customer Service & Account Management Update contractor information
Service Delivery Customer Service & Account Management Validate request
Service Delivery Customer Service & Account Management Create/inquire/delete/modify provider information
Service Delivery Customer Service & Account Management Create/inquire/delete/modify provider/member information
Service Delivery Customer Service & Account Management Validate provider/member information
Service Delivery Customer Service & Account Management Validate the authorization by requestor to acquire provider/member information
Service Delivery Customer Service & Account Management Conduct investigations and communicate
Service Delivery Customer Service & Account Management Remove provider/contractor from Medicaid Program
Service Delivery Customer Service & Account Management Review determination of noncompliance and investigation materials
Service Delivery Customer Service & Account Management Send alert of provider termination to HIX and business partners.
Service Delivery Customer Service & Account Management Rescind termination
Service Delivery Customer Service & Account Management Record inquiry information
Service Delivery Customer Service & Account Management Manage call transfer business rules
Service Delivery Customer Service & Account Management Administer employer liability
Service Delivery Customer Service & Account Management Manage FAQs
Service Delivery Customer Service & Account Management Manage performance measures/measurements
Service Delivery Customer Service & Account Management Receive complaint
Service Delivery Customer Service & Account Management Resolve complaint
Service Delivery Customer Service & Account Management Close complaint
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Technical Component Service Performed
Business Support
Business Support Information Management
Business Support Information Management Mandatory report templates
Business Support Information Management Additional report templates
Business Support Information Management Mandatory reports
Business Support Information Management Additional reports
Business Support Information Management Review reports
Business Support Information Management Manage report schedule
Business Support Information Management Manage report delivery mechanism
Business Support Information Management Manage analytic templates
Business Support Information Management Perform analytics
Business Support Information Management Portal integration of analytics
Business Support Information Management Web analytics
Business Support Information Management Ad hoc reporting
Business Support Information Management Manage data feeds
Business Support Information Management Audit collected data
Business Support Information Management Manage surveys
Business Support Information Management Manage survey templates
Business Support Information Management Review survey (includes survey estimate)
Business Support Information Management Manage survey schedule
Business Support Information Management Manage survey delivery mechanism
Business Support Information Management Publish survey
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Technical Component Service Performed
Business Support Knowledge Management
Business Support Knowledge Management Manage taxonomy
Business Support Knowledge Management Store content
Business Support Knowledge Management Tag content
Business Support Knowledge Management Retrieve content (search features)
Business Support Workflow and Rules Management
Business Support Workflow and Rules Management Create notification
Business Support Workflow and Rules Management Update notification content
Business Support Workflow and Rules Management Delete notification
Business Support Workflow and Rules Management Send notification
Business Support Workflow and Rules Management Manage notification rules
Business Support Workflow and Rules Management Manage workflow rules
Business Support Workflow and Rules Management Manage business rules (Create/Edit/Delete)
Business Support Workflow and Rules Management Maintains a rules catalog
Business Support Workflow and Rules Management Automated interfaces through a set of Application Programming Interfaces(APIs)
Business Support Workflow and Rules Management Allow the reuse of the rule-repository and rules-driven technology
Business Support Workflow and Rules Management Modification of business rules via a Graphical User Interface (GUI)
Business Support Workflow and Rules Management Ability to attach business rules to workflow activities
Business Support Workflow and Rules Management Manage business rules
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Technical Component Service Performed
Business Support Master Person Registry
Business Support Master Person Registry Manage master person data sources
Business Support Master Person Registry Resolve matching issues
Business Support Master Person Registry Determine match probability
Business Support Master Person Registry Manage probabilistic matching
Business Support Master Person Registry Manage deterministic matching
Business Support Master Person Registry Resolve matching issues
Business Support Master Person Registry Manage master person index
Business Support Financial Transaction Processing
Business Support Financial Transaction Processing Manual settlements
Business Support Financial Transaction Processing Batch settlements
Business Support Financial Transaction Processing Automated payments
Business Support Financial Transaction Processing Electronic funds transfer
Business Support Financial Transaction Processing Payment reconciliation
Business Support Financial Transaction Processing HIPAA adopted transaction standards (e.g., ASC X12N 834, ASC X12N 270,ASC X12N 271) for interfaces
Business Support Financial Transaction Processing Generate receipts
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