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Medicaid and PHA - Partnership in using the Data Warehouse

Medicaid and PHA - Partnership in using the Data Warehouse. Cynthia Green-Edwards Director, Office of Medicaid Health Information Technology Michigan Department of Community Health (MDCH). Overview. Enterprise Data Warehouse (statewide) MDCH Data Warehouse Data Warehouse – In Action!.

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Medicaid and PHA - Partnership in using the Data Warehouse

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  1. Medicaid and PHA -Partnership in using the Data Warehouse Cynthia Green-Edwards Director, Office of Medicaid Health Information Technology Michigan Department of Community Health (MDCH)

  2. Overview • Enterprise Data Warehouse (statewide) • MDCH Data Warehouse • Data Warehouse – In Action!

  3. Nation’s Longest-Standing, Most Sophisticated, and Highly Utilized State Government Data Warehouse Users Data Sources 1994 • 50 • Medicaid • Medicaid • Department of Community Health • Department of Human Services • Department of Corrections • State Police • State Court Administrative Office • Department of Natural Resources • Department of Energy, Labor & Economic Growth • Secretary of State • Department of Treasury • Federal: IRS, SSA, Census Bureau • 9000+ • All major departments • External (providers, • PIHPs, CMHs, etc.) 2010

  4. Department of Human Services Public Assistance Eligibility & History Public Assistance Payment History Child Day Care & Payment History Electronic Benefit Transfer Child & Family Services Services Provider Foster Care & Adoption Child & Adult Protective Services Adoption Subsidy Child Support Department of Corrections Prisoner, Probationer, Parolee demographics State Police Personal Protection Orders State Court Administrative Office (Circuit, District, Probate, Criminal, Juvenile, Civil & Traffic Courts) Demographics Cases Offenses Sentencing Financial Department of Natural Resources Hunting License Campground Reservations Department of Energy, Labor & Economic Growth Worker’s Compensation Unemployment Quarterly Wages MI State Housing Authority Clients Professional License Secretary of State Driver’s License Department of Treasury New Hire MI & Federal Individual Tax MI & Federal Business Tax Federal SSI and RSDI Claims & Payments Census Federal Case Registry (Child Support) U.S. Customs Financial Institution Data Match Social Security Demographics Department of Community Health… Enterprise Data Warehouse – Data Sets

  5. Data sharing across state agencies • Child Support Enforcement (CSES) • Data Sources • MDCH (TPL, paternity) • MDHS (beneficiary address) • DLEG (unemployment/quarterly wages) • MDNR (hunting license, campground) • Treasury (new hires) • Business examples • Parent Locator • Identify parent insurance • Michigan Courts • Data sources • MDCH (death records) • Corrections (parole, probation, prisoner) • Department of State (drivers license) • CSES (address) • Business examples • Cancel warrants • Cancel collections • Locate defendants • Community Health (MDCH) • Data sources • MDHS (geo codes) • CSES (court ordered medical support) • DELEG (MI State Housing Auth clients) • Business Examples • Paternity Recoveries • Homeless Project • Duplicate ID • Human Services (MDHS) • Data Sources • MDCH (well-child visits) • CSES (support orders) • Corrections (demographics) • DLEG (unemployment/quarterly wages) • Treasury (new hires) • Business Examples • Income Validation • Foster Care/Well Child

  6. Overview • Enterprise Data Warehouse (statewide) • MDCH Data Warehouse • Data Warehouse – In Action!

  7. MDCH Data Warehouse – Data Sets • Medicaid Provider • Eligibility • License • Network • DEA/CLIA • MIChild • MIHP (Maternal and Infant Health Program) • MMA (Medicare Enrollment) • Pharmacy • Claims • NDC • MAC • CMS rebate • Substance Abuse • Third Party Liability • Vital Records - Death/Birth/Paternity • Women Infants and Children • Community Mental Health • Children’s Special Health Care Services • EPSDT • Habilitation Support Waiver • HIV/AIDS (structure only; data deleted) • Home Help Payments • Lead Screening • Long Term Care • Home Care • Nursing Home • OASIS • Michigan Care Improvement Registry • Medicaid Fee-for-Service • Medicaid Beneficiary Eligibility • Medicaid Managed Care • Payments • Encounters • Provider Networks • Medicaid MI Choice Minimum Data Set

  8. CHAMPS (MMIS) Habilitation Support Waiver Michigan Care Improvement Registry MMA MSIS Pharmacy Price Finder Website Program Integrity SURS Audit Reports Federal Reporting MARS Nursing Home Assessment (MDS) Production Reporting Statewide Homeless Assistance Data Online Warehouse TPL Recovery Systems Health Paternity UCI (Unique Client Identifier) MDCH Data Warehouse – Applications/Exchanges

  9. Data Integration = Program Actions and Results

  10. MDCH Data Warehouse – Unique Client Identifier (UCI) Links person-level records from one program’s database to others (includes Medicaid, WIC, Lead Screening, MCIR, Vital Records, LTC, MIChild, DSS, CSES, Paternity, Unemployment, SHADoW) Evaluates an individual’s name, address, and other identifying data across programs to determine matches Assigns a unique ID, or UCI, to be used in all Data Warehouse databases for each individual Allows for administrative data extraction from distinctly different program databases Once person-level records are linked, they remain linked unless manual intervention introduced Gives a comprehensive view of individuals in multiple programs … making it possible to effectively assess and analyze healthcare programdata, make better and faster decisions, manage and measure programs, reduce costs, and improve outcomes

  11. MDCH Data Warehouse – Benefits • Improving the administration of healthcare services • Conducting advanced healthcare analysis to determine patterns • Assessing which programs are most effective • Detecting and reducing fraud, waste, and abuse • Improving and interpreting disease management and epidemiological patterns • Improving health care outcomes • Streamlining operations and improving efficiencies • Supporting Health Information Exchange (HIE)

  12. Overview • Enterprise Data Warehouse (statewide) • MDCH Data Warehouse • Data Warehouse – in Action!

  13. MDCH Data Warehouse - Examples of Success • Financial benefits from state healthcare programs • $200 million annually since 2005 ($800 million total) • $97 million in fraud recoveries alone during this period • Reduced cases of child lead poisoning • Reduced number of cases by 35% from 2003-2007 • Medicaid-enrolled 3-year-olds screened for lead increased from <50% in 2003 to 72% in 2009 • Identified 14 Michigan communities that represent ~80% of all child lead poisoning cases; targeting prevention efforts in those communities • Medicaid children at risk of flu complications • Identified 59,000 during 2006-07 flu season • Focus on those with asthma • When a record is accessed in Michigan Care Improvement Registry (MCIR) for a child with high-risk condition, a reminder appears for physicians to evaluate the child for influenza vaccination • Healthcare analysis and outreach in partnership with Michigan State University • Newborn metabolic and hearing screening (linking screening records to Medicaid beneficiaries) • Epidemiological analysis to determine impact of chronic disease (diabetes, asthma, cancer, cardiovascular disease, etc.) on Medicaid population of Michigan; comparison with other states

  14. The Power of Linking and Sharing InformationNewborn Screening

  15. The Power of Linking and Sharing InformationChild Immunizations

  16. Member Level Historic Data Project -Helping Health Plans Address New Member Needs Monthly data extracts to Medicaid Health Plans One year history of fee-for-service claims, pharmacy claims and encounters data for new enrollees Advantages Identify opportunities for care coordination and preventive care Baseline of information on new members Identify prior treatment, impact, and indications for future care (e.g., drug step therapy) Identify members for case and disease management prior to trigger episode as plan member Identify fraud and abuse (expensive DME) Auto populate Electronic Health Records (EHRs) Auto report members meeting criteria based upon pre-established algorithms

  17. Coordination of Care Project Monthly exchange of service level data Prepaid Inpatient Health Plan receives pharmacy and physical health data Medicaid Health Plan receives mental health encounters Includes data for one year prior to current month Goal is to provide coordination of care by multiple organizations managing a patient’s mental and physical health

  18. Michigan Care Improvement Registry (MCIR) Warehouse data integrated into online application: Lead results High Risk Indicator identifies children at risk for flu complications Well-child visits and EPSDT services indicator (up-to-date or due/overdue)

  19. HIV Registry Services Coordination of HIV programs

  20. Maternal & Infant Health Program (MIHP) Currently captures Maternal Screener data Will eventually include Infant Screener and Discharge Summary data Goals: Assess outcomes Evaluate effectiveness of program Determine impact of interventions

  21. Health Information Exchange /Electronic Health Records Meaningful use objectives and measures Improve quality, safety, efficiency Engage patients and families Improve care coordination Improve population and public health Ensure privacy and security protections Data mining to create a new Continuity of Care Document (CCD) based on HL7 standards Clinical quality measures Verifying provider reporting and tracking compliance Connected to SOM HIE

  22. How data warehouse is currently used Ideas for future use Potential expansion of data sources Division of Genomics, Perinatal Health and Chronic Disease Epidemiology Staff

  23. Process for requesting data warehouse access Data warehouse Help Desk User Group Meetings Data Warehouse Resources

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