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Memorandum of Understanding with Department of Information Technology for BusinessServices Provided by Government Data Analytics Center (GDAC) – Request for ApprovalBoard of Trustees MeetingDecember 20, 2016
Contract Approval Required by StatuteNorth Carolina General Statutes §135-48.22 and §135-48.33(a)require that the BOT approve all Plan contracts with a value over 500,000.The estimated cost of this contract is 1,442,674.2
Background & ContextPrior to transitioning to the Department of State Treasurer (DST), the StateHealth Plan held data on its own server and used the State’s enterpriselicense for SAS software to develop its data warehouse.Following the Plan’s move to DST, the then recently formed GovernmentData Analytics Center (GDAC) was engaged to facilitate a transition of thehosted data repository into a much broader statewide platform hosted bySAS. Pursuant to statute §143B-1385(b)(1), the purpose of the GDAC is to utilizepublic-private partnerships as part of a statewide data integration and datasharing initiative and to identify data integration and business intelligenceopportunities that will generate greater efficiencies in, and improved servicedelivery by, State agencies, departments and institutions. Pursuant to statute §143B-1385(b)(4)(a) all State agency business intelligencerequirements, including any planning or development efforts associated withcreating business intelligence capability, as well as any master datamanagement efforts, shall be implemented through the GDAC.3
Current Scope of GDAC Footprint Within StateNCASState Health PlanDept. of Commerce/Division of Employment SecurityPurchasing Card TransactionsMedical Claims DataEligibility/Benefit Payment DataPayment DataPharmacy Claims DataEmployer Wage/Tax DataVendor DataProvider/Member DataCase Management DataQCEW-Quarterly Census of Employment & WagesDivision of Motor VehiclesBEACONSecretary of StateDriver License DataEmployee and Position DataCorporate Registration DataVehicle Registration DataEmployee Earnings DataUCC DataIndustrial CommissionDHHS-Center for Health StatisticsOther – External SourcesWorkers Comp Insurance DataVital Records – Deceased DataBank of America P-card DataMedicaid Claims DataSocial Security Death Master FileSocial Services DataCriminal Justice (CJLEADS)Office of State Budget ManagementDPS – Prison DataDMV – Web Services (person and vehicle)DPS – Probation DataDOJ – Concealed Handgun DataDPS – Local Jail DataDOJ – Sex Offender RegistryAOC – Criminal Court/WarrantsWildlife – Web ServiceDomestic Violence Protective OrdersFuture—Federal Hot Files and CriminalIncident based data4Budget and Expenditures Data
Plan Data Analytics: Our Mission & VisionMissionBy adopting a comprehensive approach to data analytics, the State HealthPlan will systematically leverage health information assets to providevaluable insights allowing for leadership to make informed, data drivenbusiness decisions in support of the overall Plan strategic and operationalpriorities.VisionTo become a leader and visionary in health care data analytics, whereby ananalytics culture and mindset is prevalent throughout Plan. The more dataassets that are leveraged, the more insights about our members’ health andexperience as well as our performance can be derived by applying datascience and advanced modeling methods, in real or near real time.5
Plan Data Analytics: Our JourneyIt is a journey, not a destination CompetitiveAdvantageVisionaryEvolving InsightsAdvancedOperationalEarly StageBeginnerSpreadsheetsData RepositoryBasic, StaticReporting Whathappened?Data WarehouseDevelopmentData GovernanceInstitutedAnalytical Data MartData GovernanceStrategyStatistical Analysis Why is thishappening?Data Managementand Data QualityAlertsQuery Drill Down Where is theproblem or issue?Ad-hoc Reports How many, howoften? Forecasting What if thetrendcontinues?PredictiveModeling What will happennext?Leveraging BigData New datasources Unstructureddata sourcesWhat action isneeded?AutomatedReportingScalability &PerformanceOngoing optimizationPrescriptiveModeling What is the bestresult with actionsto achieve?Analytics culture isprevalent within SHPWidespread usageand high adoptionratesEmbedded instrategyDegree of Intelligence6
Plan Data Analytics: Our ProcessFrom Issue Identification to Desired OutcomesIdentifyIssuesIdentify themost pressingissues thatwould benefitfrom analyticalmodeling anddevelop theuse case, i.e.,Fraud, Waste& Abuse.Data ToLeverageIdentify all ofthe datasources toleverage,structured andunstructured.“4 V’s” of nsightsRevealedAnalyze thedata andpatterns withinthe data willreveal keyinsights andpredictors thatwill enablebetter andfaster datadriven decisionmaking.Apply the rightanalytic tools andtechnologies todrive sustainableoutcomes, i.e.,SAS, Hadoop,machinelearning.7TakeActionMake the leapto adoption bythrough theintegration ofinsightsrevealed intothe decisionmakingprocesses.DesiredOutcomesRealize theadvantages ofthe outcomes,i.e., enhancedcost savings,membersatisfaction,and memberexperience.
How We Will Get There, By FunctionGDAC, SAS and Analysts within each section of the PlanData Governance,Data Managementand Data AnalyticsDataManagementData Architecture,Analysis & DesignDatabase AdministrationData SecurityManagementMetadata ManagementData Warehousing & BIReference & Master DataManagementData Quality ImprovementUnstructured DataManagementNon-EDW Content &DocumentManagementAnalytics & DataScienceQuality Assurance &Project Coordination8Data AnalysisData Intersections & InsightsForecastingStatistical AnalysisPredictive Modeling &AnalyticsOptimizationPrescriptive Modeling &AnalyticsUse CasesUser Stories &RequirementsBusiness, Process &Functional Analysis
How We Will Get There, By RoleDirector ofHealth eveloperData LibrarianAnalytics &Data ScienceManagerData AnalystAnalyticModelerInformationAnalyst GDAC and SAS provide expertise and augment Data Analytics section, as do Analysts within each section of the Plan.9
SAS Solutions On Demand Purpose: The Plan and the GDAC, leveraging the relationship with SAS, willcontinue the partnership to support advancing the Plan’s data management andadvanced analytics strategy. The work efforts will focus on two primary projects:Healthcare Data Model (HCDM) & Extract, Transform and Load (ETL) and the VisualAnalytics (VA) Healthcare Analytics Framework (HAF).Data ModelDataManagementOrganizemeaningful dataBuild thefoundationHealthcareAnalyticsVisual dynamicreportingSAS Population Health Management10
SAS Healthcare Data Model & ETL Project Enrich existing Enterprise Data Warehouse (EDW) to focus on current and newdata assets. Complete the requirements, design, development and implement theSAS Healthcare Data Model (HCDM) to be leveraged across various Plan vendordata. Initially, the HCDM will be populated with tables that will include: Medical ClaimsProvidersPharmacy ClaimsMember EligibilityHIEEMRMedsLabsEligibility11
Plan Data AssetsCurrent PlanVendors BCBSNC Humana United Healthcare Express Scripts,Inc.Upcomingidentified datasources CVS Caremark Benefitfocus12Future datasources Medcost Cobraguard Active HealthManagement NC HospitalAssociation First Data Bank Other
SAS Visual Analytics HAF Project Purpose: Implement a population health management dynamic visual reportingsolution using SAS Visual Analytics to assist the Plan with data driven decisionmaking capabilities relative to the health and experience of our members as well asthe financial stability of the Plan. Develop useful analytical models to support thestrategic plan and Plan priorities.EMRPhase 1 Population HealthManagementDynamic VisualAnalytics Reports Deliverables: Member AnalysisReport Drug AnalysisReport Site of ServiceReport Super UtilizerReportHIEPhase 2LabsPharmacyPhase 3 Vendor, Provider &Strategic PlanDynamic VisualAnalytics ReportsMeds Initial Predictiveand PrescriptiveModeling Deliverables: Vendor DynamicReportEligibility Provider DynamicReport Strategic PlanClaimsDynamic Report Deliverables: Advancedanalytical modelsto be developedbased onbusiness issuesidentified,requirements anduse casesdeveloped fromfocus groups13
HCDM & ETL High Level Estimated TimelineIntegrate New DataSourcesBegin Parallel TestingUse New Data,Phase Out EnvironmentQA New DataAnd ETLFebExistingEnvironmentRetire ExistingEnvironment(with Modernized Environment)(CVS and BenefitFocus)AprJanMarMayProfile New Data,Develop Tables/ViewsDevelop ETL forCurrent Data SourcesJun-JulUAT, QA TEST,Load PROD,Knowledge TransferDQ Checks,Modify ETL,Validate DEV and TEST14Aug-SepSHP Sandbox,UAT,Signoff PRODRevise Documentation,QA, UAT, Resolve Issues
SAS VA HAF High Level Estimated TimelinePopulation Health ManagementJan-MarPopulation Health Management dynamicvisual analytic reports. Includes BCBS,UHC, Humana, and ESIStart Strategic PlanStartVendor ReportLaunchProvider ReportStartPredictive ModelingJanMarFebJulJunSepAugJanOct-NovCompleteVA Installon DEVLaunchStrategicPlanStart setupVA on TEST,PRODStartProvider Report15LaunchVendor Report
RecommendationPlan staff recommends approval of the MOU with GDACbeginning January 4, 2017, with an expected cost as follows:HCDM & ETL ScopeEMRVA HAF ScopeVA HAF HostingTotal CostHIEMedsLabsPharmacyEligibilityClaims16 300,000 850,000 292,674 1,442,674
Data Governance, Data Management and Data Analytics Data Management Data Architecture, Analysis & Design Database Administration Data Security Management Metadata Management . SAS Healthcare Data Model (HCDM) to be leveraged across various Plan vendor data. Initially, the
