Sheres of Influence and MTGs

It is important to remember that MITA is much more than “an MMIS on steroids” as has been eloquently stated by a well-known MITA Champion at CMS. MITA attempts to boldly go beyond the boundaries of the traditional claims processing and reporting system that we have all known and loved for 3 decades and into a realm where Medicaid information systems can be platforms upon which clinical data is shared and quality measures are monitored. MITA speaks in terms of the "Medicaid Enterprise".

In MITA Framework 2.0, The Medicaid Enterprise is defined in the MITA context as three spheres of influence. The first sphere is basically anything that has traditionally been covered under Federal matching funds – the “core” of the system - the part that would be ingesting the aforementioned steroids if they were legal and/or the league commissioner chose to look the other way.

The second “sphere” basically includes the interfaces into and out of the core system. Nothing really new here, unless we are talking about building bridges to agencies such as mental health, public health, education, corrections, etc… in an effort to expand the Medicaid Enterprise.

The third sphere is defined in Framework 2.0 as “the sphere of influence that touches, or is touched by, MITA”. This is where we break ground in the realm of Health Information Technology (HIT) and Health information Exchange (HIE). To this end, it useful to consider the Medicaid Transformation Grants (MTG) that were let by CMS over the last year.

As described on the CMS MTG web site: Section 6081 of the Deficit Reduction Act (DRA) authorizes new grant funds to States for the adoption of innovative methods to improve effectiveness and efficiency in providing medical assistance under Medicaid. Through the use of the Transformation Grants, States can work with CMS to create programs that are more aligned with today's Medicaid populations and health care environment.

Of the 46 MTGs that were awarded, 25 of them - over half - are related to HIT. While this “Third Sphere” is characterized by the exchange of information or influence without involvement of any Federal matching funds for the Medicaid agency, it is important to examine these projects through the prism of the MITA Maturity Model. There are still some MITA skeptics who believe that maturity levels 4 and 5 in the MITA framework are pipe dreams; these transformation grants, and the pioneers behind these grants are proof positive that HIT and HIE integration with MITA is truly on the horizon.

More information on these grant projects can be obtained by contacting the Medicaid systems folks in each of the named States. More information on the Medicaid Transformation Grant awards can be found here: http://www.cms.hhs.gov/MedicaidTransGrants/02_2007awards.asp#TopOfPage