Tackling Future CMS Requirements—FDCCI, Shared Services, Big Data and Mobility by Tony Trenkle, Chief Information Officer and the Director of the Office of Information Services in the Centers for Medicare and Medicaid Services, Department of Health and Human Services

1. Tackling Future CMS Requirements
Tony Trenkle
Chief Information Officer and Director,
Office of Information Services

2. Topics for Today
• CMS Operations
• Shared Services
• Big Data
• Data Center Consolidation
• Mobility
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3. CMS Operations
3

4. CMS Operations
• More than 98 million beneficiaries (not counting additional potential
30+ million Americans that will be added through health care reform).
• CMS expends approximately 1 trillion dollars annually on Medicare,
Medicaid, and CHIP programs.
• More than 900 million Medicare fee-for-service claims
• More than 1.6 billion claims for Medicaid beneficiaries
• More than 11 million home health assessment records
• More than 13 million nursing home assessment records
4

5. CMS IT
• Counting payments to the states the FY12 operating plan
was $3.8 billion.
• If CMS were a separate agency, that would make us the
third largest IT budget behind only DoD and DHS.
• CMS’s IT infrastructure is very decentralized and funded
mostly on a programmatic basis.
5

6. Critical IT Challenges …CMS IT Transformation Goals
CHALLENGES TRANSFORMATION GOALS
• Huge ACA IT Requirements • Meet Legislative Mandates with
Enterprise IT Shared Services
• Successful Health Reform depends on
more and better data • Create the Data Infrastructure to
maximize CMS Data and Information
• IT funding from multiple budgets Product Use
• Complex and Old IT infrastructure • Transform IT Portfolio Management
and Governance
• Decentralized IT infrastructure
• Transform CMS IT Operations
• Rapid Technological change
• Improve CMS’ Information Security
• Heavy Contractor Presence/Aging and Privacy Posture
Federal workforce • Identify and Adopt Innovative
Technologies
• Improve Organizational Effectiveness
6

7. Shared Services
7

8. Enterprise Shared Services
• What: Scalable, reusable business/technical solutions that
serve multiple business processes
• Why: Tight budgets, need to leverage solutions across
business lines and enhance interoperability
• Four initial “big hitters” selected to be implemented
– Enterprise Identity Management (EIDM)
– Enterprise Portal
– Master Data Management (MDM)
– Business Rules Engine
8

9. Stages of Shared Services
FY2014
FY2013 Showing
real ROI
Supporting for
major programs
FY2012
programs
Foundation
work
9

10. CMS Enterprise Shared Services: EIDM
Business Rules Enterprise Master Data
Engine Service Portal Management
Individuals will have a single identity for
engaging in business with CMS that meets
all federal security requirements
Enterprise Remote Identity Proofing (RIDP)
Identity User Identification, Verification and
Authentication
Management
Enterprise Identity Management (EIDM)
Shared Service
Managing connections from user to a CMS
application
10

11. What do we deliver to business?
• Reduce overall CMS access management costs by combining existing
authentication and authorization systems
– Over 175 CMS applications with 135,000+ users currently using seven different access management systems
• Meet the requirements to support the ACA Health Insurance Exchange
– Exchanges will potentially add 30 – 50 million users
– Legislation requires a simple and clear path for customer experience
• Improved experience for external users that access multiple CMS systems (e.g.,
providers) that currently have different proofing
• Future: Ability to rely on other identity proofers (federated identity)
• Current Status
– Contracts have been awarded for remote ID proofing and enterprise ID management
– First application uses will begin to be implemented over the next several months
11

12. CMS Enterprise Shared Services: Portal
Enterprise
Master Data Business Rules
Identity
Management Engine Service
Management
A central preferred channel for beneficiaries,
providers, organizations and States to receive
CMS information, products, and services
Secure access to
Enterprise Portal enumeration, e-enrollment,
e-Registration, status checking, and reporting
Shared Service services
Improved usability and higher customer
satisfaction
12

13. What do we deliver to business?
• Consistent user interface design to support a “single face of CMS”
• Integrated access to multiple CMS websites/portals reduces need
for users to access multiple URLs to access the information or
applications they need
• Ability for users to customize/personalize their portal experience.
• Current Status
– Initial portal capability has been implemented.
– Additional portlets will be added in the next several months
13

14. CMS Enterprise Shared Services: MDM
Enterprise Business Rules Enterprise
Identity Engine Service Portal
Management
A suite of data records and services that
will allow CMS to link and synchronize
beneficiary, provider and organization data
to multiple disparate sources
Master Data Provider and beneficiary profiles (book of
Management record) will be obtainable through a singe
call to a trusted, authoritative data service
Shared Service that is part of the MDM system
Relationships between beneficiaries,
providers and organizations can be tracked
across all CMS programs
14

15. What do we deliver to business?
• Foundational, centralized source of reference data for Providers,
Beneficiaries, Organizations/Plans, and Programs and
relationships between these entities
• Integrated data from many disparate data sources (including
Medicaid)
• Data services and BI tools that applications can consume to
access the data
• Current Status:
– Initial support provider and beneficiary alignment/assignment for ACO SSP and
Pioneer demos was implemented in May
– Other capabilities will be implemented in the next several months
15

16. CMS Enterprise Shared Services: BRES
Enterprise
Enterprise Master Data
Identity
Portal Management
Management
A software tool that can execute one or more
business rules within CMS IT application code
Establish business rules governance policies
Business Rules for creating and enhancing business rules
Engine Management of all enterprise rules, define the
Shared Service relationships between different rules and relate
some rules to the IT applications accessing the
service
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17. What do we deliver to business?
• “Rules engine” tool that supports rule development and translation
to consumable code that applications can call
• Centralized repository of business rules that new applications can
use as-is or modify
• Standardized complex logic currently embedded in many different
systems (e.g., what is a dual eligible)
• Current Status:
– Support ACO Pioneer processing with beneficiary and provider cross-check
rules 9/2012
– Discussions underway to capture cross-program precedence rules for
coordinated care programs
17

18. Medicare Provider Experience – Today at
CMS
Provider Enrolment National Plan and
Chain and Provider
Ownership System Enumeration
(PECOS) System
(NPPES)
18

19. Future State – Increased Automation and
Self-Service
Provider
Portal Automated Provider
Verification & Book of
1 Record
Enumerate Screening
Automated
Data Capture,
2
Self Service Used by
Enroll Updates
A, B MACs
3 Register
Demos, Medicaid
PQRS, etc..
1. Iden(ty
7. Tax
and
Business
2. Licensure
8. Provider
Death
No(ce
Program
3. Legal
9. Provider
Financial
Integrity
4. Criminal
Informa(on
5. Geo-­‐Spa(al
10. State
Provider
Enrollment
6. Exclusion
Data
&
Eligibility
ACOs
19

20. CMS and Big Data
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21. What is “Big Data”?
© 2012 NetApps Inc. All rights reserved
“Big Data” refers to datasets whose volume, speed and complexity
is beyond the ability of typical tools to capture, store, manage and
analyze.
Complexity
Coined by Francis
Diebold, professor of
economics at the University
of PA in 2000, when “Big”
meant Gigabytes / day1
Speed Volume
21

22. Data Trends
World’s Data Kaiser’s Data
80% 90%
STRUCTURED
STRUCTURED
UNSTRUCTURED DATA
UUNSTRUCTURED
NSTRUCTURED
DATA
DATA DDATA
ATA
Ø 80% of world’s data is unstructured (Rise of Ø 90% of Kaiser’s data is unstructured (80%
Mobility devices, and machine generated data) of EHR and Image data)
Ø 44x as much data over the coming decade (35
zettabytes by 2020) Ø 25x as much data over the coming decade.
(One exabyte by 2020)
Ø Majority of data growth is driven by
unstructured data (Active archives, Medical Ø Majority of data growth is driven by
images, Online movies and storage, Pictures) unstructured data (Medical Images, Videos,
Text, Voice)
Ø Information is centric to new wave of
opportunities (Retail, Financing, Insurance,
Manufacturing, Healthcare,…) Ø Information is centric to providing Real
time Personalized Healthcare. (Requires
Contextual – device, environment, spatial,
Ø Industry is employing Big Data Technologies Demographics, Social, and Behavioral
for Information extraction. profiles in addition to medical information)
Source:
Intel
Developers
Forum,
September
2012
Ø Kaiser is evaluating Big Data
Co-­‐presenta(on
by
Rajiv
Synghal,
Principal,
Kaiser
Permanente;
“Big
Data
and
Analy(cs
in
Healthcare
and
Life
Sciences.”
Technologies…
h[p://intelstudios.edgesuite.net/idf/2012/sf/aep/HLCS002/HLCS002.html
22

23. Big Data at CMS
• Currently, we store and maintain:
– ½ a terabyte of data each month
(roughly 1.7 million pieces of 8 1/2 x 11 paper)
– 370 terabytes of Medicare data
– 30 terabytes of Medicaid data
– 10 terabytes of unstructured data
– Quality data
– Encounter data
– Other
• By the end of 2015:
– Medicare Claims Data will reach approximately 700 terabytes
– Medicaid Claims Data will reach approximately 100 terabytes
23

24. Payment Mechanisms are Shifting
Risk to Payor Current Future Risk to Provider
Traditional Traditional Fee-For-Service Global
Episodic Bundling
Fee-For-Service Capitation Shared Savings Payment
Care Models
Episodes of Clinical Service
Accountable Care Patient Centered
Care (CABG, Centers (Retail
Organizations Medical Homes
AMI etc.) Clinics etc..)
IT and Data are the lynchpins
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25. Data Warehousing Vision
Maximize the full potential of CMS’ vast data resources to realize an enterprise
data warehouse environment that can support the internal and external analytics for
CMS’s future business model and to help transform the national healthcare sector.
• Goal #1: Design a scalable, sustainable data warehouse environment that
supports integration of new data sources such as encounter, quality and clinical
data to the traditional claims, beneficiary, and provider data sources.
• Goal #2: Provide an easily accessible, efficient, and secure environment for
analyzing and extracting the vast sums of CMS data.
• Goal #3: Enable business use of data without the need to understand
underlying technologies, evolving to a self-service model.
• Goal #4: Provide CMS user communities with the tools and information
required to make timely informed decisions and drive innovation (including but
not limited to internal and external users, such as analysts, researchers, states,
provider organizations, and Accountable Care Organizations).
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26. Data Warehousing Business Drivers
• CMS’s role is changing from paying claims to defining quality of care,
supporting multiple payment models, and driving national healthcare
improvements. This will require quicker, easier answers to broader, more
complex questions using more data.
• Legislative mandates require increased coordination with other agencies and
with external parties, driving CMS to standardize data definitions and formats and
to embrace industry best practices.
• CMS is becoming an information clearing house to support external
researchers doing increasingly sophisticated analytics that will drive innovation in
the national healthcare sector.
• Budget and operational pressures require CMS to improve efficiency, reduce
costs, provide quicker time to market and to provide better return on
investment.
26

27. The Current Environment
2011 Environment
CMS
Feedback Reports States
Raw
Researchers
Data Multiple Data
Repositories/
Public Use Files
END USER
Streams Analytics/ Plans
Knowledge Creation 7000 DUAs / Data Cuts
Providers
Feedback Loop
• Mostly unidirectional communication
• Several differing points of entry into CMS Phone/Fax
• Multiple accounts for CMS customers for
various programs eMail
• Corrections, Alterations, Clarifications take time
• Costly USPS END USER
• Cumbersome, yet manageable... For now.
Help Desk
27

28. Near Future Environment If There is No Change
2013-2014 Environment If There is No Change
Increasing Demands for CMS
Information from:
CMS
• ACO Smart Reports
• 10332 (Availability of
Raw Medicare Data for Perf.
Measurement
States
Data Multiple Data
• 3002 (PQRS Improvements)
• 6002 (Physician Sunshine ) Researchers
Repositories/
Streams Analytics/
• 3003 (Quality Resource
Utilization Reports) END USER
• 3007 (Physician Value Plans
Knowledge Creation
Modifier)
• CBRs for Non-Physician, Non- Providers
Hospital Providers
• 10331 (Physician Compare)
Will lead to:
• Hundreds of thousands of new DUAs and data cuts
• Large increase in feedback reports, public use files and DUAs
• Increasingly inefficient transfer of data/knowledge
• Increased costs
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29. Desired Future CMS Data Environment
States
Researchers
Dissemination
Collection EXTERNAL Plans
Data Enclave USER
Providers
Health 2.0
Organizing
Program CMS marketplace
data
Data Streams Gateway
Maximizing Use Contractors
of Data Portal
Fed Partners
INTERNAL
USER
Operations
Web Services
CMS Data
BENEFITS Products
• Improved business • Easy, timely and secure • Reduced cost of
intelligence access to information operations
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30. Key 2012 Activities
• Partnered with Oak Ridge National Laboratories to test new
ways of faster and more efficient data management
(Knowledge Discovery Infrastructure). Follow up activities
will be conducted in Baltimore to test scalability and
applicability.
• Created new office to focus on data management and analysis to
partner with the Office of Information Services.
• Beginning analysis for data warehouse consolidation as part of
DW strategy
• Virtual Data Center work will help with providing more
flexible environments
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31. Data Center Consolidation
31

32. Current CMS Data Center Environment
Baltimore Data
Center
• MAPD Apps
Mixture of Development • HITECH
EDC 1, Inefficient
• Data Warehouses
Direct and Contractors • Medicare FFS Claims use of
• Public Websites
Indirect Contracts • CWF Hosts computing
resources
EDC 2
Research Data Over 80 • Medicare FFS Claims
Centers operational data • HITECH NLR
• 1-800-Medicare-
centers have been NDW
identified by the Inconsistent
OMB Data requirements
Center IBM Boulder for security,
MAC Data
Varying pricing Centers Consolidation • HIGLAS
architecture and
and ownership Initiative Software
models across Development
data centers Medicare Program Buccaneer
Integrity • Quality Net
Life Cycle
• PSCs, RACs, & ZPICs • CCW (SDLC)
UC San Diego
• MIG Data Engine
(Medicaid) 32

33. CMS Data Center Consolidation Strategy
Will award a multi-billion dollar Virtual Data Center (VDC) IDIQ
contract in 2012 that will:
• Support Federal and HHS data center consolidation strategies
• Consolidate the CMS data center footprint across 6-8 data centers.
• Reduce overall energy consumption by improving server virtualization, IT
equipment utilization and environmental control devices
• Eliminate redundant spending and solutions on software, infrastructure and
operations
• Leverages shared resources, reduces time to market for new initiatives and
provides high availability to mission critical applications
• Improve security, disaster recovery times, and effectively employ cloud and
virtualization technologies.
33

34. VDC and Energy Use
• Partnered with the Department of Energy and Lawrence Berkeley Laboratories to
have VDC Contractors to provide an Energy Conservation Measures Plan that will
be evaluated as part of their overall technical solution which will include but not be
limited to:
• Current Power Usage Effectiveness (PUE) of contractor owned and contractor operated
VDC facilities.
• Minimum baseline for PUE improvement that will be monitored and reported
periodically after the initial baseline report.
• Energy consumption as it relates to CMS system’s resources, both dedicated and shared.
• Technical solution alternatives that will improve PUE, adhere to security standards and
achieve performance objectives.
• Return on investment, realized by CMS, over a specific task orders period of
performance.
34

35. Mobility
35

36. HHS Mobility Strategy
• Identifying the user and business requirements for mobile
technologies;
• Identifying the security and privacy requirements for mobile
technologies;
• Developing configuration baselines for mobile technologies;
and
• Providing recommendations on identified mobile technologies
for implementation
36

37. CMS Strategy for Mobility
Internal Users
• Work with HHS through the CTO Council and CIO Council to ensure that CMS policies and
initiatives are in line with the overall Department approach and the Federal Digital
Government Strategy
• CMS has engaged in an effort to continually investigate technologies that position us to deliver
services via a more mobile and agile framework.
• The following technologies are being implemented to the CMS support population:
– Mobile Workforce – 100% mobile capability –currently being implemented, will complete
early next year
• Windows 7/Office 2010
• Dell 6320/HP 2760P Convertible Tablets
• Cisco Virtual Private Network for remote access
• 67% work remotely on a consistent basis with as much as 85% working episodic
• 100% Telework - 120 day pilot
– Mobile Device Management-being piloted for full implementation in the next 1-2 years
• Replace RIM devices with selection options for iOS and Android
• Deploy iPads – manage with MDM enterprise system
• Bring your own device
37

38. Unified Communications
Anywhere, Anytime, Any Medium
Voice
Over IP
Wi-Fi
Softphone
Converged Network
Desktop
Instant
Messaging Unified Desktop VTC
& Presence
Enriched experience for CMS employees through integrated data, voice, video & services
38

39. Supporting Mobility Needs of Stakeholders
• Optimize websites for mobile users
– Engage with customers to identify at least two existing priority customer-facing
services to optimize for mobile use.
• CMS has worked with Medicare beneficiaries and 1-800-MEDICARE customer
service representatives (CSRs) to identify Medicare.gov top tasks. This feedback
was incorporated into the redesign and drove the design of the Medicare.gov mobile
site's navigation structure.
– Optimize at least two existing priority customer-facing services for mobile use
and publish a plan for improving additional existing services.
• CMS has launched a redesign of the Medicare.gov website which uses responsive
design. This means that the website fully supports access on smartphones and
tablets
• Looking to mobile optimize other priority public websites within the next 12
months.
• Ensure that shared services support mobility

40. What Does it all mean?
• Creative tensions abound
– Rise of end user tools vs. centralized IT management
– Growing need for data and data analytics vs. maintaining
appropriate security and privacy
– Budget controls vs. more diverse IT needs
• Policy/business requirements and technology solutions are
becoming harder to align
• Skill set needs are becoming more complicated
• New and different partnerships will be needed
40