Business Case
Given their size and societal charters, many State Medicaid programs are stepping forward as change agents, helping to transform the healthcare ecosystem as it transitions from an episodic, fee-for-service or capitated orientation, to quality focused, value-based business models.
States and leading industry stakeholders are leveraging expanded datasets, sophisticated analytics and timely reporting of key performance indicators to navigate the complexities associated with the redesign of care systems and the implementation of innovative payment schemes, not to mention other business challenges including the detection and prevention of fraud, waste, and abuse.
Large and complex, today’s Medicaid programs need highly scalable and secure environments capable of managing, enriching and analyzing massive amounts of data, from an ever-increasing number of sources.
The Solution
CMA created the Secure Healthcare Analytics and Research Platform (SHARP) with Oracle technologies, to provide states with an enterprise-wide solution for healthcare analytics.
Several companies provide commercial, off-the-shelf (COTS) based analytical solutions. SHARP goes a step further. Its Service-Oriented Architecture (SOA) and modular design:
- Satisfies Medicaid Information Technology Architecture (MITA) Framework 3.0 and the Enhanced Funding Requirements Seven Conditions and Standards.
- Enables a comprehensive foundation, which enables a total solution.
- Provides transformed, accurate, and current data that is available for high-speed data access.
- Allows for easy transferability and reuse of specific components to meet a state’s business needs.
SHARP was implemented on a robust, best-in-class server technology foundation with a carefully-designed blend of platforms. Based on Oracle software, SHARP’s architecture was developed to provide high performance, scalable, fault-tolerant platforms to support various processing requirements including database, ETL, and BI application functions.
Each configuration is scalable, either upwards or downwards, to support the required service levels for both performance and system availability. SHARP’s architecture includes a defined topology for supporting a multi-tier environment including development, testing, training, and disaster recovery.
SHARP comprises six fully-integrated platforms: Web Portal, Business Intelligence, Metadata, Data Delivery, ETL, and Database. These platforms optimize many Oracle technologies, including Oracle WebCenter Portal, Oracle Business Intelligence Suite, Oracle SOA Suite built Enterprise Service Bus (Oracle OSB), Oracle Warehouse Builder (OWB), Oracle Data Integrator (ODI), Oracle Goldengate, Oracle Enterprise EDQ, Oracle MDM, and Oracle Databases.
The Results
The SHARP-driven MDW in New York currently supports the following:
- An ETL platform that cleanses, iterates, and transforms data in real-time for over 250 inbound files from several different entities.
- The secure data transfer of over 450 outbound files to 13 different entities.
- Secure and customized access to over 1,400 users via a single sign-on web portal.
- A BI platform that provides dashboards, standard, custom, and ad hoc reporting, and direct SQL access to over 600 tables.
- Support for the execution of over 4,000 queries and 1,500 reports weekly, with 90% of all requests completing in under 5 minutes.
- Configurable, real-time metadata that drives scheduling, process control, and auditing while providing users with an online Data Dictionary that is fully integrated throughout.
- Over a petabyte of accessible and secure healthcare data, including over 5 billion historical managed care and fee-for-service claims spanning 9 years and enrollment data for over 6 million members.