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FEI SUCCESS STORIES

Medicare-Medicaid Data Integration (MMDI) Technical Assistance

BUSINESS CHALLENGE

State Medicaid agencies have the option to request Medicare data from CMS for integration with Medicaid data in order to improve care coordination and address program integrity for individuals enrolled in both Medicare and Medicaid (dual eligible beneficiaries). States face a number of challenges to bring Medicare data into their technical environments and integrating it with their Medicaid data. From identifying an appropriate integration environment and the tools necessary to process and load the various types of data, to having the expertise and available resources on hand to perform the tasks, to becoming familiar with the new data sets and understanding their potential value to the state, each state represents a unique set of circumstances that must be navigated to achieve the common goal of effective Medicare-Medicaid data integration.

SOLUTION

Through competitive procurement, the Centers for Medicare and Medicaid Services (CMS) selected FEI to assist states with their efforts to integrate data from multiple state and CMS databases, and make effective use of that data for the improvement of care coordination and program integrity for the dual eligible population. Through highly focused meetings with states and a range of technical and clinical subject matter experts, FEI assessed the technical assistance needs and developed a robust framework of tools that are designed to facilitate state acquisition, familiarization, integration, and utilization of the Medicare data. FEI’s flexible approach captures best-practices at a macro level, but also allows for sensitivity to state-specific needs.

States deemed FEI’s support as “invaluable” and “integral” to their successes with data integration. FEI has helped states gain efficiencies to support effective Medicare-Medicaid data integration by:

RESULTS

Results Star

States deemed FEI’s support as “invaluable” and “integral” to their successes with data integration. FEI has helped states gain efficiencies to support effective Medicare-Medicaid data integration by:

  • Developing common guidelines and tools, such as mappings and database staging models, which assist states with the integration of multiple datasets.
  • Creating taxonomies to assist states with developing a consistent interpretation of data fields across different data sources.
  • Assisting states with developing solutions to address gaps associated with missing or inconsistent data.
  • Assisting states with programming and complex algorithms, such as final action processing and master data management solutions, that are required to read and use the data for integration.
  • Assisting states to develop collaborative processes that facilitate data-driven decision making for program improvement.
  • Assisting states with understanding how the integrated data can be utilized to help meet their program improvement goals. States have been “extremely impressed” by this analytic guidance, which is provided in the form of use cases that incorporate an analytic approach, metrics, bench marking resources, algorithms, and a technical supplement describing the methodology for implementing the use case in a state environment.
  • Providing individualized, hands-on knowledge transfer for all assistance initiatives, ensuring that states are able to implement, maintain, customize, and expand on a solid data integration foundation.

Let’s Work Together

Interested in learning more about our solutions? Use the contact form and we’ll get back to you!

Gwen Williams

Gwen Williams

SVP, Business Development

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GPRA Tools and Upload

WITS’ current version of the Discretionary Services GPRA tool supports data collection for the SOR program. This includes the intake, 3 month, 6 month, and discharge CSAT GPRA interviews. The system currently includes an automated, nightly upload of all completed GPRA data to the SPARS system, and it is assumed that SAMHSA will allow the same upload for SOR GPRA data.

WITS includes a follow-up due screen and related alerts to ensure that each provider, oversight agency, and the State can monitor the GPRA follow ups that are coming due, as well as monitor overall compliance with the grant’s rules regarding 80% completion of follow ups within the specified timeframe.

FEI will keep pace with changes to the GPRA as they are introduced by SAMHSA to ensure continued compliance.

Evidence Based Practices

WITS will allow the tracking of a client that is placed into any program of care, including the evidence based criteria that are used for that particular program of care. The program record also includes the level of care or service level. The system will record the length of time (days) that a client is treated in that particular program and the reasons for disenrollment/discharge.

Additional tracking is allowed for the medication used when Medication Assisted Therapy (MAT) is part of the care. WITS allows for the use of evidence based screeners and assessments, including the ASI, ASI Lite, and other ASAM criteria based tools. Modules allow the capture of all workflow and payment data related to services, core functions supporting treatment, prevention and recovery services.

Reporting of each service paid for by SOR funding is also available, by client and date, if desired. The State may track the burn rate and monitor trends in spending by provider, by client type, or by type of service.

Reporting

FEI will provide help gathering as much information possible for the semi-annual and final progress reports, as well as for the annual and final financial status reports and yearly sustainability report, as soon as the reporting requirements become available. Details will be available after award, WITS addresses these reporting requirements, as it has with many discretionary CSAT grants over the past decade. Whenever possible, prescribed reports are available in WITS to help compliance with CSAT progress and financial reports. The WITS platform also includes robust ad-hoc reporting in real time, allowing the State and its providers to access and analyze data to understand the impact of the services and outcomes.

Structured Reporting System

Prevention WITS gives you ready access to all data through a structured reporting system. Easily and rapidly generate formal reports, such as Block Grant reports. Create and run ad‐hoc reports to answer questions from state officials, legislators, or providers. Review SPF data entered and run QA and progress reports at any point in time. Compare data from Prevention WITS against state or national numbers to better understand community needs. Prevention WITS robust reporting puts the data for decision‐making in your hands at all times.

Workflow Driven

All screens center around the user’s workflow, guiding the user to the next step. See how Prevention WITS can be configured to support your user workflows.

Third Party Billing for Prevention Services

WITS allows providers or states to manage a variety of third party billing, establishing billable services, rates, and the method of billing for each payor. Tracking of EOBs, payments and client balance and payments is also available.

Addresses the SPF SIG Logic Model

Admission

Admits the client into the program and gathers additional information on the client’s background and legal history. The information entered creates a snapshot of the client at the time of intake/admission, which can be used to compare to similar data captured at Discharge to measure client progress.

Eligibility

Using industry standard tools, such as ORAS for criminogenic risk, and other screeners and assessments (such as ASAM’s CONTINUUM™) for appropriate placement in a level of care in the community, the court can place individuals in the best setting for treatment success.

Case Management

Records all case management and related events, referrals and services provided to the drug court client. By tracking each case management activity, it is possible to identify ancillary services provided to the client and to track the client’s progress and participation. This includes detailed reporting of employment and education milestones, sanctions and incentives, new charges, community service hours, as well as court and other criminal justice events.

Drug Testing

Allows the tracking of drug test results and attendance. HL7 messaging can pull in drug test results from a lab or lab hub.

Fee Tracking

Track fees (charges and corresponding payments) for any type of financial transaction associated with the client.

Treatment Encounters

Records all treatment related services provided to the drug court client. These are coded against standard procedure codes, and may be exported to an external billing system. Treatment encounters may reference goals and objectives from the client’s treatment plan.

Treatment Planning

Allows the treatment provider to enter a comprehensive plan including problems, goals, objectives, and planned interventions, and update those plans as needed with coordinated reviews.

Integrated Scheduling and Group Notes

Includes scheduling of groups, management of the client roster and attendance at sessions, streamlined integration with progress note reporting.

System Generated User Alerts

Provider alerts to case managers for upcoming client activities.

Discharge

This module mirrors Admission in that it collects the same data for clients at the time of discharge that was collected during the client’s drug court admission.

Health Care Environment

The health care industry is moving toward greater interoperability and pervasive health information exchange. Health care organizations and systems must ensure that behavioral health patient data is shared in compliance with Federal and State confidentiality laws, such as 42 CFR Part 2 and the Health Insurance Portability and Accountability Act (HIPAA). At the same time, patients have the legal right to control which aspects of their information are shared with or withheld from providers within a health information exchange environment.

Need for Consent2Share

Federal and State laws regarding sharing sensitive health information are driving the need for data segmentation, capturing patient consent, and enforcing patient preferences. Federal and expert stakeholders developed standards and guidelines to enable data segmentation and patient consent management. Thus, there is a need for health care organizations and systems to use online systems that segment data, elicit patient consents, comply with patient preferences, comply with confidentiality and privacy laws, and use national interoperability standards.

Solution: Consent2Share

FEI Systems developed Consent2Share as an open source application for consent management and data segmentation. It integrates with existing electronic health record (EHR) and health information exchange (HIE) systems via interoperability standards. Consent2Share enables electronic implementation of sensitive health information disclosure policies by applying the information-sharing rules needed to constrain the disclosure of sensitive data according to patient preferences. It supports Federal and State requirements related to specially protected health information, including 42 CFR part 2 and Health Insurance Portability and Accountability Act (HIPAA). It puts control of information exchange in the hands of the person in the healthcare system that has a right to decide who has access to their data: the patient.