Building the Foundation NAMD Fall Conference September 7

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

Kan. Care Overview • Kan. Care 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, K 2 blackpearl Workflow Management, In. Rule 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 in. Sight Dashboard = Product Managed Care Enrollment Broker Services KEES Integration Data Warehouse and Analytics (DWA) HPE Managed Care Product Modernized Kansas Member Management Cerner Healthe. Intent 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 ü Web Service ü Business logic ü 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

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Improved As Is Photo from Ed O’Neil

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