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State Health Care Mulls Potential Modernization

In a new request for information, the California Department of Health Care Services wants to learn more about potentially updating processes around data and reporting.

Streams of data in blue on a black background.
A linchpin state health-care department is looking to do more with the data it collects.

In a request for information (RFI) released March 6, the California Department of Health Care Services (DHCS) seeks to learn more about business intelligence services to further inform and empower the services it offers residents. DHCS is required by law to provide data to the federal Centers for Medicare and Medicaid Services (CMS) as prescribed pursuant to federal laws. The department would face “financial consequences” should that data not meet CMS requirements. CMS will use the data provided to it via the Medicaid Statistical Information System (MSIS) to “evaluate contracted managed care plans compliance with data reporting requirements,” according to the RFI. Among the takeaways:

  • DHCS’ Health Information Management Division (HIMD) wants to get input from respondents on contractor services to deliver “business solutions analysis and data engineering to support data quality analysis and monitoring for encounter data improvement.” High quality data is vital for “implementation, monitoring, and oversight activities” needed for programs DHCS administers. It’s also needed to monitor work streams in the California Advancing and Innovating Medi-Cal initiative; and better analysis and reporting of data quality is needed to be consistent with federal requirements and drive improvements. Contracts for these services, per the RFI, “are exempt from the State Administrative Manual and the Department of General Services review and approval” per state terms, conditions and code.
  • Existing DHCS reporting on encounter data quality is pulled together via an Enterprise Performance Monitoring module which computes and compiles “monthly encounter data submission statistics for the quality measures for encounter data and the stoplight reports” for managed care plans that are managed by the Managed Care Quality and Monitoring Division. DHCS staff uses the module but it’s not directly available to plan. The department needs “additional measures, access for plans, and extending public reporting.” DHCS is seeking one of two options to meet this need: one is an existing solution capable of delivering “data quality dashboards” consistent with “Transformed MSIS” (T-MSIS) analysis, and which can be configured to assess data quality at plan and provider levels — and let those plans and providers view data quality dashboards. The alternate is leveraging DHCS’ existing business intelligence toolset to expand the existing data quality module with dashboards consistent with T-MSIS analysis and which are configurable and viewable by plans and providers. The respondent chosen will work closely with HIMD and will be responsible for other services including “project coordination, business analysis, documentation, or rollout support” as required.
  • A proposed solution would have to include “all measures that are part of the T-MSIS data quality reports” that are produced by CMS; expand plans to DHCS managed care delivery systems; allow plans, delegated entities and providers to “log in to see their specific data quality reports”; and expand public reporting commensurate with the expanded monitoring. Requirements include having “T-MSIS data quality metrics” viewable at plan, delegated entity and provider levels. Solutions proposed should be able to generate or publish dashboards for DCHS staff and for plans, entities and providers; and for public use. Proposed expansions to DHCS’ existing module should be able to provide performance reports; interactive performance dashboards; an interactive performance data query tool; and performance data on the California Health and Human Services Agency’s Open Data Portal. Also needed will be the development of performance monitoring for DHCS programs; knowledge transfer and training; and monthly and quarterly updates. DHCS also asks respondents to provide “nonbinding budgetary pricing information for each identified solution” — for planning purposes only and not to be considered an offer by the respondent.
  • This RFI, DHCS says, is for information and planning purposes, and isn’t a solicitation. Responses to it are not offers, and do not obligate respondents to DHCS, or the department to respondents. The department may use the information it receives to “initiate future discussions with vendors/contractors.” Questions are due by 3 p.m. March 13, and responses will come March 20. Responses to the RFI are due by 3 p.m. April 3.
Theo Douglas is Assistant Managing Editor of Industry Insider — California.