Medicaid and PHA -

Partnership in using the Data Warehouse

Cynthia Green-EdwardsDirector, Office of Medicaid Health Information Technology

Michigan Department of Community Health (MDCH)

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Overview

• Enterprise Data Warehouse (statewide)

• MDCH Data Warehouse

• Data Warehouse – In Action!

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Nation’s Longest-Standing, Most Sophisticated, and Highly Utilized State Government Data Warehouse

• 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

1994

2010

• Medicaid

• 9000+• All major departments• External (providers, PIHPs, CMHs, etc.)

• 50 • Medicaid

Users Data Sources

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• 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

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Data sharing across state agencies• 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

• 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

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Overview

• Enterprise Data Warehouse (statewide)

• MDCH Data Warehouse

• Data Warehouse – In Action!

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MDCH Data Warehouse – Data Sets

• 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

• 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

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• 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

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Data Integration = Program Actions and Results

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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 program data, make better and faster decisions, manage and measure programs, reduce costs, and improve outcomes

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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)

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Overview

• Enterprise Data Warehouse (statewide)

• MDCH Data Warehouse

• Data Warehouse – in Action!

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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

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The Power of Linking and Sharing Information Newborn Screening

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The Power of Linking and Sharing Information Child Immunizations

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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

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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

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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)

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HIV

• Registry

• Services

• Coordination of HIV programs

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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

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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

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• 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

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• Process for requesting data warehouse access• Data warehouse Help Desk• User Group Meetings

Data Warehouse Resources