Manage Registry

Case Management

Description

The Manage Registry business process receives a member’s health outcome information, prepares updates for a specific registry (e.g., immunizations, cancer, disease) and responds to inquiries with response information. In the context of MITA, a medical registry consolidates related records from multiple sources (e.g., intrastate, interstate or federal agencies) into one comprehensive data store. This data store may or may not reside within the Medicaid information system.

Business Process Template

Trigger events

Environment-based

Receive inquiry for health outcome information.

Interaction-based

Receive health outcomes that The State Medicaid Agency (SMA) sends to a registry.

Results

The SMA prepares and sends response to inquiry for health outcome.
The SMA prepares and sends updated health outcome.
Tracking information as needed for measuring performance and business activity monitoring.

Business process steps

1. START: Receive member’s health outcome information.
2. Validate information submitted is correct and as complete as possible. Information complies with syntax criteria and submitter has completed all required fields.
3. Validate that the provided information is authentic.
4. Prepare submittal for member’s health outcome information to registry.
5. END: Send member’s health outcome information to registry.
Alternate Path:
1. START: Receive request for health outcome information.
2. Validate requestor has authorization to receive desired information.
3. Prepare submittal for member’s health outcome information to requestor.
4. END: Send member’s health outcome information to requestor.

Predecessor processes

Successor processes

Shared data

Health Registry data store including health outcomes (e.g., immunizations, cancer, heart, diabetes, or disease)
Data sources needed for validation of registry information
Enterprise Master Patient Index (EMPI) for single and complete view of patient information

Constraints

State and federal regulations regarding entities authorized to access registry information.

Failures

The SMA is unable to find registry information to update.
Requestor does not have authorized access to the Registry.

Performance measures

Time to complete registry update = __days
Successful delivery rate of responses = __%

Source: CMS MITA 3.0 Business Process Template, Care Management BPT.pdf, pages 9-10.

Business Capability Model (10 questions)

Each capability question defines five maturity levels, from Level 1 through Level 5.

Business Capability Descriptions

Is the process primarily manual or automatic?

LEVEL 1The process consists primarily of manual, paper-based activity to accomplish tasks.
LEVEL 2SMA uses a mix of manual and automatic processes to accomplish tasks.
LEVEL 3SMA automates process to the full extent possible within the intrastate.
LEVEL 4SMA automates the process regionally to the extent possible across the interstate.
LEVEL 5SMA fully automates the process nationally to the extent possible across the nation.

Does the State Medicaid Agency use standards in the process?

LEVEL 1SMA focuses on meeting compliance thresholds for state and federal regulations using state-specific standards.
LEVEL 2SMA applies a mix of HIPAA and state-specific standards.
LEVEL 3SMA adopts MITA Framework, industry standards, and other nationally recognized standards for intrastate exchange of registry information.
LEVEL 4SMA adopts MITA Framework, industry standards, and other nationally recognized standards for clinical and interstate information exchange of regional registry information.
LEVEL 5SMA adopts MITA Framework, industry standards, and other nationally recognized standards for national exchange of registry information.

How does the State Medicaid Agency collaborate with other agencies or entities in performing the process?

LEVEL 1Very little collaboration occurs with other agencies to standardize information exchange or business tasks.
LEVEL 2SMA collaborates with other agencies and entities to adopt HIPAA standards and Electronic Data Interchange (EDI) transactions.
LEVEL 3SMA collaborates with other intrastate registry agencies and entities to adopt national standards, and to develop and share reusable business services.
LEVEL 4SMA collaborates with other regional registry agencies and entities to adopt national standards, and to develop and share reusable processes including clinical information.
LEVEL 5SMA collaborates with national agencies and entities for national (and international) interoperability improvements that maximize automation of routine operations.

Business Capability Quality: Timeliness of Process

How timely is this end-to-end process?

LEVEL 1Process meets threshold or mandated requirements for timeliness (i.e., the process achieves results within the time specified by law or regulation).
LEVEL 2Process timeliness improves through use of automation. Timeliness exceeds legal requirements.
LEVEL 3Timeliness improves via state and federal collaboration, use of information sharing, standards, and regional information exchange hubs. Timeliness exceeds Level 2.
LEVEL 4Information is available in near real time. Processes that use clinical information result in immediate action, response, and results. SMA has regional interoperability, which further improves timeliness over Level 3.
LEVEL 5Information is available in real time. Processes improve further through connectivity with other States and with federal agencies. Most processes execute at the point of service. Results are almost immediate.

Business Capability Quality: Data Access and Accuracy

How accurate is the information in the process?

LEVEL 1Use of direct data entry for information collection is manually intensive and susceptible to inconsistent or incorrect information. Stakeholders are unable to rely on information for decision-making.
LEVEL 2HIPAA standard transactions improve accuracy of information, but the decision-making process may be erroneous or misleading. Accuracy is higher than at Level 1.
LEVEL 3Automation of information collection increases the reliability of the state SMA’s internal information. External sources of information use MITA Framework for information exchange. Decision-making is automatic using standardized business rules definitions. Accuracy rating is at 99% or higher.
LEVEL 4Automation of information collection increases the reliability of the regional SMA’s internal and external sources of information. SMA adopts MITA Framework for information exchange by regional agencies. Decision-making is automatic using regional standardized business rules definitions. Accuracy rating is at 99% or higher.
LEVEL 5SMA adopts MITA Framework for national information exchange. Decision-making is automatic using national standardized business rules definitions. Accuracy rating is at 99% or higher.

How accessible is the information in the process?

LEVEL 1SMA stores information in disparate systems including paper storage and obtains information manually.
LEVEL 2SMA stores information in disparate systems, but automation and HIPAA standards increase accessibility over Level 1.
LEVEL 3SMA easily obtains and uses information from intrastate registry agencies and entities based on MITA Framework and industry standards. Accessibility is greater than Level 2.
LEVEL 4SMA easily obtains and uses information from regional registry agencies and entities based on MITA Framework and industry standards. Accessibility is greater than Level 3.
LEVEL 5SMA easily obtains and uses information from national registry agencies and entities based on MITA Framework and industry standards. Accessibility is greater than Level 4 information

Business Capability Quality: Cost Effectiveness

What is the cost to perform the process compared to the benefits of the results?

LEVEL 1High relative cost due to low number of automatic, standardized tasks.
LEVEL 2Automation improves process and allows focus on exception resolution, improving cost effectiveness ratio over Level 1.
LEVEL 3SMA adopts MITA Framework, industry standards, and other nationally recognized standards further improving cost effectiveness ratio over Level 2.
LEVEL 4SMA adopts MITA Framework, industry standards, and other nationally recognized standards for regional registry exchange improving cost effectiveness ratio over Level 3.
LEVEL 5SMA adopts MITA Framework, industry standards, and other nationally recognized standards for national (and international) registry exchange improving cost effectiveness ratio over level 4.

Business Capability Quality: Effort to Perform; Efficiency

How efficient is the process?

LEVEL 1Process is labor intensive. There is wasted effort or expense to accomplish tasks. Process meets minimum state process guidelines and SMA performance standards. Efficiency is low.
LEVEL 2Automation and state standards increase productivity. SMA focuses more on analyzing information and issuing alerts for detected issues. Efficiency is higher than Level 1.
LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate registry agencies and entities improving efficiency to 95% or higher.
LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with regional registry agencies and entities improving efficiency to 98% or higher.
LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national registry agencies and entities improving efficiency to 98% or higher.

Business Capability Quality: Accuracy of Process Results

How accurate are the results of the process?

LEVEL 1Manual processes result in greater opportunity for human error. Accuracy is low.
LEVEL 2Automation and standardized business rules definitions reduce error and improve accuracy above Level 1.
LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate registry agencies and entities improving accuracy to 90% or higher.
LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with regional registry agencies and entities improving accuracy to 98% or higher.
LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national registry agencies and entities improving accuracy to 98% or higher.

Business Capability Quality: Utility or Value to Stakeholders

Does the business process satisfy stakeholders?

LEVEL 1Stakeholders lack confidence in information negatively affecting stakeholder satisfaction with the process.
LEVEL 2Automation and standardization provides clear and useful information. Stakeholder satisfaction is greater than Level 1.
LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate registry agencies and entities improving stakeholder satisfaction to 90% or higher. SMA uses survey or questionnaire for information collection.
LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with regional registry agencies and entities improving stakeholder satisfaction to 95% or higher.
LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national registry agencies and entities improving stakeholder satisfaction to 98% or higher.

Source: CMS MITA 3.0 Business Capability Model, Care Management BCM.pdf, pages 21-26.

Other Care Management processes

Authorize Referral Authorize Service Authorize Treatment Plan Establish Case Manage Case Information Manage Population Health Outreach Manage Treatment Plan and Outcomes Perform Screening and Assessment