How SHARP Supports Enhanced Funding Requirements from CMS

SHARP, CMA’s Secure Healthcare Analytics and Research Platform, meets MITA’s Enhanced Funding Requirements: Seven Conditions and Standards and the Business Objectives for CMS Certification.

At the recent Medicaid Innovations Forum in Orlando, Florida, CMA’s Brian Dougherty (Chief Data Warehouse Architect) and Joe Chiarella (Medicaid Practice Lead) gave a presentation on how CMA’s Secure Healthcare and Research Platform (SHARP) supports Medicaid innovation with its technology accelerators.

In its second half, the presentation summed up how the system supports the Seven Conditions and Standards, which are enhanced funding requirements from CMS. SHARP also meets the business objectives for CMS certification.

CMS Enhanced Funding Requirements: Seven Conditions and Standards

As a company, CMA has decades of Medicaid experience. And if you add up all the experience of our employees, we have hundreds of years. So it’s no surprise that our Medicaid services and products support the Seven Conditions and Standards required by CMS for enhanced funding opportunities.

Modularity Standard

CMA’s technology accelerators are built upon this concept. In our SHARP solution, we keep things modular, flexible, and extendable. We use open interfaces and expose APIs. We support Java, XML, .NET and other protocols. We also have a proven, component-based system development methodology that we implement in large-scale data warehouses. This methodology ensures that all components and tools are smoothly integrated into a unified, high-quality SHARP solution that meets our clients’ specific needs.

MITA Condition

SHARP is a MITA-compliant analytics platform. CMA’s vast Medicaid experience ensures SHARP will advance your state’s MITA maturity levels, including those for these Seven Conditions and Standards. And CMA is ready to support states in their self-assessments, roadmaps, and post-implementation CMS certification efforts.

Industry Standards Condition

SHARP complies with many industry standards, including:

  • Security standards (including annual security assessments performed by independent companies)
  • HIPAA standards
  • Section 508 accessibility standards
  • NIST standards

These standards are incorporated into the SHARP solution on day one. They are clearly defined at the requirements stage and carried through all phases of the implementation.

Leverage Condition

The Leverage Condition speaks to making technologies and systems reusable and configurable for state-specific requirements. Like the Modularity Standard, this is what SHARP is all about. SHARP was built in a modular and configurable way that allows reuse, support of multi-state initiatives, and easy integration of commercial and open source products.

Business Results Condition

The key is getting access to understandable, accurate, and timely data that will be transformed into information to make decisions about the Medicaid program. This includes providing accurate and timely processing of data, excellent customer service, and meeting high performance standards and rigorous testing requirements.

SHARP’s dedicated ETL configuration processes source data (including claims, encounter, member eligibility, and provider enrollment) as frequently as daily and real-time. It meets the strictest of standards for timeliness of refreshes, data quality, and system performance.

The SHARP solution is supported by a comprehensive training curriculum and an enterprise-level helpdesk, whose staffers possess years of experience in the Medicaid program and assisting users in a data warehouse.

CMA incorporates a strict set of service-level agreements into their data warehouse engagements. And our implementations are thoroughly tested and perform very strongly.

Reporting Condition

The Reporting Condition is fulfilled by providing accurate data, automatic reports, and audit trails. SHARP accomplishes all this and more. Our standard reporting framework has scheduling, queue display, and history display. SHARP also excels at running large volumes of ad hoc queries.

Allow us to show you how well our ad hoc query tool performs in the New York State Medicaid data warehouse. These are not predefined, optimized reports. The following graph shows a weekly operational report. In it, you see that SHARP delivers and executes 80 percent of OBIE queries in under five minutes, and often much less than that. 60 percent deliver in under a minute.

SHARP delivers: Query and report performance

Interoperability Condition

This condition speaks to the ability of the platform to have meaningful interaction with the exchange and with other entities. In NYS, we have approximately 1,500 users in the Medicaid data warehouse, including users from CMS, 13 state agencies, 57 upstate counties, and New York City entities.

SHARP can be easily configured to ingest industry-standard formats, including ACA, HL7, X12, and HIPAA 5010, as well as other health data standards established by entities like the U.S. Department of Health and Human Services and the Institute of Health.

SHARP addresses the data semantics, data harmonization, data ownership, security, and privacy implications of shared data.

Decision Support System and Data Warehouse Checklist for CMS Certification

SHARP also meets the business objectives for CMS certification. SHARP accomplishes the business objectives of a Decision Support System (DSS) in regard to its critical role in the management of the state Medicaid program. There are three checklist items. We deliver on all these and more.

  • Support better understanding and management of Medicaid program
  • Provide timely and effective reports for management planning and control
  • Support improved analysis for decision making

CMA provides a very understandable data model to users, which was perfected for New York State, and would be leveraged for another state’s implementation. It reflects the data received from more than 250 source data files, received on varying frequency.

We think of our solution as sort of an iceberg. The users see the very tip of the iceberg. They see the query tools and the predictive analysis tools. But there is also that piece of the iceberg that lies below the surface. That is what the SHARP solution provides—a solid technological foundation. With its modular design, you can plug in the tools that are most appropriate for your clients.

All three portions of the “Medicaid Innovations” presentation can be seen online, and we’ve posted summaries as well.

Technology Accelerators
Enhanced Funding Requirements
Medicaid Innovation in New York State

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