Medicaid began more than three decades ago as a jointly funded federal-state program for low-income and disabled individuals. Today, it has evolved into a $150 billion public health care program, serving approximately 36 million beneficiaries in 50 states, the District of Columbia and five U.S. territories--proving that it has become more than just a health care program. Medicaid is a business charged with a mission that ranges from providing medical care to supporting the development of state health policies and health care reform. Technology is playing an increasingly important role in running Medicaid programs efficiently and effectively.
In the early 1970s a public law was enacted requiring states to have a mechanized claims processing and information retrieval system for Medicaid purposes. This system is commonly known as MMIS (Medicaid Management Information System). These systems are designed to help states administer Medicaid programs with high degrees of efficiency and effectiveness, while safeguarding the limited state and federal funds allocated to the program. EDS, a major information technology service company, provides MMIS services to nearly 20 states, including Arkansas and Mississippi.
Friendly governmental relations exist between the two states and EDS, as their service provider. So when the need arose for MMIS enhancements, EDS was able to successfully leverage in Mississippi an information retrieval solution, based on a data warehouse system first introduced in Arkansas. The data warehouse provides each state with quick, "fingertip" access to all information contained within the MMIS. Pertinent data about Medicaid beneficiaries, providers and claims are now accessed, analyzed and translated into valuable information to save the states money and provide adequate, cost-effective health care to Medicaid beneficiary populations--all without assistance from a technical expert.
Bill Carpenter, Arkansas systems and support section administrator, credits three key factors for the state's successful implementation: 1) a quality implementation team assembled by EDS; 2) the database design; and 3) the technology. Once the staff was in place, they selected a dimensional database design, in the form of a star schema and the appropriate technology. BusinessObjects by Business Objects was chosen as the user interface, another critical factor, Carpenter notes. "I think it's a really flexible, extremely user-friendly way for a non-data processing staff to extract information from the database," says Carpenter.
Business Objects can transfer data to other tools, such as MapInfo by MapInfo Corporation for spatial information management and SPSS by SPSS, Inc., for statistical data analysis. The Document Agent feature of Business Objects, which provides batch execution and scheduling, is used to generate off-line analyst defined reports. Pandora Managed Care Information System by Codman Research Group is another application which provides population-based analytical information to health data researchers.
A customized application provides predefined report navigation facilities including capabilities to group common reports together, track predefined report usage, send messages to the system administrator, distribute surveys to users, track password aging and distribute global system messages to users.
Both Medicaid administrators have experienced very few drawbacks associated with the software architecture.
ETI*EXTRACT by Evolutionary Technologies International generated COBOL to extract the data from mainframe operational systems. EDS technical experts developed a customized application called "Star Schema Data Builder" that generates the dimensions of the star schemas. Oracle's SQL Loader converts the data from EBCDIC to ASCII and loads the data to the warehouse tables. Lastly, three custom server utilities generate load cards for the SQL Loader based on the defined database, automate the process of disease groupings based on user-defined characteristics and perform random samples based on user-generated SQL statements.
The data warehouse implementation has transformed the day-to-day operations of the Arkansas and Mississippi Medicaid programs. Program administrators are uncovering trends and patterns that lead to new solutions and service delivery. Mississippi Medicaid administrators requested a hospital review report to identify patients that could have received preventive care--eliminating the high cost of a hospital stay. After reviewing the patients' diagnoses and lengths of stay, key areas were identified for educating health care providers and patients in preventive care maintenance.
Another report illustrated the need for the state to investigate diagnoses related to outpatient services and determine whether the same services could be performed in an office visit setting.
"The dollars saved in the reduced amount of time it takes to produce reports and retrieve information is significant. We've even seen a reduction in the number of requests for ad hoc reports because this information is now so easily retrieved from the data warehouse that many staff members are doing it themselves," states Terry Childress, systems information director for Mississippi's Division of Medicaid.
In Arkansas, before the data warehouse was introduced about 132 ad hoc reports were produced annually. ROI was realized after the implementation when the number of reports topped 200 in the first two months alone.
"It's a stunning product and that's why I encouraged the Mississippi team to visit to see it at work," says Carpenter. "The ease of use of the system and the speed of access to a large amount of data is outstanding. The system is flexible, plus it's comprehensive. You have access to all of your beneficiaries, providers, paid claims history, pricing and claims processing, editing and auditing. You have access to the ultimate amount of information a health care manager could need."
For other states contemplating securing a data warehouse enhancement to their MMIS through the competitive bid process, Arkansas and Mississippi Medicaid administration teams offer a "Top 5" list of practical advice:
- Choose a technology partner with successful experience in mainframe and client/server environments, since most data warehouses source from mainframe systems.
- Develop well-defined work plans and test plans.
- Start with an analysis of your current reporting requirements and include as much detail as possible in your data model supporting these requirements.
- Ensure your system has features that allow it to continually analyze your user needs over time, such as surveys, query tracking and report utilization. These features will greatly assist you in identifying key areas for future enhancements and in assessing the need for additional hardware.
- Consider a laboratory environment for initial system implementation. Staff the lab with experts to assist users until they're comfortable with the technology.
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