Transcript 415_Mosier_MMIS-Modularity-NAMD-Fall-2016

Building the Foundation
NAMD Fall Conference
September 7, 2016
Susan Mosier, MD, MBA, FACS
Secretary, Kansas Department of Health and Environment
Roadmap
• Overview of Kansas Medicaid
• Overview of Kansas Modular Medicaid System
(KMMS)
• Goals of KMMS
• Modules and modularity
• Foundation for future growth
• Summary
2
KanCare Overview
• KanCare is a Medicaid Managed Care program
• 3 Managed Care Organizations (MCOs)
• Operate statewide
• Operate across the spectrum of health
• Goals:
• To improve quality/outcomes and
• To reduce the rate of rise in cost growth
• Through:
• integrated, coordinated care and
• an increased emphasis on health, wellness,
prevention, earlier detection and intervention
3
KMMS Overview
• Recent RFP award for Kansas Modular Medicaid
System (KMMS) to Hewlett Packard Enterprise
(HPE) as the system integrator
• Service oriented architecture with enterprise
service bus in a virtual private cloud
• HPE partners on KMMS include:
• Cerner for population health management,
data analytics, predictive modeling and
enterprise data warehouse
• SAS for program integrity functions
4
Goals of KMMS
• Provide a 360 degree view of a Medicaid
beneficiary in order to meet that individual’s
needs holistically
• Facilitate increased and improved coordination
and integration of services
• Break down silos of: behavioral and physical
health, agencies and organizations, data,
funding
• Provide skinny data
5
Core System: 8 Modules
Module Overview
Customer Self Service
Portal (CSSP)
Microsoft Dynamics CRM,
Avaya Unified Communications,
Aspose Correspondence Management
Claims/Encounter
Processing
HPE Business Policy
Administration
Provider Management
HPE Provider Product,
K2 blackpearl
Workflow Management, InRule
Business Rules Engine
Program Integrity/
Utilization Management
SAS Fraud Framework
Investigative Case Management
HPE PI SURS Product
KMMS - Enterprise Service Bus
Financial Management
Modernized Kansas Financials,
HPE TPL Product,
HPE Drug Rebate Product
HPE inSight Dashboard
= Product
Managed Care Enrollment
Broker Services
KEES Integration
Data Warehouse
and Analytics (DWA)
HPE Managed
Care Product
Modernized Kansas
Member Management
Cerner HealtheIntent
Data Warehouse Platform
= Modernized
Advantages of Modularity
• Facilitates new and innovative collaborations
• Encourages new entrants into the Medicaid
marketplace
• Improves ease of upgrades and replacement
• Facilitates standardization
• Provides a platform for expansion:
• New modules within the Medicaid enterprise
• Connect to modules in other agencies and
beyond
7
Challenges of Modularity
• A new IT infrastructure for the health care
industry
• Multi-vendor
• Management
• Issue resolution
• Attracting new vendors to the public side of
health IT
• Higher dependence on strong governance
structures
8
Medicaid Enterprise
•
New Module
 Web Service
 Business logic
 Data Stores
•
New Data Stores
State Enterprise
Statewide SOA Framework
All State agencies, programs, and supporting IT
services
HHSE Enterprise
All Health, Human Service, and Environment agencies, programs,
and supporting IT services
Resolve conflictual ser
ME
Modernized Medicaid Enterprise
As Is
Improved As Is
Photo from Ed O’Neil
Improved As Is
Photo by: jordan hogenson. No changes. https://creativecommons.org/licenses/by-nd/2.0/legalcode
To Be