Business Architecture

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See also: BA

Introduction

In keeping with the guiding principle that MITA represents a business-driven enterprise transformation, the BA is the starting point of the MITA Framework. The BA describes the needs and goals of the individual State Medicaid Enterprise, and presents a collective vision of the future.

The BA[1] focuses on the State Medicaid Enterprise that centers on the Medicaid environment including leveraged systems and interconnections among Medicaid stakeholders, providers, beneficiaries, insurance affordability programs (e.g., CHIP, tax credits, Basic Health Program), Health Insurance Exchange (HIX), Health Information Exchange (HIE), other state and local agencies, other payers, Centers for Medicare & Medicaid Services (CMS), and other federal agencies.

Background

States, territories, and the District of Columbia (hereinafter referred to as States) are responsible for their individual State Medicaid Enterprise, and all entities are different in important ways. Differences include:  Enterprise can have other meanings. For instance, Enterprise Architecture (EA) defines an enterprise-wide integrated set of components that incorporates strategic business thinking, information assets, and the technical infrastructure of an enterprise to promote information sharing across agency and organizational boundaries. *Organizational structure, covered programs, and lines of business;

  • Business rules, policies, and procedures affecting stakeholders;
  • Relationships with other state and local agencies;
  • Revenue sources;
  • Location of business units;
  • Workflow;
  • Range of outsourcing;
  • Technical solutions

These entities also differ in their concept of an enterprise, the roles and responsibilities of one or more Chief Information Officers (CIO), adoption of data and technical standards, and the use of legacy versus state-of-the-art applications.

Given these differences, it is not possible or desirable, in the context of the MITA Framework, to develop a standalone business and technical model for each individual Medicaid Enterprise. Instead, MITA establishes a national framework of common processes and enabling technologies to support improved program administration in all States.

The BA focuses on areas of common ground (e.g., that all States will enroll providers and pay for services rendered to eligible beneficiaries and that all States seek to improve health care outcomes and improve administrative processes).

There is no ready-made methodology for building the MITA Framework to accommodate the business needs and transformation strategies of the States. To meet the special needs of MITA, the components included in the BA draw upon methodologies commonly in use today across industries as diverse as financial, transportation, and defense. The MITA team designed templates and models to help States identify and prioritize their specific business needs.

Notes

  1. http://medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Data-and-Systems/MITA/Medicaid-Information-Technology-Architecture-MITA-30.html