Develop Agency Goals and Objectives

Plan Administration

Description

The Develop Agency Goals and Objectives business process periodically assesses and prioritizes the current mission statement, goals, and objectives to determine if changes are necessary. Goals and objectives may warrant change for example, under a new administration, in response to changes in demographics, public opinion or medical industry trends, or in response to regional or national disasters.

Business Process Template

Trigger events

Environment-based

Periodic timetable (e.g., annual) is due for review of goals and objectives.
Periodic timetable (e.g., annual) is due to implement new goals or objectives.
Ad hoc request for goals or objectives updates.

Interaction-based

None published

Results

The State Medicaid Agency (SMA) defines new or modified statement of goals or objectives.
Tracking information as needed for measuring performance and business activity monitoring.

Business process steps

1. START. Receive notice that the SMA requires a review of current goals and objectives or the review interval is due.
2. Review existing goals, objectives, and priorities.
3. Review information such as current performance measurements, industry successes, budget, and other States/programs successes.
4. Convene Stakeholders.
5. Develop consensus on changes and priorities.
6. END. Publish new or revised statement of goals and objectives, including performance measurements and priorities.

Predecessor processes

Manage Performance Measures

Successor processes

Shared data

Plan data store including Medicaid State Plan, health plan, health benefits, performance measures, and benchmarks information
Business Activity data store including performance information (e.g., Consumer
Assessment of Healthcare Providers and Systems (CAPHS) and Healthcare
Effectiveness Data and Information Set (HEDIS) measures)

Constraints

Economic conditions shift, making less revenue available to fund the approved and planned budget. The State Medicaid Agency will comply with federal and state regulations.

Failures

Stakeholders are unable to reach consensus on the SMA goals and objectives.

Performance measures

Time to complete the process = within __ days, ___ weeks
Achievement of goals and objectives linked to policy implementation

Source: CMS MITA 3.0 Business Process Template, Plan Management BPT.pdf, pages 1-2.

Business Capability Model (12 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. SMA uses tools to gather, record, analyze, formulate, communicate, and distribute information on goals and objectives to SMA leadership and other state agencies.
LEVEL 3SMA automates process to the full extent possible within the intrastate. SMA uses brainstorming and automatic collaboration tools that enable statewide input to the goal setting process.
LEVEL 4SMA automates process to the full extent possible across the interstate.
LEVEL 5SMA automates process to the full extent possible across the nation.

How adaptable is the process to change?

LEVEL 1SMA is unable to adapt easily to changes to the goals and objectives. SMA is unable to provide timely information to stakeholders.
LEVEL 2SMA is able to develop and maintain goals and objectives with collaboration from other agencies that encourages flexibility.
LEVEL 3SMA develops and maintains goals and objectives with collaboration from other intrastate agencies. SMA quickly distributes modifications to policy to stakeholders.
LEVEL 4SMA develops and maintains goals and objectives with collaboration from other interstate agencies. SMA distributes in near-real time modifications to policy to stakeholders.
LEVEL 5SMA develops and maintains goals and objectives with collaboration from other intrastate agencies. SMA distributes in near-real time modifications to policy to stakeholders.

Are goals and objectives traceable throughout the organization?

LEVEL 1SMA is unable to trace operational activities directly to goals and objectives.
LEVEL 2SMA is able to trace some operational activities directly to goals and objectives.
LEVEL 3SMA directly ties all relevant operational activities to goals and objectives within the intrastate. SMA uses business intelligence tools to monitor progress toward benchmarks.
LEVEL 4SMA directly ties all relevant operational activities to goals and objectives across the interstate.
LEVEL 5SMA directly ties all relevant operational activities to goals and objectives 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 nationally recognized and state-specific standards.
LEVEL 3SMA adopts MITA Framework, industry standards, and other nationally recognized standards for intrastate exchange of information.
LEVEL 4SMA adopts MITA Framework, industry standards, and other nationally recognized standards for clinical and interstate information exchange.
LEVEL 5SMA adopts MITA Framework, industry standards, and other nationally recognized standards for national exchange of 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 standards and Electronic Data Interchange (EDI) transactions.
LEVEL 3SMA collaborates with other intrastate agencies and entities to adopt national standards, and to develop and share reusable business services.
LEVEL 4SMA collaborates with other interstate agencies and entities to adopt national standards, and to develop and share reusable processes including clinical information.
LEVEL 5SMA collaborates with agencies and entities for national (and international) interoperability improvements that maximize automation of routine operations.

Business Capability Quality: Timeliness of Process

How timely is the 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). SMA develops goals and objectives in an ad hoc manner. Time to complete process is indeterminate.
LEVEL 2Process timeliness improves through use of automation. SMA conducts more frequent review and modification to goals and objectives. The process completes in less than one (1) month.
LEVEL 3Timeliness improves via state and federal collaboration, use of information sharing, standards, and regional information exchange hubs. SMA develops, modifies, tracks, and report on goals and objectives in generally less than one (1) week.
LEVEL 4Information is available in near real time. Processes that use clinical information result in immediate action, response, and results. SMA has interstate 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 2SMA uses standard transactions to 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 SMA’s internal information. External sources of information use MITA Framework and industry standards for information exchange. Accuracy rating is at 99% or higher.
LEVEL 4Automation of information collection increases the reliability of SMA’s internal and external sources of information. SMA adopts MITA Framework and industry standards for information exchange with interstate agencies. Accuracy rating is at 99% or higher.
LEVEL 5SMA adopts MITA Framework and industry standards for information exchange with national agencies. 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. Goals and objectives are vague and incomplete.
LEVEL 2Goals and objectives are up-to-date and more accurate. SMA stores information in disparate systems, but automation and standards increase accessibility over Level 1.
LEVEL 3SMA obtains information easily and exchanges with intrastate agencies and entities based on MITA Framework and industry standards. Goals and objectives are central, up-to-date and accurate. Accessibility is greater than Level 2.
LEVEL 4SMA obtains information easily and exchanges with interstate agencies and entities. Accessibility is greater than Level 3.
LEVEL 5SMA obtains information easily and exchanges with national agencies and entities. Accessibility is greater than Level 4.

Business Capability Quality: Cost Effectiveness

What is the cost of the process compared to the benefits of its 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 clinical and interstate information exchange. SMA increases cost effectiveness ratio over Level 3.
LEVEL 5SMA adopts MITA Framework, industry standards, and other nationally recognized standards for national (and international) information exchange. SMA increases 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. Efficiency is higher than Level 1.
LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate agencies and entities improving efficiency to 95% or higher.
LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with interstate agencies and entities improving efficiency to 98% or higher.
LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national 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 reduce error and improve accuracy above Level 1.
LEVEL 3SMA adopts MITA Framework, industry standards and information exchange with intrastate agencies and entities improving accuracy to 90% or higher.
LEVEL 4SMA adopts MITA Framework, industry standards and information exchange with interstate agencies and entities improving accuracy to 98% or higher.
LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national 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 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 interstate agencies and entities improving stakeholder satisfaction to 95% or higher.
LEVEL 5SMA adopts MITA Framework, industry standards and information exchange with national agencies and entities improving stakeholder satisfaction to 98% or higher.

Source: CMS MITA 3.0 Business Capability Model, Plan Management BCM.pdf, pages 1-8.

Other Plan Management processes

Maintain Program Policy Maintain State Plan Manage Health Benefit Information Manage Health Plan Information Manage Performance Measures Manage Rate Setting Manage Reference Information