Delivering Essential Healthcare Services

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California Department of Health Care Services

Delivering essential healthcare services to 13.3 million Californians while meeting federally mandated Medicaid Management technology standards

One-third of Californians receive health care services financed or organized by DHCS, including California Children’s Services; Child Health and Disability Prevention program; the Genetically Handicapped Persons Program; the Newborn Hearing Screening Program; the Family Planning, Access, Care, and Treatment (PACT) program; Program of All-Inclusive Care for the Elderly (PACE); Every Woman Counts; and Coordinated Care Management. DHCS also administers programs for underserved Californians, including farm workers and American Indian communities. This makes the department the largest health care purchaser in California.

Over time, the DHCS organization has developed functional silos because new programs and services were rapidly added to meet the needs of an ever growing Medi-Cal population. Additionally, DHCS has integrated the Drug Medi-Cal and Mental Health departments which were previously independently managed. This led to program-centric business operations and services, multiple Medicaid Management and Information Systems (MMISs) and business activities and processes occurring in multiple, entirely separate divisions.

To operate more efficiently, and to meet CMS’s Seven Standards and Conditions and Medicaid Information Technology Architecture (MITA) Framework maturity goals, DHCS must better align with the MITA Framework. DHCS must focus strategic planning, system changes and upgrades around business processes rather than duplication of systems, software and resources across the enterprise. DHCS must also become more agile to effectively serve its growing number of members and to quickly and accurately report upon the immense Medicaid data the department collects daily.

Infiniti’s nationally recognized leader in MITA guides DHCS to lower costs and improved health outcomes

Infiniti’s expert in Healthcare Services, State Self-Assesments (SS-A) and MITA framework has lead DHCS’ MITA activities since 2007, defining the enterprise framework now used as the springboard towards achieving their goals. This long-term vision for DHCS success has brought the department to its current level of maturity, well prepared for further adoption of their business, information and technical architectures.

Infiniti recognized early on that MITA was more than just the SS-A, and that it was on the precipice of Enterprise transformation. This led to the development of the Enterprise Business Process Management Strategy that has been adopted by the department and forms a basis for a department wide business driven transformation. A repeatable SS-A process developed for DHCS has been executed not only in California, but also in the states of Georgia, Hawaii, and Rhode Island. Infiniti’s holistic approach to long term organizational success led to the development of the Enterprise Business Process Management Strategy that has been adopted by the department and forms the basis for a department wide business driven transformation.

California DHCS is national leader in state Medicaid programs

With Infiniti’s expert guidance California DHCS is not only leading the enterprise architecture development within the CA Health and Human Service Agency but also nationally among state Medicaid programs. With a mission to assist the department with redefining itself to meet the goals of lower costs and improved health outcomes, Infiniti helped them define a governance structure and take on the difficult task of naming Business Champions to the roll of improved enterprise governance. The purpose of enterprise governance is to ensure that strategic objectives are met through the effective use of resources — whether people, data or technology — while measuring performance and assessing risk.

Infiniti took the CMS governance structure, applied the unique characteristics of DHCS and the resulting structure is now being used to establish necessary levels of control. As a result of the recommendations, the DHCS MITA Governance Team (MGT) was initiated in late 2013 with the appointment of the executive level leads for the business, information and technical architectures. The MGT approves, directs, influences, and monitors DHCS IT approaches to ensure alignment with the DHCS Strategic Plan and MITA goals. Since that time, the Business Architecture Board (BAB) was established (April 2015) based upon the recommendations. The BAB includes the DHCS Business Process Champions as voting members and is chaired by the Chief Business Lead. Great progress has been made by both the MGT and the initial sessions of the BAB.

Additionally, Infiniti assisted in the development of the DHCS Enterprise Business Process Management Strategy which includes a project delivery framework for business process improvement. The goal being that, before implementing any technical solution the current business processes go through a reengineering process to define the target To-Be state that incorporates all program area specific requirements; reduces duplication and “waste”; establishes performance measures; and produces a documented target process flow (business process model) for approval by MGT prior to the implementation of a solution.

Infiniti continues to interpret the MITA Framework and apply enterprise architecture principles to integrate and standardize duplicative business processes across DHCS to achieve MITA advancement. Throughout the last several years Infiniti’s expert provides ongoing consultation to DHCS on the key components of BPM including the critical significance of Business Process Improvement (BPI).