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Medicaid Enterprise Management System

RFP Pre
-
Release Vendor Conference

101
Cold Harbor
, Frankfort,
KY

Thursday 01/24/2013

2:30 pm to 5 pm


2


Welcome to Kentucky and Introductions



Kentucky’s
Strategic Vision for Healthcare
Transformation



Medicaid Enterprise Management System RFP
Structure and Scope



Medicaid Enterprise Management
System
Vendor
Procurement Tentative Timeline



Medicaid Enterprise Management
System
Implementation Timeline



Open Questions and Feedback









Kentucky Medicaid Enterprise Management System RFP

Pre
-
release Vendor Conference

Discussion Outline

3




Kentucky has developed a complete and
achievable
eHealth

IT Architecture.



Kentucky has a consolidated Cabinet
organization that encompasses all of the
program pillars depicted in our vision.



CHFS
Secretary Haynes and Governor
Beshear

have been engaged and
aggressive in our efforts to improve
healthcare in
Kentucky
and nationally.





Early
adoption of
HIE, GOHIE
,
HBE, etc.



Focus on improved delivery and quality
of
healthcare through
Managed Care and
push to streamline
MMIS
.




Kentucky’s Strategic Vision for Healthcare Transformation

4




QHI Components for CHFS Supported Systems:



Citizen, Worker,
P
artner Web Portals



SharePoint Document Management System



Corticon

Business Rules Engine



BizTalk Enterprise Service Bus



IBM
Infosphere

Master Data Management



SAS Fraud Analytics



KEUPS Seamless Security Services



HP
Exstream

Fulfillment




Kentucky’s Strategic Vision for Healthcare Transformation

5

Option 1 MEMS System Replacement:

Design
, development, implementation and maintenance of the
new
Kentucky
Medicaid Enterprise Management System
and
Fiscal
Agent.


Proposed solutions and pricing for the following “Options to Buy”:


System
Hosting and Disaster Recovery
services


Decision
Support
System


Utilization
Management
Services




Option 2 MEMS System Takeover:

Planning
, migration and operations necessary to
assume

the
operation of the current MMIS and
Fiscal Agent services.




Option 3 Combined MEMS System Replacement and Takeover:

Providing
of all services necessary for Options 1 & 2. (Takeover and
Replacement)



Medicaid
Enterprise Management
System RFP Structure and Scope

6


Medicaid
Enterprise Management
System RFP Structure and Scope


Seamless data exchange of information within QHI framework including as close as possible to
real
-
time integration with Kentucky Health Benefits Exchange System
.



Optimization of Managed Care Relationships and streamlined support for remaining Fee for
Service processes.



SOA based solution comprised of components that integrate into the Commonwealth’s SOA
framework or directly utilizes the Commonwealth’s components.



MITA based modular solutions from a single Vendor or a “best
-
of
-
breed” multi
-
vendor
solution.



Meets CMS certification requirements as defined in the CMS MECT.


Comprehensive data management strategy that organizes all of the data and enables easy access
to information.



Configurable and extendible solution to
cost
-
effectively support
Kentucky’s future expansion
of programs and populations, and to meet current and future regulatory needs.

The Commonwealth requires that the future Medicaid Enterprise Management system
be built using the following principles:

7


Medicaid
Waiver
Management Application



Pharmacy Benefit Management




Not in RFP Scope:


Medicaid
Enterprise Management
System RFP Structure and Scope

8

The functional requirements cover the business operations of the enterprise. These
requirements are grouped as follows
:



Business Relationship
Management



Care
Management



Contractor
Management



Financial
Management



Member Management
Lite



Operations
Management



Program
Management



Program Integrity
Management



Provider Management


Medicaid
Enterprise Management
System RFP Structure and Scope

February

March

April

17

31

06

13

20

04

11

18

25

04

11

December

18

25

08

10

29

15

22

01

27

24

03

Vendor
Solicitation

May

06

13

20

27

June

06

13

July

Vendor Selection

Release RFP

Vendor written
q
uestions

Ky

written responses

Vendor Conference /

Vendor Questions

Ky

written
responses

Proposals Due

Vendor Orals/Demos

Final Scoring

Vendor Selected

Proposals Scored

MEMS Procurement Tentative Timeline

Open Questions and Feedback