© 2011 IBM Corporation 1

FAMS Visualization Report Card

Report Card’s show a providers behavior across all features in a model

– Shows values, ranking, and peer group comparison scoring for all features, groups and composite

© 2011 IBM Corporation 2

Claims Reports

General procedure and diagnosis utilization reporting

Procedure, diagnosis and claim detail breakdowns by– Provider– Recipient– Provider and recipient

Recipient Drift Report

Procedure Code combination reporting

Claim detail reporting

Claim detail cross referencing to models

© 2011 IBM Corporation 3

Models available to MCO’s for profile creation

Outpatient Behavioral Health Therapist Model– Outpatient Therapist Profile– Outpatient Therapist Group Profile

CABHA Model– CISA Profile– CABHA Profile

Outpatient Behavioral Health Physicians Model– Outpatient Physician Profile– Outpatient Physician Group Profile

Residential Child Care Center Model– Residential Child Care Center Profile

Psychiatric Residential Treatment Facility Model– Psychiatric Residential Treatment Facility Profile

© 2011 IBM Corporation 4

Maintaining and upgrading models

FAMS Application Models

Data Analytics Team(DAT)

MCO Analyst

MCO ModelCommittee

AnalysisProfiles

•MCO’s will all use the same models

•Models are maintained by Program Integrity

•Changes to the model and creation of profiles are managed by the Data Analytics Team

© 2011 IBM Corporation 5

Claims Data Process

Recipient + Provider = Visit

HP /MMIS/DRIVE

Recipients Provider EncounterData

Claim for visit

MCO SpecialInvestigations

Unit

Monthly FAMS

Data Load

MCO ClaimProcessing

FAMS datamart

ModelsAnalysis Profiles

Program IntegrityData Analytics

Team

© 2011 IBM Corporation 6

Data quality

FAMS depends on encounter claims submitted– All claims need to be submitted– Claims should not be duplicated

Since FAMS is retrospective…– There must be historical claims to analyze– Claims must be submitted on a timely basis

Garbage in Garbage out– Claims must be accurate and contain the appropriate information in the fields– More information the better

© 2011 IBM Corporation 7

Separation of Data

DMA IT Access

Data Analytics

Team Access

Value Sets by MCO

MCO Access

FAMS Data StorageIncludes MCO Claims

NCID

FAMS Models

AnalysisProfilesby MCO

MCOMCO

MCO

MCO

MCO

MCO Claims System

MCO Reporting System

HP MMIS/DRIVE

•Each MCO will only have access to their own data

•This will be achieved through role based security at login

•MCO’s will be allowed 4 users per organization (expected)

© 2011 IBM Corporation 8

Security requirements for access

Security requirement definitions are currently in process

Items being discussed:– What hardware will be needed for access?– How will logins be configured?– How will access be maintained?

Once they are defined security settings will be communicated to the MCO’s

© 2011 IBM Corporation 9

Project Timeline

Assign models for MCO’s to use

Establish Beta tester

Complete mapping and test loading of encounter claims

Create test profiles

Hold MCO training

Implement FAMS for MCO’s ready to go live– January 1, 2013– For those MCO’s not yet live, a rolling implementation will occur once encounter claims

history is established

Hold follow up training

© 2011 IBM Corporation 10

Training

Identification Methods

Investigation process

Common Schemes

Basic “How to” in FAMS

Helpful reports

Business examples

How to create “Allegation

packages”

© 2011 IBM Corporation 11

Ongoing Support

FAMS Team– Thomas Nisbet IBM Consultant– Marianne Hungate, IBM Consultant– Steve Sharp, IBM Project Manager

Support line

Allegation Package creation

Ongoing scheduled meetings and communications

© 2011 IBM Corporation 12

Questions?