Vermont IT Gap Analysis Report

8/13/2019 Vermont IT Gap Analysis Report

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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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http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Childrens-Health-Insurance-Program-CHIP/Childrens-Health-Insurance-Program-CHIP.htmlhttp://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Childrens-Health-Insurance-Program-CHIP/Childrens-Health-Insurance-Program-CHIP.html


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STATE OF VERMONT/HEALTH INSURANCE EXCHANGE ASSISTANCE/IT GAP A NALYSIS REPORT 66

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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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 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 Analyzing information, performance measures, feedback from community, andpolicy directives

Service Delivery Marketing & Outreach Log communication message


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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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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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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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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

Documents

Vermont IT Gap Analysis Report