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MEDICAID: People and Money PeopleMoney U.S. Totals294 million$1.54 trillion Medicaid52 million (1 out of every 6 Americans) $305 billion (1 out of every 5 health care dollars) Medicare42 million$ 297 billion Medicaid and Medicare 87 million*$602 billion *About 7 million duals have been subtracted from the total to avoid double-counting Source: Kaiser Commission, 2005
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MITA -- A Vision of MITA -- A Vision of Evolving Evolving Medicaid Medicaid SystemsSystems
The View from CMS
Rick Friedman Director, Division of State Systems
Centers for Medicare & Medicaid Services
April 18, 2006
Growth in Medicaid Growth in Medicaid BeneficiariesBeneficiariesMillions of
Medicaid Beneficiaries
0
10
20
30
40
50
60
1965 1970 1975 1980 1985 1990 1995 2000 2004
MEDICAID: People and MEDICAID: People and MoneyMoneyPeople Money
U.S. Totals 294 million $1.54 trillionMedicaid 52 million
(1 out of every 6 Americans)
$305 billion (1 out of every 5
health care dollars)
Medicare 42 million $ 297 billion
Medicaid and Medicare
87 million* $602 billion
*About 7 million duals have been subtracted from the total to avoid double-counting
Source: Kaiser Commission, 2005
Growth in ProgramGrowth in ProgramComplexityComplexity
►Waivers►HIPAA—Privacy, NPI, etc.►Focus on Quality►Rising Concerns re
Privacy and Security►Duals►Medicare Part D
What Is MITA?What Is MITA?► MITA is a CMS IT initiative to transform the concept of
today’s State-based claims processing systems into an enterprise-wide backbone architecture capable of addressing tomorrow’s Medicaid needs, as well as today’s. 1. IT Architecture Framework Consolidation of principles, business and technical models and guidelines
that form a template for states to use to develop their own enterprise architectures
2. Planning Guidelines Assistance to States to define their own strategic MITA goals and objectives
consistent with CMSO expectations and requirements
3. Processes For States to use in adopting the MITA framework through shared
leadership, partnering and reuse of solutions
What Are MITA’s Goals?What Are MITA’s Goals?
► Help Medicaid managers improve health care outcomes
► Align with Federal Health Architecture
► Ensure patient-centric views not constrained by organizational barriers
► Make use of common IT and data standards
► Foster Interoperability between and within State Medicaid organizations
► Provide web-based access and integration
► Support software reusability with commercial off-the-shelf (COTS) software
► Seamlessly integrate clinical and public health data
MITA’s Key PrinciplesMITA’s Key Principles► Business-driven service oriented
architecture solution
► Firmly grounded in enterprise architecture principles
► Defines a business transformation over a five year and long-term (10 years and greater) timeframe
► Includes a technical architecture and a transition strategy to enable the business transformation
MITA’s ComponentsMITA’s Components► Business Architecture
Operations Concept MITA Maturity Model Business Process
Model Business Capability
Matrix MITA Self-Assessment MITA Business
Services
► Technical Architecture MITA Application
Architecture MITA Data
Architecture Technology
Architecture Technical Capability
Matrix MITA Standards
Why Business Processes?Why Business Processes?► Views the business cross-functionally► Organizes the actions of the business as a
set of activities in response to business events
► Cuts through the existing silos enabling opportunities for real process improvement
► Discover Shared Business Capabilities► Capabilities point to the Services
needed by the architecture
3
Multi- Layer Application Architecture Model
.NETJavaJ2EE
Unix/C++
OS/390MQ
EligibilitySystems
CustomCode
MMIS/Legacy
COTS
DB
Case Workers,State Agencies
State Staff PartnersParticipants
Benefic iaries &Providers
Public Health,Other
Access Layer: Interface &Access Channels
Service Management Layer :•Service contexts & Contracts related to Business Services•Service Infrastructure
Service- Application Layer: Service Implementat ions• New servic es• Existing Applications wi th Service Wrappers• COTS with Service Wrappers• new SOA Services
Platform Layer: Existing PlatformsWith Service Enablement or New Service Computing and Networking
SOA Services
EnrollEnrollMemberMemberEnrollEnroll
ProviderProvider
Service Wrappers
BusinessBusinessServiceService
BusinessBusinessServiceService
Service Wrappers
Service Infrastructure
Service Wrappers
Service WrappersCompon et
Services
Service Wrappers
4
Others
Provider ManagementMember Management
LegacySystems
Others
Language TranslationCRM
Service Components COTS, Open Source
The MITA Architecture is a Service-OrientedArchitecture
BusinessApplications
Area(s)
CommonServices
Cross-CuttingService Areas(i.e., Search,
Security)
PerformanceMeasurement Services
Process Automation
Interoperability Elements
Access Channels
Pattern Recognition and Audit
Forms Management
Rules Engine
Adaptability and Extensibility
Data Sharing
Others
Utility Services
Kiosk, VRS,PDA, Web
Browser, WebServices, Other
5
Logical Level Interoperability Model-Data Sharing and Coordination Architecture
State 1 State 2 State N Partners…………
MITAStrategic
Hub
ExternalData
Sharing Hub
TacticalHub
TacticalHub
6
MITA Maturity Model for States
HubsUtility
Services
Initiatives(NHII, CHI)
FederalHealth
ArchitectureCommon
Processes
• Target MITA Architecture
• Traceability
• Progress Tracking
Level 1Claims Processing Focus
Level 3Quality of Care Focus
Level 4Health Outcomes Focus
Level 5National Health and Safety Focus
Level 2Beneficiary Focus
HubsUtility
Services
Initiatives(NHII, CHI)
FederalHealth
ArchitectureCommon
Processes
• Target MITA Architecture
• Traceability
• Progress Tracking
Level 1Claims Processing Focus
Level 3Quality of Care Focus
Level 4Health Outcomes Focus
Level 5National Health and Safety Focus
Level 2Beneficiary Focus
ApproachApproach► MITA framework contains models and tools to
guide states in the transformation process -- it does NOT contain implementation solutions. Implementation solutions will be developed by
states and vendors These solutions can be shared with others through
a MITA repository.► MITA team needs state support to refine
business processes and develop business services.
► No vendor’s product is “MITA-certified”
Steps Along MITA PathSteps Along MITA Path1. Adopt a business orientation -- identify program needs,
objectives, goals. Later, decide what technology is required.
2. Map business processes to MITA business process model (see CMS white paper).
3. Do a self-assessment against the MITA business capability matrix (another CMS white paper).
4. Determine maturity level of each business process.
5. Decide which business processes are candidates for improvement by implementing higher level capabilities.
6. Begin to collaborate on the development of business services that can be shared through a MITA repository.
Follow Up ActivitiesFollow Up Activities► Publication/distribution of Release 2.0► Additional MITA white papers ► Emphasis on
Outreach/Training/Communications► More info on deployment and implementation► Detailed Business Service specifications► Creation of work groups, collaboration to
develop Business Services and Solution Sets► Work on one or more MITA repositories
