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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

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)

  • Enterprise Data Warehouse (statewide)
  • MDCH Data Warehouse
  • Data Warehouse – In Action!
nation s longest standing most sophisticated and highly utilized state government data warehouse
Nation’s Longest-Standing, Most Sophisticated, and Highly Utilized State Government Data Warehouse


Data Sources


  • 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.)


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)






Department of Natural Resources

Hunting License

Campground Reservations

Department of Energy, Labor & Economic Growth

Worker’s Compensation


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


SSI and RSDI Claims & Payments


Federal Case Registry (Child Support)

U.S. Customs

Financial Institution Data Match

Social Security Demographics

Department of Community Health…

Enterprise Data Warehouse – Data Sets

data sharing across state agencies
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
  • Enterprise Data Warehouse (statewide)
  • MDCH Data Warehouse
  • Data Warehouse – In Action!

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
  • 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

Habilitation Support Waiver

Michigan Care Improvement Registry



Pharmacy Price Finder Website

Program Integrity




Federal Reporting


Nursing Home Assessment (MDS)

Production Reporting

Statewide Homeless Assistance Data Online Warehouse

TPL Recovery Systems



UCI (Unique Client Identifier)

MDCH Data Warehouse – Applications/Exchanges

mdch data warehouse unique client identifier uci
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

mdch data warehouse benefits
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)
  • Enterprise Data Warehouse (statewide)
  • MDCH Data Warehouse
  • Data Warehouse – in Action!
mdch data warehouse examples of success
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
member level historic data project helping health plans address new member needs
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


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

coordination of care project
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

michigan care improvement registry mcir
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)




Coordination of HIV programs

maternal infant health program mihp
Maternal & Infant Health Program (MIHP)

Currently captures Maternal Screener data

Will eventually include Infant Screener and Discharge Summary data


Assess outcomes

Evaluate effectiveness of program

Determine impact of interventions

health information exchange electronic health records
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

division of genomics perinatal health and chronic disease epidemiology staff
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