Texas Health and Human Services Commission
RFP No. 529-13-0018
Attachment N:
[Date]
Data Collection Document
The following content provides data collection specifications.
Data Collection Specification - CV - Authorizations Collection
Opportunity:
CV - Client Visibility Across Programs
Collection:
DC149 - Authorizations Collection
Description:
Collect client authorization for programs and services across FFS and LTC
programs. Data can be used to forecast future medical needs and
financials. Currently, do not have access to Managed Care authorizations,
but that could change with contract updates between the State and MCO.
Functional
Requirements:
FR027 - Provide visibility to client authorization for Medicaid
FR049 - Track health care timeliness, process of service delivery
(including disease mgmt).
FR065 - Measure and evaluate health impact of non-continuous service
utilization
Content:
List By Client By Provider By Program By Location By Time
Metrics:
Number Clients Authorized for Program Service by Period, Estimated
Potential Cost for Authorized Program Services by Period
Topics:
Service Authorization, Service Utilization
Usage:
Track health care timeliness, delivery and impact as it relates to client
authorization for Medicaid services.
Dimensions:
Client, Program, Location, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Retroactive rolling for up to 12 months [Eligibility and Enrollment]
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Provider @[Performing Provider, Provider Type/Specialty, Health Plan]
Program @[Risk Group, Waiver Program]
Location
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RFP No. 529-13-0018
Time @[Date of Authorization, Authorization Period]
Major Source
Systems:*
Compass 21 (228 Tables, 2624GB)
SAS (23 Tables, 7GB)
Minor Source
Systems:*
Additional
Data Sources:
Leveraged
Collections:
Program Enrollment by Client Collection
Provider Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
MFADS Users
SDS
System Forecasting
Vendor Drug Program
Status:
New
EDW/BI DD&I
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Confidential – Sensitive Procurement Information
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Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - CV - Churn Collection
Opportunity:
CV - Client Visibility Across Programs
Collection:
DC099 - Churn Collection
Description:
Periodically identify clients who have changes in eligibility, enrollment, and
authorization across the enterprise then summarize and transform this
information to produce churn
Functional
Requirements:
FR024 - Trend client enrollment / disenrollment across programs and risk
groups.
FR025 - Investigate client churn by program or risk group.
FR026 - Classify clients by disenrollment reasons to trigger intervention
and/or alternate
program placements
Content:
List By Client By Program By Time
Metrics:
Number of Clients Enrolling by Month, Number of Clients Disenrolling by
Month, Number of Eligible Clients by Month, Ranked Reasons for
Disenrollment, Ranked Reasons for
Topics:
Client Enrollment
Usage:
Assess course of changes on an individual and aggregate basis to
ascertain reasons for changes: member communication issues, policy
changes, changes in client residence or health status, or fraud and abuse
are some potential reasons. Initiate processes to follow up on agency and
enterprise service quality issues, forward potential fraud and abuse to OIG.
Dimensions:
Client, Program, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Program @[Risk Group, Waiver Program, Dis/Enrollment Code]
Time @[Date of Service, Fiscal Month, Fiscal Quarter, Fiscal Year]
Major Source
EDW/BI DD&I
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Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
Systems:*
Compass 21 (228 Tables, 2624GB)
Encounters (64 Tables, 356GB)
MAXSTAR - MAXIMUS (Sizing TBD)
TIERS (262 Tables, 448GB)
Minor Source
Systems:*
ASKIT (356 Tables, 50GB)
CMS/ICF/MR PRV PMT (90 Tables, 10GB)
HEART (ALHQ/HQ) (300 Tables, 16GB)
SAVERR (363 Tables, 1GB)
Additional
Data Sources:
Alignment of EHR Data Elements
CHIP
Eligibility Codes and Descriptions
SNAP
SURS
Texas Department of Justice Medical Records
Leveraged
Collections:
Authorizations Collection
Client Personal Cross-Reference
Program Enrollment by Client Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
MFADS Users
SDS
THSteps
Status:
EDW/BI DD&I
Updated
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Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - CV - Client Composite Eligibility
Collection
Opportunity:
CV - Client Visibility Across Programs
Collection:
DC069 - Client Composite Eligibility Collection
Description:
Collect information on Client eligibility across programs including those
outside of Medicaid
(i.e. Medicare).
Functional
Requirements:
FR022 - Track client eligibility across all programs included in TIERS
FR063 - Integrate Medicaid and Medicare data for dual-eligible
population.
FR059 - Provide integrated visibility of drugs dispensed to
Medicaid/Medicare dual eligibles.
Content:
List By Client (Eligible) across Programs By Time
Metrics:
Count of Eligible Clients, Number of Clients Enrolled in related Medicaid
and Medicare Programs, Percent of Clients with continuous care by period,
Percent of Continuous Care by Client over Time, Percent of Continuous
Care by Client by Program
Topics:
Client Dual Eligibility
Usage:
Enable monitoring of client eligibility across all Medicaid programs.
Integrate Medicaid data with Medicare data to improve visibility of client
services.
Dimensions:
Client, Program, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Retroactive rolling for up to 12 months [Eligibility and Enrollment]
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Program @[Risk Group, Waiver Program]
Time @[Enrollment Month, Fiscal Month, Fiscal Quarter, Fiscal Year]
EDW/BI DD&I
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RFP No. 529-13-0018
Major Source
Systems:*
Compass 21 (228 Tables, 2624GB)
Encounters (64 Tables, 356GB)
TIERS (262 Tables, 448GB)
Minor Source
Systems:*
HEART (ALHQ/HQ) (300 Tables, 16GB)
Additional
Data Sources:
BME File
CHIP
Eligibility Codes and Descriptions
Medicare Eligibility
Leveraged
Collections:
Client Personal Cross-Reference
Program Enrollment by Client Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC Actuarial Analysis
HHSC IT
MFADS Users
SDS
System Forecasting
THSteps
TMHP
Vendor Drug Program
Status:
EDW/BI DD&I
New
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Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - CV - Cohort Collection
Opportunity:
CV - Client Visibility Across Programs
Collection:
DC151 - Cohort Collection
Description:
Collection of utilization data for custom client cohort aggregations as
defined by policy Subject Matter Experts.
Functional
Requirements:
FR005 - Compare rates & costs for a client cohort within/across programs
FR007 - Monitor service utilization by program, risk group, or cohort.
FR083 - Perform geographic and/or demographic analysis of client drug
utilization.
FR012 - Determine when to modify existing programs or design a new
waiver based on drug data.
Content:
List By Client (Client-demographic, Client-geographic), By Program, By
Service, By Time
Metrics:
Average Cost by Custom Client Aggregation, Average Cost by Program
Topics:
Service Utilization
Usage:
Enable comparison of rates and costs for ad hoc client groupings within
and across programs. Facilitate monitoring of service utilization by Risk
Group, Program or custom Cohort. Allow analysis using geographic and
demographic criteria associated with clients and services to help determine
trends in program and service usage.
Dimensions:
Client, Program, Service, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Program @[Risk Group, Waiver Program]
Service @[Diagnosis, Procedure]
Time @[Date of Service]
Major Source
EDW/BI DD&I
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Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
Systems:*
ACS PCRA-VDP (Sizing TBD)
CARE (17 Tables, 7GB)
Compass 21 (228 Tables, 2624GB)
Encounters (64 Tables, 356GB)
SAS (23 Tables, 7GB)
Minor Source
Systems:*
MEHIS (Sizing TBD)
Additional
Data Sources:
Standard Measurement Libraries
Leveraged
Collections:
Client Personal Cross-Reference
Utilization Timeline by Client Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
MFADS Users
SDS
System Forecasting
THSteps
TMHP
Vendor Drug Program
Status:
New
EDW/BI DD&I
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Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - CV - Program Enrollment by
Client Collection
Opportunity:
CV - Client Visibility Across Programs
Collection:
DC150 - Program Enrollment by Client Collection
Description:
Collect client enrollment for programs and services across Medicaid
programs.
Functional
Requirements:
FR081 - Perform geographic and/or demographic analysis of client
access to care.
FR072 - Discover duplication based on enrollment in the integrated
eligibility systems.
FR076 - Implement enterprise view across agencies of case management
portfolio.
FR077 - Monitor drug use for clients in concurrent/complex case
management programs.
FR080 - Perform geographic and/or demographic analysis of clients.
FR024 - Trend client enrollment / disenrollment across programs and risk
groups.
FR004 - Provide capability to share data with other states for disaster
response.
FR006 - Monitor [cost] impact of migration between programs and
services (including both internal and external as available)
FR005 - Compare rates & costs for a client cohort within/across programs
FR023 - Provide visibility to client enrollment for all Medicaid programs
Content:
List By Client By Location By Program
Metrics:
Number of Enrolled Clients
Topics:
Program, Client Enrollment
Usage:
Enable forecasting of future medical needs and financials based on Client
program enrollment. Improve Case Management views across Programs
and Agencies. Compare Client population and access to related Programs
and services by demography and geography.
Dimensions:
Client, Location, Program
Frequency:
Continuous where possible, otherwise daily
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RFP No. 529-13-0018
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
[Date]
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Location
Program @[Risk Group, Program Waiver]
Major Source
Systems:*
MAXSTAR - MAXIMUS (Sizing TBD)
TIERS (262 Tables, 448GB)
Minor Source
Systems:*
SAVERR (363 Tables, 1GB)
Additional
Data Sources:
Program Codes and Descriptions
SSA Addresses
Leveraged
Collections:
Program Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
DSHS Center for Health Statistics
ECI Analysts
HHSC IT
HHSC Operations Support (Managed Care)
MFADS Users
Office of the Medical Director
SDS
System Forecasting
THSteps
TMHP
Vendor Drug Program
Status:
EDW/BI DD&I
New
Page N-10
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - CV - Risk Groups Collection
Opportunity:
CV - Client Visibility Across Programs
Collection:
DC125 - Risk Groups Collection
Description:
Collect all episodes of care for individuals who meet HHS established Risk
Group criteria (by Program). Integrate charges/costs,
procedures/treatments, and prescriptions. Accumulate costs and align and
track individuals’ episodes of care for frequency and severity of diagnoses
(e.g. preventive and maintenance office visits versus hospital). Admissions
and catastrophic
Functional
Requirements:
FR007 - Monitor service utilization by program, risk group, or cohort.
FR024 - Trend client enrollment / disenrollment across programs and risk
groups.
FR025 - Investigate client churn by program or risk group.
FR086 - Provide consistent, integrated reference data (e.g.,
programs/waivers, risk groups, providers, drugs) to support: MCO
oversight, regulatory reporting, and forecasting.
Content:
List By Client By Program
Metrics:
Number of Risk Group Clients, Projected Number of Risk Group Clients
Topics:
Risk Groups, Service Utilization
Usage:
Establish baselines for Risk Groups. Use service utilization data to define
Risk Group profiles and trends. Compare courses of treatment for Risk
Groups with established quality of care standards, and evidence-based
protocols. Identify providers who may need education regarding
updated standards of care for high risk and chronic conditions.
Dimensions:
Client, Program
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Program @[Risk Group, Waiver Program]
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Texas Health and Human Services Commission
RFP No. 529-13-0018
Major Source
Systems:*
TIERS (262 Tables, 448GB)
Minor Source
Systems:*
HEART (ALHQ/HQ) (300 Tables, 16GB)
Additional
Data Sources:
Leveraged
Collections:
Client Personal Cross-Reference
User Groups:
DADS Budget Analysts
DFPS Analysts
ECI Analysts
HHSC IT
MFADS Users
SDS
System Forecasting
THSteps
TMHP
Vendor Drug Program
Vision 21 Users
Status:
EDW/BI DD&I
New
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Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - CV - Unduplicated Count
Collection
Opportunity:
CV - Client Visibility Across Programs
Collection:
DC076 - Unduplicated Count Collection
Description:
Collect data to produce periodic unduplicated counts of eligible individuals
by program and/or Texas and MSIS Type Program codes, along with any
other groupings regularly used for internal or CMS reporting. Maintain
additional unduplicated counts that apply retroactive
eligibility counts to the same groupings.
Functional
Requirements:
FR002 - Create consistent and readily available per capita program
denominators
FR003 - Determine availability in comparable programs (Medicaid)
Content:
List By Program across Time
Metrics:
Count of Eligible and/or Enrolled Clients by Program, Risk Group or Cohort
Topics:
Program, Client Enrollment
Usage:
Provide easily accessible statistics for use in various program reporting
and forecasting
Dimensions:
Program, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Retroactive rolling for up to 12 months [Eligibility and Enrollment]
Security:
None - Contains Program Aggregates Only
Historical
Retention:
In perpetuity
Granularity:
Program @[Type Program Code, Risk Group, Waiver Program]
Time @[Member Month, Fiscal Month, Fiscal Quarter, Fiscal Year]
Major Source
Systems:*
Compass 21 (228 Tables, 2624GB)
TIERS (262 Tables, 448GB)
Minor Source
Systems:*
EDW/BI DD&I
HEART (ALHQ/HQ) (300 Tables, 16GB)
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RFP No. 529-13-0018
Additional
Data Sources:
Leveraged
Collections:
Program Collection
Program Enrollment by Client Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
MFADS Users
SDS
System Forecasting
THSteps
TMHP
Vendor Drug Program
Status:
EDW/BI DD&I
Updated
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Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - SD - Cost Collection
Opportunity:
SD - Service Delivery (Episodes of Care)
Collection:
DC104 - Cost Collection
Description:
Maintain periodic running totals by client of paid claims across all claim
types including actual payouts as well as cost estimated managed care
encounters. Maintain separate parallel totals of premiums and/or capitation
payments attributable at individual levels. Contains a mapping for Fee for
Service costs and Capitated Costs.
Functional
Requirements:
FR005 - Compare rates & costs for a client cohort within/across programs
FR006 - Monitor [cost] impact of migration between programs and
services (including both internal and external as available)
FR044 - Track cost of care across programs and providers
FR052 - Track health outcomes by services and cost.
FR054 - Identify what ought to be the norms for programs and services.
FR009 - Benchmark Medicaid prices/costs/rates for comparisons within
an agency and across programs with historical data.
FR042 - Track and analyze differences in reimbursement units of service,
e.g., time (day, hourly, fifteen minutes, encounter, etc.)
FR011 - Improve ability to predict and manage the impact of changes to
programs and service delivery models.
FR051 - Track client quality of life linked to services and cost and
vulnerability.
FR088 - Compare Medicare with Medicaid providers
Content:
List By Client (Demographic), By Program, By Service, By Diagnosis, By
Period [sum(quantity), sum(cost)]
Metrics:
Quantity, Actual Cost, Rate, Cost by Reimbursement Unit
Topics:
Cost, Service Utilization, Episodes of Care
Usage:
Enable tracking of costs by individual, and by identifiable groupings such
as program, TP codes, primary diagnosis code (for LTC), and permit the
identification of cost outliers. Compare actual costs of FFS versus
Managed Care by Diagnosis, Demographic Groupings, Geography, etc.
Identify candidates for PCCM, lock-in, other forms of Case Management.
Dimensions:
Client, Program, Service, Time
EDW/BI DD&I
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RFP No. 529-13-0018
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
In perpetuity
Granularity:
Client
Program @[Risk Group, Waiver Program, Benefit Plan]
Service @[Diagnostic Level]
Time @[State Fiscal Month, Quarter, Year, Biennium]
Major Source
Systems:*
ACS PCRA-VDP (Sizing TBD)
CARE (17 Tables, 7GB)
Compass 21 (228 Tables, 2624GB)
Encounters (64 Tables, 356GB)
PPS (42 Tables, 1075GB)
SAS (23 Tables, 7GB)
Minor Source
Systems:*
MEHIS (Sizing TBD)
Additional
Data Sources:
Medicare Part A Claims
Medicare Part B Claims
Medicare Part C Claims
Medicare Part D Claims
OASIS
Standard Measurement Libraries
Leveraged
Collections:
Episode of Care Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
MFADS Users
SDS
System Forecasting
THSteps
EDW/BI DD&I
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Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
TMHP
Vendor Drug Program
Status:
EDW/BI DD&I
Replacement
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Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - SD - DME and Supplies Collection
Opportunity:
SD - Service Delivery (Episodes of Care)
Collection:
DC121 - DME and Supplies Collection
Description:
Collect Durable Medical Equipment and Supplies data from Claims and
Encounters. Combine standard measurement libraries and reference
categorization data.
Functional
Requirements:
FR070 - Detect, delineate, and track potential waste and inappropriate
use (Drugs and Supplies).
FR071 - Detect inappropriate use with respect to “once per lifetime” care
episodes.
Content:
List By Client By Provider By Service By Procedure By Product, By Time
Metrics:
Units per Period, Excess per capita, Supplies Consumed versus
Authorized, Excess Cost
Topics:
Service Utilization, DME
Usage:
Enable tracking of Durable Medical Equipment through Episode of Care
integration. Allow for identification of inappropriate DME and/or supplies
utilization.
Dimensions:
Client (Authorization), Service, Product, Time, Provider
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Service @ [Procedure]
Product @ [Unit]
Provider @ [Performing Physician]
Time @ [Any Level]
Major Source
Systems:*
CARE (17 Tables, 7GB)
Compass 21 (228 Tables, 2624GB)
EDW/BI DD&I
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RFP No. 529-13-0018
Encounters (64 Tables, 356GB)
SAS (23 Tables, 7GB)
Minor Source
Systems:*
Additional
Data Sources:
DME Conformance
DME Registry
Medicare Part A Claims
Medicare Part B Claims
Medicare Part C Claims
Medicare Part D Claims
Product Categories
Supplies Conformance
Leveraged
Collections:
Drug Category Collection
Episode of Care Collection
Provider Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
HHSC Operations Support (Managed Care)
Office of the Medical Director
THSteps
Status:
Updated
EDW/BI DD&I
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Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - SD - Episode of Care Collection
Opportunity:
SD - Service Delivery (Episodes of Care)
Collection:
DC103 - Episode of Care Collection
Description:
Collect and integrate normalized service delivery details and costs by
diagnostic, procedural, demographic and geographic groups across all
service delivery modes (from claims and encounter data).
Functional
Requirements:
FR021 - Integrate service data from the All Payers database (THCIC).
FR026 - Classify clients by disenrollment reasons to trigger intervention
and/or alternate
program placements
FR013 - Design more proactive services and programs given wider view
of healthcare delivery over time
FR034 - Track service delivery to client by provider including parent
company.
FR035 - Track service delivery across programs by provider including
parent company
FR036 - Compare episodes of care by provider type, specialty, or health
plan.
FR040 - Parse encounters and claims data into Episodes of Care service
categories.
FR041 - Expose streams of care episodes that cross programs or
departments or agencies
FR045 - Identify clients with a specified primary diagnoses over a specific
period of time.
FR046 - Detect clients with diagnoses indicating the need for disease
management
FR047 - Identify clients who have frequent service or provider changes to
determine cause.
FR050 - Integrate lab data with client records.
FR052 - Track health outcomes by services and cost.
FR053 - Provide the ability to predict and prevent negative outcomes,
including data to help assess client quality of life
FR055 - Map prescription drug stream to episode of care services data.
FR056 - Collect physician administered drug data.
EDW/BI DD&I
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RFP No. 529-13-0018
[Date]
FR057 - Monitor drugs prescribed by client, diagnosis, program, service,
and provider.
FR058 - Analyze drug delivery by provider.
FR059 - Provide integrated visibility of drugs dispensed to
Medicaid/Medicare dual eligibles.
FR060 - Identify indicators of aberrant or irregular client use of drugs.
FR062 - Monitor duration and continuity of care.
FR064 - Identify, measure and evaluate health impact of non-continuous
eligibility or enrollment (Medicaid programs)
FR065 - Measure and evaluate health impact of non-continuous service
utilization
FR069 - Detect, delineate, and track potential waste and inappropriate
use (Services).
FR070 - Detect, delineate, and track potential waste and inappropriate
use (Drugs and Supplies).
FR073 - Discover duplication of services based on service utilization.
FR074 - Discover duplication of services based on drug utilization.
FR075 - Discover duplication across Texas healthcare services; not just
Medicaid programs.
FR078 - Compare client outcomes across case management programs.
FR082 - Compare services used against services available by client &
location.
FR084 - Compare treatments for similar diagnoses by geography or
demography
FR086 - Provide consistent, integrated reference data (e.g.,
programs/waivers, risk groups, providers, drugs) to support: MCO
oversight, regulatory reporting, and forecasting.
FR071 - Detect inappropriate use with respect to “once per lifetime” care
episodes.
FR051 - Track client quality of life linked to services and cost and
vulnerability.
FR054 - Identify what ought to be the norms for programs and services.
FR063 - Integrate Medicaid and Medicare data for dual-eligible
population.
FR066 - Integrate Vendor drug by incorporating drugs prescribed through
private insurance providers.
EDW/BI DD&I
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Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
FR067 - Integrate health data from private insurers.
FR068 - Integrate data about veterans who are also clients from the VA
FR087 - Compile a history of care pertaining to EPSDT (THSteps)
requirements
FR049 - Track health care timeliness, process of service delivery
(including disease mgmt).
FR011 - Improve ability to predict and manage the impact of changes to
programs and service delivery models.
FR039 - Support coordination of care between successive care providers
or programs
FR019 - Align to State Medicaid Health IT Planning (SMHP)
FR079 - Identify specific services by location.
FR012 - Determine when to modify existing programs or design a new
waiver based on drug data.
FR103 - Provide visibility to clients by providers.
FR099 - Provide history in accordance with retention requirements
FR102 - Provide the ability to compare outcomes in institutional and noninstitutional providers
FR005 - Compare rates & costs for a client cohort within/across programs
FR006 - Monitor [cost] impact of migration between programs and
services (including both internal and external as available)
FR007 - Monitor service utilization by program, risk group, or cohort.
FR008 - Anticipate future needs for programs by analysis of trends in
services
FR009 - Benchmark Medicaid prices/costs/rates for comparisons within
an agency and across programs with historical data.
FR010 - Detect outlier client cohorts and rates that merit new
programs/waivers
FR043 - Assess comparable services within and across all agencies
FR044 - Track cost of care across programs and providers
FR061 - Provide a single view of Medicaid services across
programs/agencies.
FR088 - Compare Medicare with Medicaid providers
Content:
EDW/BI DD&I
List By Client [client demographic]
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Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
By Provider [Place of Service]
By Program By Service By Time
Metrics:
Episode Duration, Episode Cost
Topics:
Episodes of Care, Service Utilization
Usage:
Provide conformed views of treatment across service utilization to enable
outcomes measurement and comparison across Clients, Programs and
Providers.
Dimensions:
Client, Provider, Program, Service, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Provider @[Performing Provider, Provider Type/Specialty, Health Plan]
Program @[Risk Group, Waiver Program]
Service @[Diagnosis, Procedure]
Time @[Date of Service, Episode Duration]
Major Source
Systems:*
ACS PCRA-VDP (Sizing TBD)
CARE (17 Tables, 7GB)
Compass 21 (228 Tables, 2624GB)
Encounters (64 Tables, 356GB)
KIDS (18 Tables, 18GB)
SAS (23 Tables, 7GB)
Minor Source
Systems:*
ASKIT (356 Tables, 50GB)
CMIS - CSHCN (522 Tables, 1000GB)
CRS (Tables TBD, 500GB)
ImmTrac (100 Tables, 1024GB)
MEHIS (Sizing TBD)
MTS (Tables TBD, 40GB)
TKIDS (140 Tables, 35GB)
TWICES (365 Tables, 70GB)
EDW/BI DD&I
Page N-23
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
Additional
Data Sources:
Alignment of Correlated Events
Claims Parser for Drug Delivery
Claims Parser for Services
Client Identity Reconciliation and Merge
Course Treatment Time-Line
CPT-4 Procedure Codes
DARS ECI
Diagnostic Code Translators
DME Conformance
Drug Formulary
Drugs to Diagnosis [External]
DSHS TPC
DSM-IV Codes and Descriptions
Geocode Data (Stand alone)
HCPCS Procedure Codes and Descriptions
Health Care Coverage Time-Line
HIX
ICD-10 Diagnostic Codes and Descriptions
ICD-10 Procedure Codes and Descriptions
ICD-9 Procedure Codes and Descriptions
Insurance Brokerage Data
Mapping to Stages of Care
Medicare Part A Claims
Medicare Part B Claims
Medicare Part C Claims
Medicare Part C Claims
Medicare Part D Claims
Procedure Code Translators
RDM
Service Categories
SNOMED (D Axis) Codes and Descriptions
Standard Measurement Libraries
State Data Center Population Data
Supplies Conformance
Texas Department of Education School Records
Texas Procedure Codes and Descriptions
Leveraged
Collections:
EDW/BI DD&I
Cost Collection
Page N-24
Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
Provider Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
DSHS Center for Health Statistics
ECI Analysts
HHSC IT
HHSC Operations Support (Managed Care)
MFADS Users
Office of the Medical Director
SDS
System Forecasting
THSteps
TMHP
Vendor Drug Program
Vision 21 Users
Status:
EDW/BI DD&I
Updated
Page N-25
Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - SD - Provider Performance
Collection
Opportunity:
SD - Service Delivery (Episodes of Care)
Collection:
DC120 - Provider Performance Collection
Description:
Collect Episodes of Care data to assess the quality of service offered by
Provider. Currently, this is largely based on definitions from Business
Analysts. In the future, performance will be defined by Episode of Care
outcomes.
Functional
Requirements:
FR037 - Assess quality of service by provider.
FR038 - Consolidate provider metrics.
FR088 - Compare Medicare with Medicaid providers
FR078 - Compare client outcomes across case management programs.
FR029 - Create an integrated provider profile.
FR102 - Provide the ability to compare outcomes in institutional and noninstitutional providers
Content:
List By Client By Provider By Program By Service By Time
Metrics:
Average Cost Per Procedure by Provider, Number of Clients Serviced
Topics:
Provider Performance, Episodes of Care
Usage:
Compare client outcomes and costs across programs by Provider to
evaluate provider performance.
Dimensions:
Client, Provider, Program, Service, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
In perpetuity
Granularity:
Client
Provider @[Performing Provider, Provider Type/Specialty, Health Plan]
Program @[Risk Group, Waiver Program]
Service @[Diagnosis, Procedure]
Time @[Date of Service]
EDW/BI DD&I
Page N-26
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
Major Source
Systems:*
ACS PCRA-VDP (Sizing TBD)
CARES (106 Tables, 351GB)
Minor Source
Systems:*
HCS (INFO) (56 Tables, 5GB)
Additional
Data Sources:
ASPEN
Dartmouth Atlas
DM Contract for Manageable Conditions
Medicare Part A Claims
Medicare Part B Claims
Medicare Part C Claims
Medicare Part D Claims
Provider Analytic Categories
Provider Taxonomy
Leveraged
Collections:
Episode of Care Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
MEHIS Analysts
MFADS Users
Office of the Medical Director
SDS
System Forecasting
THSteps
TMHP
Vendor Drug Program
Status:
EDW/BI DD&I
Updated
Page N-27
Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - SD - Utilization Timeline by Client
Collection
Opportunity:
SD - Service Delivery (Episodes of Care)
Collection:
DC014 - Utilization Timeline by Client Collection
Description:
Collect service utilization data for all Clients over time. Maintain optimized
datasets for client service use over time versus cost.
Functional
Requirements:
FR006 - Monitor [cost] impact of migration between programs and
services (including both internal and external as available)
FR008 - Anticipate future needs for programs by analysis of trends in
services
FR017 - Identify caregivers and track status (e.g., age, health, availability
to client, location)
Content:
List By Client By Program By Service By Location across Time
Metrics:
Number of Procedures by Member Month, Number of Clients by Diagnosis
Related Group, Number of Clients by BETOS, Number of Procedures by
BETOS
Topics:
Service Utilization
Usage:
Track Client Service utilization over time in order to identify trends and
anticipate future client needs.
Dimensions:
Client, Program, Service, Location, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Program @[Risk Group, Waiver Program]
Service @[Diagnosis, Procedure]
Location @[Place of Service]
Time @[Date of Service]
EDW/BI DD&I
Page N-28
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
Major Source
Systems:*
ACS PCRA-VDP (Sizing TBD)
CARE (17 Tables, 7GB)
Compass 21 (228 Tables, 2624GB)
Encounters (64 Tables, 356GB)
KIDS (18 Tables, 18GB)
SAS (23 Tables, 7GB)
Minor Source
Systems:*
ASKIT (356 Tables, 50GB)
CRS (Tables TBD, 500GB)
MEHIS (Sizing TBD)
MTS (Tables TBD, 40GB)
Additional
Data Sources:
Standard Measurement Libraries
Leveraged
Collections:
Client Personal Cross-Reference
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
MFADS Users
SDS
System Forecasting
THSteps
TMHP
Vendor Drug Program
Status:
EDW/BI DD&I
Updated
Page N-29
Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - DI - Composite Drug Utilization
Collection
Opportunity:
DI - Drug Integration (with Episodes of Care)
Collection:
DC106 - Composite Drug Utilization Collection
Description:
Combine drug utilization data from prescription, physician administered,
and client direct procurement sources.
Functional
Requirements:
FR077 - Monitor drug use for clients in concurrent/complex case
management programs.
Content:
List By Client By Provider By Program By Service By Location By Drug By
Time
Metrics:
Average number of prescriptions (Demographic), Percent of Program
exceeding Utilization, Cost by Program
Topics:
Drug Utilization, Episodes of Care
Usage:
Allow for monitoring and analysis of client drug utilization based on the full
universe of drugs dispensed by providers regardless of delivery method.
Dimensions:
Client, Provider, Program, Service, Location, Drug, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Provider @[Performing Provider, Provider Type/Specialty, Health Plan]
Program @[Risk Group, Waiver Program]
Service @[Diagnosis, Procedure]
Location @[Place of Service]
Product @[Drug]
Time @[Date of Service, Fiscal Month, Fiscal Year, Any Aggregate Level]
Major Source
Systems:*
EDW/BI DD&I
ACS PCRA-VDP (Sizing TBD)
Page N-30
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
Compass 21 (228 Tables, 2624GB)
Encounters (64 Tables, 356GB)
Minor Source
Systems:*
MEHIS (Sizing TBD)
Additional
Data Sources:
Standard Measurement Libraries
Leveraged
Collections:
Drug Category Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
THSteps
Status:
EDW/BI DD&I
Updated
Page N-31
Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - DI - Drug Utilization Category
Collection
Opportunity:
DI - Drug Integration (with Episodes of Care)
Collection:
DC105 - Drug Utilization Category Collection
Description:
Collect drug utilization data by therapeutic categories. Compile statistics
including cost by client, client characteristics, diagnosis, program, or
medical provider.
Functional
Requirements:
FR057 - Monitor drugs prescribed by client, diagnosis, program, service,
and provider.
FR058 - Analyze drug delivery by provider.
FR060 - Identify indicators of aberrant or irregular client use of drugs.
FR070 - Detect, delineate, and track potential waste and inappropriate
use (Drugs and Supplies).
FR074 - Discover duplication of services based on drug utilization.
FR083 - Perform geographic and/or demographic analysis of client drug
utilization.
FR012 - Determine when to modify existing programs or design a new
waiver based on drug data.
FR059 - Provide integrated visibility of drugs dispensed to
Medicaid/Medicare dual eligibles.
FR009 - Benchmark Medicaid prices/costs/rates for comparisons within
an agency and across programs with historical data.
FR010 - Detect outlier client cohorts and rates that merit new
programs/waivers
FR011 - Improve ability to predict and manage the impact of changes to
programs and service delivery models.
Content:
List By Client (Client Demographic, Client Characteristics) By Provider By
Program BY Service By Location By Product (Product Category) By Time
Metrics:
Average number of prescriptions (Demographic), Percent of Program
exceeding Utilization, Cost by Drug Category
Topics:
Service Utilization, Drug Utilization
Usage:
Enable analysis of Program, Client, and Provider dimensions across drug
categories. Identify trends in drug utilization across Programs,
EDW/BI DD&I
Page N-32
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Demographics and Geography.
Dimensions:
Client, Provider, Program, Service, Location, Product, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Provider @[Performing Provider, Provider Type/Specialty, Health Plan]
Program @[Risk Group, Waiver Program]
Service @[Diagnosis, Procedure]
Location @[Place of Service]
Product @[Drug Category, Drug]
Time @[Date of Service, Fiscal Month, Fiscal Year, Any Aggregate Level]
Major Source
Systems:*
ACS PCRA-VDP (Sizing TBD)
Compass 21 (228 Tables, 2624GB)
Encounters (64 Tables, 356GB)
Minor Source
Systems:*
MEHIS (Sizing TBD)
Orchard (Harvest) (211 Tables, 70GB)
Additional
Data Sources:
Claims Parser for Drug Delivery
Standard Measurement Libraries
Leveraged
Collections:
Client Personal Cross-Reference
Drug Category Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
HHSC Operations Support (Managed Care)
MFADS Users
SDS
EDW/BI DD&I
Page N-33
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
System Forecasting
THSteps
TMHP
Status:
EDW/BI DD&I
New
Page N-34
Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - DI - Drugs by Diagnosis Collection
Opportunity:
DI - Drug Integration (with Episodes of Care)
Collection:
DC108 - Drugs by Diagnosis Collection
Description:
Collect drug claims by Client and Provider associated with Episodes of
Care by primary diagnosis and diagnostic group.
Functional
Requirements:
FR055 - Map prescription drug stream to episode of care services data.
Content:
List By Client By Provider By Program By Service By Location By Product
By Time
Metrics:
Aggregated Drug Utilization by Episode Diagnosis, Top 10 Drugs Utilized
by Episode Diagnosis, Bottom 10 Drugs Utilized by Diagnosis
Topics:
Drug Utilization, Episodes of Care
Usage:
Analyze drug utilization to reveal trends by cohort based on Client
characteristics and diagnosis. Reveal common and divergent drug delivery
patterns.
Dimensions:
Client, Provider, Program, Service, Product, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Provider @[Performing Provider, Provider Type/Specialty, Health Plan]
Program @[Risk Group, Waiver Program]
Service @[Diagnosis, Procedure]
Location @[Place of Service]
Product @[Drug]
Time @[Date of Service, Fiscal Month, Fiscal Year, Any Aggregate Level]
Major Source
Systems:*
EDW/BI DD&I
Page N-35
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
Minor Source
Systems:*
Additional
Data Sources:
Alignment of Correlated Events
Drugs to Diagnosis [Internal]
Drugs to Procedure [External]
HIE
Leveraged
Collections:
Drug Category Collection
Episode of Care Collection
User Groups:
DFPS Analysts
HHSC IT
THSteps
Status:
Updated
EDW/BI DD&I
Page N-36
Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - DI - High Utilization Collection
Opportunity:
DI - Drug Integration (with Episodes of Care)
Collection:
DC139 - High Utilization Collection
Description:
Collect all service utilization data, integrate industry standard norms to
allow for outlier
Functional
Requirements:
FR010 - Detect outlier client cohorts and rates that merit new
programs/waivers
FR054 - Identify what ought to be the norms for programs and services.
FR069 - Detect, delineate, and track potential waste and inappropriate
use (Services).
FR060 - Identify indicators of aberrant or irregular client use of drugs.
Content:
List By Client By Provider By Program By Service By Time
Metrics:
Average number of ER Visits (Demographic), Percent of Program
exceeding Utilization
Topics:
Service Utilization
Usage:
Enable benchmarking of service utilization over time to establish norms
and identify outliers. Facilitate detection of potential fraud, abuse and
waste.
Dimensions:
Client, Provider, Program, Service, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Provider @[Performing Provider, Provider Type/Specialty, Health Plan]
Program @[Risk Group, Waiver Program]
Service @[Diagnosis, Procedure]
Time @[Date of Service, Fiscal Month, Fiscal Year, Any Aggregate Level]
Major Source
EDW/BI DD&I
Page N-37
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
Systems:*
ACS PCRA-VDP (Sizing TBD)
CARE (17 Tables, 7GB)
Compass 21 (228 Tables, 2624GB)
Encounters (64 Tables, 356GB)
PPS (42 Tables, 1075GB)
SAS (23 Tables, 7GB)
Minor Source
Systems:*
Additional
Data Sources:
Standard Measurement Libraries
Leveraged
Collections:
Client Personal Cross-Reference
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
HHSC Operations Support (Managed Care)
MFADS Users
Office of the Medical Director
SDS
THSteps
Status:
EDW/BI DD&I
New
Page N-38
Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - DI - Inappropriate Usage
Collection
Opportunity:
DI - Drug Integration (with Episodes of Care)
Collection:
DC140 - Inappropriate Usage Collection
Description:
Collect all drug utilization data, integrate industry standard norms to allow
for outlier analysis.
Functional
Requirements:
FR054 - Identify what ought to be the norms for programs and services.
FR069 - Detect, delineate, and track potential waste and inappropriate
use (Services).
FR060 - Identify indicators of aberrant or irregular client use of drugs.
FR070 - Detect, delineate, and track potential waste and inappropriate
use (Drugs and Supplies).
FR071 - Detect inappropriate use with respect to “once per lifetime” care
episodes.
Content:
List By Client By Provider By Program By Service By Product By Time
Metrics:
Estimated Cost of Inappropriate Service, Total Number of Inappropriate
Encounters by Client, Percent of Clients with aberrant use by Program
Topics:
Drug Utilization
Usage:
Enable benchmarking of drug utilization over time to establish norms and
identify outliers.
Facilitate detection of potential fraud, abuse and waste.
Dimensions:
Client, Provider, Program, Service, Product, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Provider @[Performing Provider, Provider Type/Specialty, Health Plan]
Program @[Risk Group, Waiver Program]
Service @[Diagnosis, Procedure]
EDW/BI DD&I
Page N-39
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
Location @[Place of Service]
Product @[Drug Category Drug]
Time @[Date of Service]
Major Source
Systems:*
ACS PCRA-VDP (Sizing TBD)
CARE (17 Tables, 7GB)
Compass 21 (228 Tables, 2624GB)
Encounters (64 Tables, 356GB)
SAS (23 Tables, 7GB)
Minor Source
Systems:*
MEHIS (Sizing TBD)
Additional
Data Sources:
HEDIS
Medicare Part A Claims
Medicare Part B Claims
Medicare Part C Claims
Medicare Part D Claims
Standard Measurement Libraries
Supplies Conformance
Texas Preferred Drug List
Leveraged
Collections:
Client Personal Cross-Reference
Drug Category Collection
Drugs by Diagnosis Collection
Episode of Care Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
HHSC Operations Support (Managed Care)
MFADS Users
Office of the Medical Director
SDS
THSteps
Status:
EDW/BI DD&I
New
Page N-40
Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - CLH - Course of Treatment
Collection
Opportunity:
CLH - Client Life History
Collection:
DC110 - Course of Treatment Collection
Description:
Collect episodes of care by individual for all stages of care for primary
diagnoses and/or diagnostic groups, including costs, procedures, and
prescriptions
Functional
Requirements:
FR084 - Compare treatments for similar diagnoses by geography or
demography
FR087 - Compile a history of care pertaining to EPSDT (THSteps)
requirements
Content:
List By Client By Service By Product By Time
Metrics:
Number of Visits, Frequency of visits, Average Length of Treatment
Sequence for particular diagnoses or Diagnostic Groups
Topics:
Service Utilization, Episodes of Care, Drug Utilization
Usage:
Enable analysis and outcome measurement across providers and
programs by diagnosis. Allow for comparison of treatment against
established quality of care standards, and evidence-based protocols.
Identify outliers by individual, provider, and Managed Care Organization.
Dimensions:
Client, Service, Product, Time
Frequency:
On-Request or Triggered or Subscription from Health Information
Exchanges
Periodicity:
Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Service @[Diagnosis, Procedure]
Product @[Drug]
Time @[Date of Service]
Major Source
EDW/BI DD&I
Page N-41
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
Systems:*
Minor Source
Systems:*
Additional
Data Sources:
Alignment of EHR Data Elements
Leveraged
Collections:
Drug Category Collection
Episode of Care Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
DSHS Center for Health Statistics
HHSC IT
MFADS Users
SDS
THSteps
Vendor Drug Program
Status:
EDW/BI DD&I
Updated
Page N-42
Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - CLH - Eligibility Lapse Collection
Opportunity:
CLH - Client Life History
Collection:
DC113 - Eligibility Lapse Collection
Description:
Identify individuals with lapses in eligibility and organize data into Episodes
of Care.
Functional
Requirements:
FR064 - Identify, measure and evaluate health impact of non-continuous
eligibility or enrollment (Medicaid programs)
Content:
List By Client (client-eligible)
By Provider By Program By Service By Time
Metrics:
Number of Diagnoses after Eligibility Lapse, Number of Treatments after
Eligibility Lapse, Average Cost of Treatment post Eligibility Lapse, Number
of Eligibility Denials by Reason
Topics:
Client Eligibility, Episodes of Care
Usage:
Enable tracking of Client Episodes of Care pre- and post-coverage lapse
for frequency and severity of diagnoses (e.g. preventive and maintenance
office visits versus hospital admissions and catastrophic events). Allow
Cost analysis to be performed to quantify the cost of cover
Dimensions:
Client, Provider, Program, Service, Time
Frequency:
On-Request or Triggered or Subscription from
Health Information Exchanges
Periodicity:
Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Provider @[Performing Provider, Provider Type/Specialty, Health Plan]
Program @[Risk Group, Waiver Program, Eligibility Denial Code]
Service @[Diagnosis, Procedure]
Time @[Date of Service]
Major Source
Systems:*
EDW/BI DD&I
TIERS (262 Tables, 448GB)
Page N-43
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
Minor Source
Systems:*
Additional
Data Sources:
Eligibility Codes and Descriptions
Enrollment Codes and Descriptions
Service Authorization Codes and Descriptions
Leveraged
Collections:
Client Composite Eligibility Collection
Episode of Care Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
MFADS Users
SDS
System Forecasting
Vendor Drug Program
Status:
EDW/BI DD&I
Updated
Page N-44
Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - CLH - HIE Collection
Opportunity:
CLH - Client Life History
Collection:
DC152 - HIE Collection
Description:
Collect HL7 data from a variety of Health Care Services including hospitals
and Private Insurance Groups to enrich Client records.
Functional
Requirements:
FR033 - Obtain surveillance data (HL7) currently collected by hospitals.
FR050 - Integrate lab data with client records.
FR052 - Track health outcomes by services and cost.
FR028 - Identify people without health insurance.
FR066 - Integrate Vendor drug by incorporating drugs prescribed through
private insurance providers.
FR067 - Integrate health data from private insurers.
FR075 - Discover duplication across Texas healthcare services; not just
Medicaid programs.
FR013 - Design more proactive services and programs given wider view
of healthcare delivery over time
Content:
List By Client By Program By Service By Time
Metrics:
Percent of Program exceeding Utilization, Cost by Program
Topics:
HIE, Episodes of Care, Service Utilization
Usage:
Enable more detailed analysis of Client medical profile and history
including care received outside of Medicaid.
Dimensions:
Client, Program, Service, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA.
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Program @[Risk Group, Waiver Program]
Service @[Diagnosis, Procedure]
EDW/BI DD&I
Page N-45
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Product @[Drug]
Time @[Date of Service, Fiscal Month, Fiscal Year, Any Aggregate Level]
Major Source
Systems:*
Minor Source
Systems:*
Additional
Data Sources:
Alignment of EHR Data Elements
Course Treatment Time-Line
EMR Parser
Service Categories
Leveraged
Collections:
Client Personal Cross-Reference
User Groups:
DADS Budget Analysts
DFPS Analysts
DSHS Center for Health Statistics
HHSC IT
HHSC Operations Support (Managed Care)
MFADS Users
Office of the Medical Director
SDS
System Forecasting
THSteps
Status:
EDW/BI DD&I
New
Page N-46
Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - CLH - High Risk Cohort Collection
Opportunity:
CLH - Client Life History
Collection:
DC116 - High Risk Cohort Collection
Description:
Collect all episodes of care for individuals who have had specified high risk
diagnoses such as Type I and Type II Diabetes, Asthma, COPD, etc.,
including charges/costs, procedures/treatments, and prescriptions.
Accumulate costs and align and track individuals’ episodes of care for
frequency and severity of diagnoses (e.g. preventive and maintenance
office visits versus hospital admissions and catastrophic events).
Functional
Requirements:
FR010 - Detect outlier client cohorts and rates that merit new
programs/waivers
FR046 - Detect clients with diagnoses indicating the need for disease
management
FR049 - Track health care timeliness, process of service delivery
(including disease mgmt).
Content:
List By Client By Program By Service (High Risk) By Location By Time
Metrics:
Number of Clients by High Risk Cohort, Number of Diagnoses by Time,
Number of Clients with Comorbidities
Topics:
Risk Group, Episodes of Care, Service Utilization
Usage:
Accumulate baseline statistics for high risk cohorts receiving Medicaid
benefits. Develop high risk profiles. Identify candidates for Disease
Management programs. Compare courses of treatment for cohorts with
established quality of care standards, and evidence-based protocols.
Identify providers who may need education regarding updated standards of
care for high risk and chronic conditions.
Dimensions:
Client, Program, Service, Location, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
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RFP No. 529-13-0018
Program @[Risk Group, Waiver Program]
Service @[Diagnosis, Procedure]
Location @[Service Location]
Time @[Date of Service]
Major Source
Systems:*
Minor Source
Systems:*
Additional
Data Sources:
Procedure Code Translators
TANF
Leveraged
Collections:
Client Composite Eligibility Collection
Cohort Collection
Episode of Care Collection
User Groups:
DFPS Analysts
DSHS Center for Health Statistics
HHSC IT
MFADS Users
SDS
System Forecasting
THSteps
TMHP
Vendor Drug Program
Status:
EDW/BI DD&I
Updated
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Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - CLH - LTC Care Collection
Opportunity:
CLH - Client Life History
Collection:
DC111 - LTC Care Collection
Description:
Collect all Episodes of Care for individuals in LTC Programs/Waivers
across different care models such as state supported institutions,
institutional care, home and community based care, and self-directed care.
Functional
Requirements:
FR049 - Track health care timeliness, process of service delivery
(including disease mgmt).
FR051 - Track client quality of life linked to services and cost and
vulnerability.
FR053 - Provide the ability to predict and prevent negative outcomes,
including data to help assess client quality of life
Content:
List By Client (Client-Eligible, Client-Waiver) across Program (LTC) By
Service By Time
Metrics:
Average Cost per Episode, Average Length per Episode, Average Cost per
Client by Program
Topics:
LTC, Episodes of Care, Service Utilization
Usage:
Enable development of measures based on required levels of care and
care models to compare costs of similar LTC care. Align and track Clients’
other Episodes of Care for frequency and severity of diagnoses (e.g.
preventive and maintenance office visits versus hospital admissions
and catastrophic events).
Dimensions:
Client, Program, Service, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Client
Program @[Risk Group, Waiver Program]
Service @[Diagnosis, Procedure]
Time @[Date of Service]
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Major Source
Systems:*
CARE (17 Tables, 7GB)
Compass 21 (228 Tables, 2624GB)
Encounters (64 Tables, 356GB)
SAS (23 Tables, 7GB)
Minor Source
Systems:*
Additional
Data Sources:
ASPEN
Leveraged
Collections:
Episode of Care Collection
Program Enrollment by Client Collection
User Groups:
DFPS Analysts
HHSC IT
MFADS Users
SDS
Status:
EDW/BI DD&I
Updated
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[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - DM - Client Personal CrossReference
Opportunity:
DM - Data Management Foundation
Collection:
DC065 - Client Personal Cross-Reference
Description:
Over time, collect identifying and personal data for clients across all
Medicaid programs and systems. Append both financial assessment and
functional assessment data.
Functional
Requirements:
FR006 - Monitor [cost] impact of migration between programs and
services (including both internal and external as available)
FR005 - Compare rates & costs for a client cohort within/across programs
FR015 - Use Vital Statistics (or County Records) to notify business units
of client life changes.
FR023 - Provide visibility to client enrollment for all Medicaid programs
FR026 - Classify clients by disenrollment reasons to trigger intervention
and/or alternate
program placements
FR027 - Provide visibility to client authorization for Medicaid
FR045 - Identify clients with a specified primary diagnoses over a specific
period of time.
FR046 - Detect clients with diagnoses indicating the need for disease
management or
FR047 - Identify clients who have frequent service or provider changes to
determine cause.
FR052 - Track health outcomes by services and cost.
FR053 - Provide the ability to predict and prevent negative outcomes,
including data to help assess client quality of life
FR057 - Monitor drugs prescribed by client, diagnosis, program, service,
and provider.
FR059 - Provide integrated visibility of drugs dispensed to
Medicaid/Medicare dual eligibles.
FR062 - Monitor duration and continuity of care.
FR064 - Identify, measure and evaluate health impact of non-continuous
eligibility or enrollment (Medicaid programs)
FR065 - Measure and evaluate health impact of non-continuous service
utilization
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RFP No. 529-13-0018
[Date]
FR072 - Discover duplication based on enrollment in the integrated
eligibility systems.
FR073 - Discover duplication of services based on service utilization.
FR074 - Discover duplication of services based on drug utilization.
FR075 - Discover duplication across Texas healthcare services; not just
Medicaid programs.
FR076 - Implement enterprise view across agencies of case management
portfolio.
FR077 - Monitor drug use for clients in concurrent/complex case
management programs.
FR078 - Compare client outcomes across case management programs.
FR080 - Perform geographic and/or demographic analysis of clients.
FR081 - Perform geographic and/or demographic analysis of client
access to care.
FR082 - Compare services used against services available by client &
location.
FR083 - Perform geographic and/or demographic analysis of client drug
utilization.
FR084 - Compare treatments for similar diagnoses by geography or
demography
FR085 - Support longitudinal views of clients by geographic and/or
demographic groups
FR051 - Track client quality of life linked to services and cost and
vulnerability.
FR018 - Integrate DSHS registries with client records.
FR049 - Track health care timeliness, process of service delivery
(including disease mgmt).
FR020 - Incorporate public health strategy program data, e.g.,
immunizations, smoking
FR024 - Trend client enrollment / disenrollment across programs and risk
groups.
FR025 - Investigate client churn by program or risk group.
FR007 - Monitor service utilization by program, risk group, or cohort.
FR008 - Anticipate future needs for programs by analysis of trends in
services
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RFP No. 529-13-0018
[Date]
FR010 - Detect outlier client cohorts and rates that merit new
programs/waivers
FR004 - Provide capability to share data with other states for disaster
response.
FR016 - Identify family units (not just households)
FR022 - Track client eligibility across all programs included in TIERS
FR002 - Create consistent and readily available per capita program
denominators
FR034 - Track service delivery to client by provider including parent
company.
FR028 - Identify people without health insurance.
FR014 - Create integrated, unduplicated client profile and improve data
quality.
FR103 - Provide visibility to clients by providers.
FR099 - Provide history in accordance with retention requirements
FR060 - Identify indicators of aberrant or irregular client use of drugs.
Content:
List By Client (client identifiers,
financial assessments, functional assessment)
Metrics:
N/A - Base Collection
Topics:
Client Identity Resolution, Master Data Management
Usage:
Provide a single and comprehensive source for all client information.
Dimensions:
Client
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade. Must be at least as
long as Service
Granularity:
Client
Major Source
Systems:*
ACS PCRA-VDP (Sizing TBD)
KIDS (18 Tables, 18GB)
NORTH STAR (44 Tables, 8GB)
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RFP No. 529-13-0018
Minor Source
Systems:*
Access HR (2200 Tables, 2GB)
CMBHS (1296 Tables, 860GB)
CPW Provider (27 Tables, 250GB)
CRS (Tables TBD, 500GB)
DSHS IMD - MSIS Reporting (6 Tables, 65GB)
HCDCS (Tables TBD, 1GB)
HCS (INFO) (56 Tables, 5GB)
HHSAS (42000 Tables, 4GB)
IMPACT (900 Tables, 500GB)
NBS/LIMS (694 Tables, 220GB)
SAVERR (363 Tables, 1GB)
TER (Tables TBD, 1115GB)
TKIDS (140 Tables, 35GB)
Additional
Data Sources:
BME File
Case management Cross-Reference
Census Data
CHIP
Client Analytic Categories
Client Conformance
Client External Source Integration
DSHS NPAOP
DSHS TPC
Enrollment Codes and Descriptions
Functional Assessment Codes and Descriptions
Geocode Data (Stand alone)
ICD-9 Diagnostic Codes and Descriptions
Insurance Brokerage Data
Insurance Provider Data
Program Codes and Descriptions
RDM
Service Authorization Codes and Descriptions
State Data Center Population Data
WIC
Leveraged
Collections:
EDW/BI DD&I
N/A - Base Collection
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[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
User Groups:
DADS Budget Analysts
DFPS Analysts
DSHS Center for Health Statistics
ECI Analysts
HHSC Actuarial Analysis
HHSC IT
HHSC Operations Support (Managed Care)
MEHIS Analysts
MFADS Users
Office of the Medical Director
SDS
System Forecasting
THSteps
TMHP
Vendor Drug Program
Vision 21 Users
Status:
EDW/BI DD&I
Updated
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Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - DM - Drug Category Collection
Opportunity:
DM - Data Management Foundation
Collection:
DC047 - Drug Category Collection
Description:
Collect and align Drug data from a variety of sources both internal and
external to Texas HHS. Provide a single and comprehensive source for all
Drug Category information at HHS.
Functional
Requirements:
FR055 - Map prescription drug stream to episode of care services data.
FR060 - Identify indicators of aberrant or irregular client use of drugs.
FR070 - Detect, delineate, and track potential waste and inappropriate
use (Drugs and Supplies).
FR074 - Discover duplication of services based on drug utilization.
FR083 - Perform geographic and/or demographic analysis of client drug
utilization.
FR086 - Provide consistent, integrated reference data (e.g.,
programs/waivers, risk groups, providers, drugs) to support: MCO
oversight, regulatory reporting, and forecasting.
FR100 - Provide a drug reference file
FR101 - Provide a DME and supply reference file
Content:
List By Product (Drug Category)
Metrics:
N/A - Reference Collection
Topics:
Drug Categorization
Usage:
Provide Drug Categorization data that enables analysis across Episodes of
Care, Provider and Client.
Dimensions:
Product
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Reference data exists in proprietary systems but needs to be acquired for
enterprise use.
Historical
Retention:
EDW/BI DD&I
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
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Texas Health and Human Services Commission
RFP No. 529-13-0018
Granularity:
Product @[Drug Category, Drug, NDC, Formulation]
Major Source
Systems:*
ACS PCRA-VDP (Sizing TBD)
Minor Source
Systems:*
MEHIS (Sizing TBD)
Additional
Data Sources:
Claims Parser for DME and Supplies
Classification Scheme Alignment
CMS PDL
Drug Analytic Categories
Drug Classification
Drug Cross-Reference
Drugs to Diagnosis [Internal]
Drugs to Procedure [External]
Drugs to Procedure [Internal]
HEDIS
Industry Therapeutic Groups
National Drug Code Reference Data
Standard Measurement Libraries
Texas Preferred Drug List
Leveraged
Collections:
N/A - Base Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
DSHS Center for Health Statistics
ECI Analysts
HHSC IT
HHSC Operations Support (Managed Care)
SDS
THSteps
Vision 21 Users
Status:
EDW/BI DD&I
New
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Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - DM - Medicare Services
Collection
Opportunity:
DM - Data Management Foundation
Collection:
DC134 - Medicare Services Collection
Description:
Collect claims and encounters data from Medicare programs. Integrate
Medicare claims and encounters into Client Episodes of Care.
Functional
Requirements:
FR063 - Integrate Medicaid and Medicare data for dual-eligible
population.
FR088 - Compare Medicare with Medicaid providers
FR006 - Monitor [cost] impact of migration between programs and
services (including both internal and external as available)
FR059 - Provide integrated visibility of drugs dispensed to
Medicaid/Medicare dual eligibles.
FR075 - Discover duplication across Texas healthcare services; not just
Medicaid programs.
FR048 - Include non Title XIX funded program services that have a direct
impact on Medicaid client health
Content:
List By Client By Provider By Program, By Service By Time
Metrics:
Average Cost per Claim, Average Cost per Client over time
Topics:
Dual Eligibility, Service Utilization
Usage:
Enable comparison of service utilization and costs by Program for dual
eligible Clients.
Dimensions:
Client, Provider, Program, Service, Time
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Based on future detail design requirements
Granularity:
Client
Provider @[Provider Type/Specialty, Health Plan]
Program @[Risk Group, Waiver Program]
Service @[Diagnosis, Procedure]
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RFP No. 529-13-0018
Time @[Date of Service]
Major Source
Systems:*
Minor Source
Systems:*
Additional
Data Sources:
Medicare Part A Claims
Medicare Part B Claims
Medicare Part C Claims
Medicare Part D Claims
Leveraged
Collections:
Client Personal Cross-Reference
User Groups:
DADS Budget Analysts
DFPS Analysts
HHSC IT
HHSC Operations Support (Managed Care)
MFADS Users
SDS
System Forecasting
THSteps
TMHP
Vendor Drug Program
Status:
EDW/BI DD&I
New
Page N-59
Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - DM - Program Collection
Opportunity:
DM - Data Management Foundation
Collection:
DC147 - Program Collection
Description:
Collect and align Program data across the HHS Enterprise. Provide a
single and comprehensive source for all Program information at HHS to
include services offered, related legislation, benefit plans and more.
Functional
Requirements:
FR035 - Track service delivery across programs by provider including
parent company
FR001 - Map programs and waivers to create a program profile
FR002 - Create consistent and readily available per capita program
denominators
FR003 - Determine availability in comparable programs (Medicaid)
FR009 - Benchmark Medicaid prices/costs/rates for comparisons within
an agency and across programs with historical data.
FR036 - Compare episodes of care by provider type, specialty, or health
plan.
FR039 - Support coordination of care between successive care providers
or programs
FR041 - Expose streams of care episodes that cross programs or
departments or agencies
FR042 - Track and analyze differences in reimbursement units of service,
e.g., time (day, hourly, fifteen minutes, encounter, etc.)
FR043 - Assess comparable services within and across all agencies
FR044 - Track cost of care across programs and providers
FR061 - Provide a single view of Medicaid services across
programs/agencies.
FR073 - Discover duplication of services based on service utilization.
FR030 - Provide visibility to provider enrollment for all Medicaid programs.
FR072 - Discover duplication based on enrollment in the integrated
eligibility systems.
FR076 - Implement enterprise view across agencies of case management
portfolio.
FR077 - Monitor drug use for clients in concurrent/complex case
EDW/BI DD&I
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Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
management programs.
FR005 - Compare rates & costs for a client cohort within/across programs
FR006 - Monitor [cost] impact of migration between programs and
services (including both internal and external as available)
FR007 - Monitor service utilization by program, risk group, or cohort.
FR008 - Anticipate future needs for programs by analysis of trends in
services
FR010 - Detect outlier client cohorts and rates that merit new
programs/waivers
FR011 - Improve ability to predict and manage the impact of changes to
programs and service delivery models.
FR020 - Incorporate public health strategy program data, e.g.,
immunizations, smoking
FR047 - Identify clients who have frequent service or provider changes to
determine cause.
FR052 - Track health outcomes by services and cost.
FR012 - Determine when to modify existing programs or design a new
waiver based on drug data.
FR013 - Design more proactive services and programs given wider view
of healthcare delivery over time
FR057 - Monitor drugs prescribed by client, diagnosis, program, service,
and provider.
FR017 - Identify caregivers and track status (e.g., age, health, availability
to client, location)
FR029 - Create an integrated provider profile.
FR078 - Compare client outcomes across case management programs.
FR048 - Include non Title XIX funded program services that have a direct
impact on Medicaid client health
FR022 - Track client eligibility across all programs included in TIERS
Content:
None
Metrics:
N/A - Base Collection
Topics:
Program, Master Data Management
Usage:
Enable creation of per capita program denominators. Allow for comparison
of programs and services to identify areas of overlap and alternatives.
Monitor cost to programs by service to identify trends and forecast future
EDW/BI DD&I
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Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
program needs.
Dimensions:
Program
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
Observe and comply with HIPAA
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Program @[Risk Group, Waiver Program]
Major Source
Systems:*
ACS PCRA-VDP (Sizing TBD)
CARE (17 Tables, 7GB)
Compass 21 (228 Tables, 2624GB)
Encounters (64 Tables, 356GB)
SAS (23 Tables, 7GB)
TIERS (262 Tables, 448GB)
Minor Source
Systems:*
Additional
Data Sources:
Drug Merge
Medicaid Program Registry
Program Codes and Descriptions
SSA Addresses
Leveraged
Collections:
N/A - Base Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
DSHS Center for Health Statistics
HHSC Actuarial Analysis
HHSC IT
HHSC Operations Support (Managed Care)
MEHIS Analysts
MFADS Users
Office of the Medical Director
EDW/BI DD&I
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Confidential – Sensitive Procurement Information
Texas Health and Human Services Commission
RFP No. 529-13-0018
People who need clean addresses for mailings
SDS
System Forecasting
THSteps
TMHP
Vendor Drug Program
Status:
EDW/BI DD&I
New
Page N-63
Confidential – Sensitive Procurement Information
[Date]
Texas Health and Human Services Commission
RFP No. 529-13-0018
[Date]
Data Collection Specification - DM - Provider Collection
Opportunity:
DM - Data Management Foundation
Collection:
DC148 - Provider Collection
Description:
Collect data from internal and external sources on Providers and align
across the HHS
Enterprise. Provide a single and comprehensive
source for all Provider information at HHS to include Provider address,
Physicians, Certifications/Accreditations, Locations, Citation History and
more.
Functional
Requirements:
FR036 - Compare episodes of care by provider type, specialty, or health
plan.
FR038 - Consolidate provider metrics.
FR044 - Track cost of care across programs and providers
FR047 - Identify clients who have frequent service or provider changes to
determine cause.
FR079 - Identify specific services by location.
FR088 - Compare Medicare with Medicaid providers
FR039 - Support coordination of care between successive care providers
or programs
FR032 - Integrate registry data from provider accreditation organizations.
FR017 - Identify caregivers and track status (e.g., age, health, availability
to client, location)
FR030 - Provide visibility to provider enrollment for all Medicaid programs.
FR031 - Provide integrated, cleansed provider data to support regulatory
changes
FR034 - Track service delivery to client by provider including parent
company.
FR035 - Track service delivery across programs by provider including
parent company
FR037 - Assess quality of service by provider.
FR081 - Perform geographic and/or demographic analysis of client
access to care.
FR082 - Compare services used against services available by client &
location.
EDW/BI DD&I
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RFP No. 529-13-0018
[Date]
FR080 - Perform geographic and/or demographic analysis of clients.
FR084 - Compare treatments for similar diagnoses by geography or
demography
FR057 - Monitor drugs prescribed by client, diagnosis, program, service,
and provider.
FR058 - Analyze drug delivery by provider.
FR012 - Determine when to modify existing programs or design a new
waiver based on drug data.
FR083 - Perform geographic and/or demographic analysis of client drug
utilization.
FR029 - Create an integrated provider profile.
FR103 - Provide visibility to clients by providers.
FR105 - Map provider and provider parent company relationships
Content:
List By Provider By Program By Location
Metrics:
N/A - Base Collection
Topics:
Provider, Episodes of Care, Master Data Management
Usage:
Enables Provider analysis by Program, Service, Diagnosis, Location and
other attributes.
Dimensions:
Provider, Program, Services, Location
Frequency:
Continuous where possible, otherwise daily
Periodicity:
Weekly, Monthly, Fiscal Year, Calendar Year
Security:
None
Historical
Retention:
Net-change retention for a minimum of one decade (must be at least as
long as Service Delivery)
Granularity:
Provider @[Performing Provider, Provider Type/Specialty, Health Plan]
Program @[Risk Group, Waiver Program]
Location @[Service Locations]
Major Source
Systems:*
CARES (106 Tables, 351GB)
Compass 21 (228 Tables, 2624GB)
MAXSTAR - MAXIMUS (Sizing TBD)
NE Provider (61 Tables, 1GB)
PPS (42 Tables, 1075GB)
EDW/BI DD&I
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Texas Health and Human Services Commission
RFP No. 529-13-0018
TIERS (262 Tables, 448GB)
Minor Source
Systems:*
ANE (68 Tables, 4GB)
Additional
Data Sources:
BDE File
BNE
Census Data
Drug Formulary
Geocode Data (Stand alone)
ICF-MR
OASIS
PARIS
Provider Facilities
Provider Identity Reconciliation and Merge
Provider Ownership and Contract Info
Provider Structure with Employees
Provider Taxonomy
SureScripts
Leveraged
Collections:
N/A - Base Collection
User Groups:
DADS Budget Analysts
DFPS Analysts
DSHS Center for Health Statistics
HHSC IT
HHSC Operations Support (Managed Care)
MEHIS Analysts
MFADS Users
Office of the Medical Director
People who need clean addresses for mailings
SDS
System Forecasting
THSteps
TMHP
Vendor Drug Program
Status:
EDW/BI DD&I
New
Page N-66
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[Date]