ART Applying Reusable Technology for HIE

1. WEDNESDAY, 10:00 - 10:20 AM ART Applying Reusable Technology for HIE Health and Human Services Consortium of States Oregon, Utah, Illinois, Minnesota Thomas A Baden Jr., Director of Enterprise Architecture, State of Minnesota Department of Human Services

2. The State as-is Perspective • Program centric, categorical federal fundingand cost allocation • Fragmented service delivery • Human inefficiencies • Eligibility inconsistencies • Program integrity • Multiple systems that do not effectively share data • Total cost of ownership models that are not sustainable • System modernization and replacement is expensive, complicated, and risky in budgets already stressed • MMIS - 120 Million • Eligibility – 25 Million • Child Welfare - 50 Million • Adult Protective Services – 10 Million • Chemical/Mental Health – 10 Million • Self Sufficiency – 100 Million HIMSS 2010

3. National Dimension According to the State-submitted estimates, $244.2 billion will be required to fund their Medicaid benefit programs during FY 2011. • Fragmented service delivery • Federal • State • Local (county) • 12 billion dollar IT concern • Stifled competition • Stagnated innovation • High risk • Slow to market • Institutionalized entry and exit barriers • Loss of focus • Program costs rise while budgets are constrained • Program processes measured while quality outcomes are not • Program integrity issues occur while fraud and abuse compound The State-submitted estimates for FY 2011 State and local administration costs total $11.5 billion HIMSS 2010

4. Program Centric • Traditionally, HHS programs are delivered through program-specific systems • Each independent program and system becomes business service andIT silo that • Negatively impacts quality of service to constituents • Negatively impacts service efficiency • Compounds total cost-of-system ownership • The cost increases by order of magnitude whenviewed across all of the states, programs and the federal government HIMSS 2010

5. IHS ACF Public Health SAMHSA RSA As is Children, Adults & Families Medical Assistance Programs Addictions & Mental Health Seniors & People with Disabilities HIMSS 2010

6. Program Focus Today, the onus is on the individual and their family to navigate the landscape of federal, state, local, and private programs available to address their needs. There is little coordination across programs. The individual has to determine which programs apply to their situation and provide the same information repeatedly. NewbornMetabolicScreening HeadStart Medicaid HealthcareProviders SchoolLunchProgram Schools IRS TANF CHIP SNAP NewbornHearingScreening ChildCare Local ChildWelfare School Breakfast Program HIMSS 2010

7. Serving With All of Government Information is shared resulting in improved services to the individual and operational efficiencies. Instead, the individual reaches out to one program, and with consent, information is electronically shared with other applicable programs from which he/she might benefit. HeadStart Medicaid HealthcareProviders SchoolLunchProgram Schools School Breakfast Program TANF ChildCare Local ChildWelfare CHIP SNAP HIMSS 2010

8. Impact on Individuals • Multiple systems and entry points do notrecognize clients’ interrelated needs • 60% of clients receiving child support services are also on a health care program • 90% percent of clients receiving food support are also on health care programs • 88% percent of clients receiving child care assistance also receive cash, food and health care. • Navigating through uncoordinated, and sometimes conflicting rules and processes is difficult for families as well as the people that provide social services Minnesota 2009 HIMSS 2010

9. Path to a Solution • Start with a big idea: A “Game-changing” common business architecture linking health and human service team and partnering federal agencies can create a new approach going forward, TRANSFORM. • Build partnerships: Start with four states with the experience, know-how, and commitment to collaborate along with federal partners focused on the value potential. • Realizable focus: Design and build component parts in the context of a multi-tenancy, multi-state, cross program application vision in tightly managed scope. Contractor Management Provider Management Program Management Member Management Medicaid Child Welfare Self Sufficiency Elderly & Disabled Chemical & Mental Health Operations Management Care Management Program Integrity Management Business Relationship Management HIMSS 2010

10. Applying Reusable Technology • Consortium of states partner with TRANSFORM to further a national HHS business architecture • Develop and implement governance structures which support the architectural continuum • Prototype a reusable cloud component of the architecture which crosses federal programs, is reusable by four states, and is a multi-tenant cloud HIMSS 2010

11. Crawl-Walk-Run • Federal • FEA • HHS EA • NIEM • NHIN • MITA • FHA • TRANSFORM • CONNECT • Common Ground • Common State HHS • Aligned with Fed • NIEM • NHIN • MITA • FHA • TRANSFORM • CONNECT • State • State Architecture • NASCIO • MITA Self Assessment • HHS Business Architecture • Start a new way thinking for the state-federal team. • Design a modular, actionable, phased approach. • Plan an incremental commitment but defines a pathway to results. • Sustain a vision, with focus on results that can be delivered incrementally and frequently. • Execute a game plan can quickly move from crawling to walking to creating more teams that can run forward with a proven approach. HIMSS 2010

12. Strategic Course Correction • Person centric services versus program centric • Modular evolution versus massive replacement • Reusable components versus monolithic systems • Information availability versus data silos • Competition based on: • Functional differentiation • Time to market solutions • Quality of service realization • Total cost of ownership HIMSS 2010

13. Value in Return Reduction in redundant IT Spend • 11.5 Billion in Medicaid administration expenditures 2011 Reduction in Societal Burden • Medicare and Medicaid – 20% combined share of the federal budget • The United States healthcare - over 15 percent of GDP • Loss of productivity in people, commerce, and government Improved Program Delivery • Good Care - Measured and assured quality and value • Bad Care - Transparent performance measured • No Care - Medicare and Medicaid fraud and abuse, about $44 billion each year per National Center for Policy Analysis HIMSS 2010

14. Governance In addition to involving multiple states and jurisdictions, each project is likely to touch other stakeholders. Federal funding agencies, accreditation organizations, and various agencies within states will have an interest in the projects and must be included in the governance structure. Potential stakeholders include: • National Association of State Chief Information Officers (NASCIO) • National Information Exchange (NIEM) • American Public Human Services Association (APHSA/ISM) • National Governors Association (NGA) • National Association of State Budget Officers (NASBO) • Health and Human Services IT Advisory Groups (e.g., TechAmerica) HIMSS 2010

15. Next Steps HIMSS 2010

16. Health and Human Services Consortium of States Thomas A. Baden Jr. Director of Enterprise Architecture Cell 651-431-2917 Thomas.Baden@State.mn.us The participation of any company or organization in the NHIN and CONNECT area within the HIMSS Interoperability showcase does not represent an endorsement by the Office of the National Coordinator for Health Information Technology, the Federal Health Architecture or the Department of Health and Human Services. Thank You