Program information is distributed across multiple Program Information Repositories (KYMMIS, KHBE, MCOs, PBM) that receive requests to add, delete, or change data in program records. The Repositories validates data upload requests, apply instructions, and track activity. The Program Information Repositories provides access to payment records to other Business Area applications and users, especially those in Program Management and Program Integrity Management, via batch record transfers, response to queries, and and services. “publish subscribe” Currently, business users have direct and dynamic access to the Medicaid DW. DMS has adopted HIPAA standards. It has entered into memorandums of agreement to obtain data from other state agencies or to share data with them. Request from individuals in DMS or outside agencies pass through a common automated security process. The DW uses COTS products including Business Objects, Oracle and Economic and Social Research Institute (ESRI). State staff has been trained in the process, products and data to effectively use the Program Information. Also, state and vendor technical staffs are dedicated to assist or generate needed information. The data in the data warehouse has improved over time and the accuracy has steadily improved. The data warehouse is very accessible but there are occasional outages or special jobs that may limit availability. The stakeholders in the Program Information Business process are pleased with the utility of the process. To-Be Kentucky Process Narrative: In the future, there will be connectivity with Centers for Disease Control and Prevention (CDC), Vital Statistics, and Department of Juvenile Justice (DJJ), to gain additional data for data analytics. There will be continued training and sufficient licensing to connect additional DMS and other staff to increase access the DW and accessibility of data analytics. AS-IS TO-BE Manage Health Plan Information Assessment Assessment Capability Question Level Level Is the process primarily manual or automatic? 3 4 Does the State Medicaid Agency use standards in the 3 4 process? How does the State Medicaid Agency collaborate with 3 4 other agencies or entities in performing the process? How timely is this end-to-end process? 3 4 How accurate is the information in the process? 2 3 How accessible is the information in the process? 2 3 What is the cost of the process compared to the benefits 3 4 of the results? How efficient is the process? 2 3 How accurate are the results of the process? 3 4 Does the business process satisfy stakeholders? 3 4 Business Process Assessment 2 3
Program information is distributed across multiple Program Information Repositories (KYMMIS, KHBE, MCOs, PBM) that receive requests to add, delete, or change data in program records. The Repositories validates data upload requests, apply instructions, and track activity. The Program Information Repositories provides access to payment records to other Business Area applications and users, especially those in Program Management and Program Integrity Management, via batch record transfers, response to queries, and “publish and subscribe” services. Currently, business users have direct and dynamic access to the Medicaid DW. DMS has adopted HIPAA standards. It has entered into memorandums of agreement to obtain data from other state agencies or to share data with them. Request from individuals in DMS or outside agencies pass through a common automated security process. The DW uses COTS products including Business Objects, Oracle and Economic and Social Research Institute (ESRI). State staff has been trained in the process, products and data to effectively use the Program Information. Also, state and vendor technical staffs are dedicated to assist or generate needed information. The data in the data warehouse has improved over time and the accuracy has steadily improved. The data warehouse is very accessible but there are occasional outages or special jobs that may limit availability. The stakeholders in the Program Information Business process are pleased with the utility of the process. To-Be Kentucky Process Narrative: In the future, there will be connectivity with Centers for Disease Control and Prevention (CDC), Vital Statistics, and Department of Juvenile Justice (DJJ), to gain additional data for data analytics. There will be continued training and sufficient licensing to connect additional DMS and other staff to increase access the DW and accessibility of data analytics. Manage Health Plan Information AS-IS Assessment TO-BE Assessment Capability Question Level Level Is the process primarily manual or automatic? 3 4 Does the State Medicaid Agency use standards in the process? 3 4 How does the State Medicaid Agency collaborate with other agencies or entities in performing the process? 3 4 How timely is this end-to-end process? 3 4 How accurate is the information in the process? 2 3 How accessible is the information in the process? 2 3 What is the cost of the process compared to the benefits of the results? 3 4 How efficient is the process? 2 3 How accurate are the results of the process? 3 4 Does the business process satisfy stakeholders? 3 4 Business Process Assessment 2 3