4.9 Key Activity #9 – Manage Change Order Process 4.9.2.1 Deliverable 1 – Change Order Request Reports 4.9.2.2 Deliverable 2 – Monthly. Change Order Reports 4.9.2.3 Deliverable 3 – Draft Change Orders 4.9.2.4 Deliverable 4 – Change Order Tracking 4.10 Key Activity #10 – Assist with CMS Certification 4.10.2.1 Deliverable 1 – Certification Documentation 4.10.2.2 Deliverable 2 – CMS Certification Letter 4.10.2.3 Deliverable 3 – Other Certification Documentation 4.11 Key Activity #11 – Coordinate with Other Initiatives 4.11.2.1 Deliverable 1 – Communication Plan 4.11.2.2 Deliverable 2 – Project Dashboard 4.11.2.3 Deliverable 3 – Periodic Reports 4.11.2.4 Deliverable 4 – Risk Impact Reports 4.12 Key Activity #12 – Support the Healthcare Project Coordination Committee 4.12.2.1 Deliverable 1 – Attend All meetings 4.12.2.2 Deliverable 2 – Prepare Meeting 4.12.2.3 Deliverable 3 – Prepare Meeting Agendas 4.13 Key Activity #13 – Post Implementation Monitoring 4.13.2.1 Deliverable 1 – Monthly Status Reports RFP § 1.8 Identify any gaps in the scope of work as it relates specifically to oversight, integration or management of the project and define how the gaps would be closed. 4.14 Gaps – Identification and Closure Strategies Industry Standards and Best Practices The Cognosante POMI will use industry standards and best practices shown in Table 4. Table : Industry Standards and Best Practices Practice Area Standard Reference Name Subject Project Management IEEE 1490-1998 PMBOK IEEE 1220-2005 Adoption of PMI Standard PMI Project Management Body of Knowledge Standard for Application and management of the Systems Engineering Process Software Project Management IEEE 1058-1998 IEEE 12207-2008 S/W Project Management Plan (SPMP) Information Technology – Software life cycle processes IT/Software Design and Development IEEE 1063-2001 IEEE 1471-2000 IEEE 2001-1999 MITA Version 2.01 Standard for S/W User Documentation Recommended Practice for Architectural Description (AD) of S/W Intensive Systems
Processes which ensure that elements of the project are properly coordinated using Microsoft Project software based on the project scope of work and metrics from previous, similar projects Incorporating the project plan into the contract scope of work Utilizing the project plan as the basis for all work activities and staff assignments Generating project reports tracking activity status, deadlines and costs Making the baseline project plan a “living document” to incorporate changes discussed with and agreed upon with the Agency Project Scope Management Processes ensure that the scope of work is defined and Refining activities into a work breakdown structure (WBS) format
resources appropriate internal resources and assigning them to project as appropriate Orienting project members to the project’s objectives, of work, deliverables, schedules and budget Monitoring staff utilization and assignments versus the project plan Project Communication Management Processes which ensure effective and timely communication with the client, team members and project stakeholders Developing project directory for Cognosante, State, MMIS and Professional Services contractors with email addresses, phone numbers and other directory information Defining project reporting and deliverable distribution protocols including who, when and how gets appropriate
Steps associated with human resource management include: Review project documents to understand personnel qualifications related to project management / lead and other staff activities; review and determine the number of planned staff to actual and determine activity descriptions Define and communicate staff roles and responsibilities Determine the level of training/experience related to staff responsibilities Prepare and submit report to DHS Executive Sponsor that includes findings and recommendations for improvements Issue and Risk Management The POMI will facilitate risk assessment sessions with the project team, review risk matrices and mitigation plans, and identify and analyze technical project risks. The POMI will provide recommendations on how to mitigate each identified risk and will ensure that risks impacting the project’s cost, schedule, scope, and/or quality are continuously assessed and analyzed throughout the project. Steps associated with issue and risk management include: Use our database of potential risks that we developed from our risk management activities in dozens of MMIS projects Use the that are identified from the MMIS Implementation Contract Risk assessment Identify risks in the following categories: Management, Technical, Integration, Medicaid Policy, and State Resources Analyze each technical risk for probability of occurrence and potential impact on the project, and prioritize Facilitate risk management planning that will produce for addressing each major risk item (such as defining risk triggers) and criteria for associated corrective action plans Coordinate individual risk plans to the overall Project Plan Ensure that risk planning includes accurate project schedule and budget/cost estimates and potential adjustments Manage critical risk so they are highlighted and communicated as part of project reviews Manage and oversee risk and mitigation logs Activity #3 Deliverables The POMI team will provide the following deliverables for this activity: POMI Project Organizational Plan Project Tools Reporting Structure POMI Staff Resource Plan Agendas, and Decisions
Table : Current Medicaid Contracts Encompassing Services Similar to the Iowa Project Client / Project Dates Role Contract Project Description On-Time and Budget Contact Information Alabama Medicaid Agency 8/2009 – 5/2012 P $3.8 million Conducted a MITA Framework Version 2.01 SS-A system and enterprise-level assessment based on current and future MITA alignment and interoperability Assisting with reengineering the business processes of the Alabama MMIS Recipient Subsystem and its related subsystems interfaces. The Recipient Subsystem is a separate State-maintained application system that is not part of the AMMIS. Within budget; some schedule slippage Paul Brannon, MMIS Coordinator/Privacy Officer 501 Dexter Avenue Montgomery, Alabama 3610 334.242.5017 Arkansas Department of Services, Division of Medical Services (DMS) 8/2009 – 6/2012 P $4.8 million Assisting DMS with the re-procurement and implementation of the replacement MMIS. Conducted the MITA SS-A Assisted with defining the MMIS procurement strategy Assisted with development of the Arkansas Medicaid Enterprise (AME) data model Led the development of the RFPs: AME Core System RFP – includes the SI framework and eight distinct core module AME Products RFP covers business areas AME Professional Services RFP establishes seven business offices Will provide IV&V services during the DDI phase Yes Drenda Harkins, Assistant Director, DMS DHS – Division of Medical Services PO Box 1437, Slot S401 Little Rock, AR 72203-1437 501.682.2139 Drenda.Harkins@arkansas.gov
schedule; establishing reporting relationships; and developing the Project Methodology Guide MITA SS-A Business requirements gathering and technical requirements assessment IADP and RFP development 217.782.0614 Kentucky Department for Medicaid Services 10/2010 – 6/2012 P $1.2 million Development of separate Fiscal (FA)/MMIS, IV&V Services, and Utilization Management RFPs and Implementation Advance Planning Documents (IAPDs) Yes John Hoffmann Assistant Director Division of Information Systems 275 East Main Street Frankfort, KY 502.564.5183 New Jersey Department of Human Services, Division of Medical Assistance and Health Services 9/2009 – 8/2010 P $5.2 million Assisting with planning and development of a MMIS RFP for a new modular MMIS Conducted the MITA SS-A Documenting requirements for the Replacement MMIS to support and interface with the Master Client Index Documenting requirements to integrate Modifications (X12 version 5010 transactions and code sets; Privacy and Security; and ICD-10 codes) and integrate requirements into the Replacement MMIS RFP Developing requirements for a Medicaid Enterprise data warehouse Assisted with assessing the impact of the PPACA on the new MMIS and developed resulting RFP requirements Yes Marla Golden Project Manager, MMIS Replacement Team Division of Medical Assistance and Health Services Bldg. 7 Quakerbridge Plaza, Room 104 Mercerville, NJ 08619 609.588.7328
4 years of experience as a project management which include: planning, organization and risk mitigation; Knowledge of current Medicaid Information Technology Architecture (MITA); Experience with large scale IT implementations; Possess at least one successful MMIS implementation; Possess excellent communication and writing skills Desired: 5 years project management experience; 5 years in Medicaid information technology experience He has almost 10 years of experience in Project Management, including planning, organization, and risk mitigation He as perform MITA assessment reviews for strategic IT planning His experience in small, medium, and large publicly and privately IT projects encompasses the entire project lifecycle He possesses sound organizational leadership skills and proven ability to work collaboratively with stakeholders and successfully manage and coordinate multiple concurrent projects, gain consensus, think strategically, motivate employees, and build teams Excellent communication and writing skills with internal and external stakeholders His 4 years of Medicaid experience includes information technology Our team has a good balance of local staff and MMIS and healthcare industry staff to support the POMI scope of work. Our team has depth and breadth of experience to effectively support the primary business areas, interfaces, and standards that are involved with any MMIS implementation. Table 13 shows that experience that will ensure coverage for these areas in the Iowa MMIS project. The table is following by descriptions of each team member’s qualifications. Table : Summary of Cognosante POMI Team Member Experience Cognosante Proposes Kevin Driscoll, MBA, to Lead the Iowa POMI Team Kevin Driscoll is an experienced MMIS implementation and operations director with over ten years of project management experience in healthcare product delivery and private sector delivery projects. He is currently the Implementation Director for the New Hampshire MMIS project. He brings 10 years of excellent leadership and project management skills to effectively manage MMIS project schedule, risks, issues and project performance improvement. Kevin has extensive Medicaid and MMIS business knowledge and experience to bring to the IME Systems Services Implementation project. His experience includes Provider relations, Member management, Benefit Plan administration, Third Party Liability, Service Authorization and Claims management. Kevin’s experience includes managing subcontractor staff on large projects. In addition, he has successfully coordinated large product development teams, including an offshore subcontractor team, business units, and with onshore technical team during requirements, design,
Technology Overview The ACS Enterprise System consists of the specific functionalities of MMIS, Pharmacy Benefit Management System (PBMS – also referred to as POS) and Enrollment Broker with integrations to COTS developed into a single “Enterprise System.” The Enterprise System will be built using newer technologies keeping the customizability requirement as major focus in addition to Service Oriented Architecture. ACS’s Enterprise System is a re-engineer of its current suite of Medicaid management products as a highly customizable J2EE application using IBM Websphere, IBM Rational Software Architect, IBM ReqPro, IBM ClearCase, IBM ClearQuest, IBM DB2, Oracle, Tivoli, LDAP technologies, Edifecs, ANSI X12N (EDI Technical Language), ANSI (4010) 5010 IDC-10 Standards managed using ITIL. Education MBA with Healthcare Administration Focus, Auburn University, Auburn, AL B.S. in Computer Science, Jacksonville State University, Jacksonville, AL Medico: Legal Aspects of Healthcare, Emerging Policy Issues; Southern Medical Association, Washington D.C.
used user acceptance testing to ensure product met the requirements Elicited and documented requirements for operational business initiatives and on-going project enhancements Managed multiple and complex projects. Utilize project management and quality methodology such as six sigma, lean office, and Microsoft project Provided management oversight of the recruitment, staffing ratios, hiring, training, retention, coaching and deployment of resources for the Customer Care department Used workforce management to forecast volume, identify campaigns success, and schedule staff Projects included: Real time technology implementation, Team member: Self service IVR application, Employee Network set-up Norwood Airtex, Des Moines, IA 2000 – 2003 As Director of Customer Care, responsibilities included: Start-up and site development including operations, recruiting, hiring, strategic plan and technology acquisition Provided direction and project management to functional team responsible for a variety of project and product management activities, including opportunity analysis, process redesign, technology implementation, change management Analyzed service standards, trends, and issues to develop new business strategies Analyzed and provided best practice solutions for complex business issues related to the operational implementation of process changes, Web site design and functionality, customer e-mail management and entry/management, and point-of-sale system functionality Served as the field requirements expert by assisting outside vendors in the elicitation and documentation of requirements. Developed CRM marketing strategy for differentiating and monetizing services and developing customer loyalty metrics Projects included: Telephony and CRM implementation, Organizational restructure, Facility Consolidation. West Teleservices, NE 1995 – 1999 As Operations Manager/Client Service Manager, responsibilities included: Oversaw all operational of Client programs, which included the design, implementation, execution, control, review, analysis, and reporting of client programs/projects Participated in key account price negotiations and decisions that ensured revenue growth and profitability Developed resource planning and schedules
Summary of Qualifications 25 of experience IT project management and business analysis experience Certified Project Management Professional with experience executing industry best practices and standards on large IT projects Current experience with Iowa Department of Human Services on the Integrated Eligibility Project (IIEP) Knowledge of the IME Expertise in risk, change, schedule, communications, and integration management Seasoned leader of cross-functional teams on large IT projects Relevant Experience Dave Musgrove is seasoned Project Manager and Senior Consultant who has led a wide variety of business and technical projects within his 25 year career. He brings knowledge of the IME and recent experience with Iowa’s Integrated Eligibility Project (IIEP). He is also a certified Project Management Professional and holds Professional Academy for Healthcare Management (PAHM) certification. Dave’s strong project management skills on diverse healthcare and information technology and business projects, coupled with his recent work with on the IIEP, will be an asset to the Cognosante POMI team. Iowa Department of Human Services (DHS) January 2011 – Present As Process Optimization Senior Consultant, assisting DHS with implementation of the Patient Protection and Affordable Care Act of 2010 health care reform laws. Activities and accomplishments include: Conduct end-to-end process definition, documentation, analysis and optimization with senior State administrators, policymakers, operations supervisors and technology managers Facilitate system vendor demonstrations Mentor State and contractor staff on process optimization best practices and project management maturity Aviva North America, Des Moines, IA November 2009 – December 2010 As Senior Project Manager: Led project to establish new executive offices for North America region in Chicago, IL. Working in a highly visible role for C-level and Executive Committee stakeholders, coordinated activities of internal IT, telecommunications, facilities, physical security and procurement teams and external architecture, construction, AV, telecommunication, logistics and PM firms to open a 49,000 square foot LEED GOLD-certified facility. Led project to migrate all SAN-attached enterprise data from Hitachi-SUN array to new EMC2 V-max/Clariion array. Project purchased, installed, and configured new SAN
Coordinated enhancement and release deliveries from development department Planned and coordinated system change management process business requirements analysis for technical development Aetna US Healthcare 1996 – 1999 As Claims Examiner adjudicated indemnity medical and dental claims, making benefit determinations in accordance with policy provisions and responding to various inquiries via telephone and in writing. TPA of Washington 1994 – 1995 As Manager, Strategic Accounts: Reporting directly to the President, provided on-going service to both clients and brokerage community on benefit issues, renewals, proposal specifications, claim and enrollment reporting, etc. on accounts exceeding 1,000 enrollees and/or $100,000 annual revenue Managed claims department, staff of 30 permanent employees, including claims adjudication, customer service, front-end claims data entry, mail room, reception, medical review, reinsurance, training, quality assurance, provider file maintenance, subrogation and pre-certification activities Group Health Cooperative of Puget Sound 1992 – 1993 Eastlake Administrators 1993 – 1994 As Claims Consultant: Managed daily claims flow for designated client groups Adjudicated medical and dental claims Contacted State and other payors for claim status information Interfaced with medical clinic personnel Conducted workflow analysis and provide recommendations for improvement Cost Care, Inc. 1991 – 1992 As Claims Manager for Western Region: Managed all administrative and operational aspects of PPO group health claims processing department. Duties included staff direction and training, information systems analysis, performance evaluations, salary and disciplinary actions, etc. Created increased workflow efficiencies that reduced claims turnaround time from 17 days to 2 days Designed performance-based incentive compensation program which contributed to a 10 per cent increase in productivity Headed system analysis team of end-users and programmers for development and testing of major claims system software upgrade
Iowa Health System, Des Moines, IA Implementation Applications Analyst 2010 – Present Apex Systems, Incorporated, Des Moines, IA Information Technology Manager 2010 Broadlawns Medical Center, Des Moines, IA Pharmacy Information Support Analyst / Business Analyst 2008 – 2010 Mercy Medical Center, Des Moines, IA Certified Pharmacy Technician, Trainer, Automation Coordinator, Narcotics Inventory Controller 2004 – 2008 Super Target, Urbandale, IA Pharmacy Technician Level 2 2001 – 2004 Self Employed, Des Moines, IA Funeral Director 2000 – 2003 Education BS History (Sociology minor), Iowa State University, Ames, IA Training and Certification Certified trainer for pharmacy and outpatient services
Managed four supervisors responsible for Medicare Policy, Medical Review, Reimbursement Profiles, Edit Resolutions, and Edit Data Managed 75 staff Developed, analyzed, and communicated Medicare coverage, limitations, utilization review, reimbursement rates, and reimbursement policy Implemented these policies and procedures into the Medicare claims processing and reimbursement profile system May 1981 –May 1984 As Supervisor – Medicare Policy, Medical Review and Reimbursement Profile Unit, supervised 18 Medicare claims examiners and staff responsible for medical and utilization review and reimbursement. Developed and maintained Medicare fee schedules and reimbursement system. Employment Summary Organization Position Cognosante, LLC Director of MMIS May 2011 – Present State of Wisconsin, Department of Health Services (DHS), Division of Health Care Access and Accountability (Wisconsin Medicaid Agency) Director, Bureau of Operational Coordination June 2010 – May 2011 Section Chief-Systems and Vendor Management Section March 2009 – June 2010 Project Director, MMIS and Fiscal Agent Contract Replacement Project January 2003 – December 2010 Director, Bureau of Health Care Systems and Operations January 1999 – March 2009 Section Chief – Operations Section October 1994 – January 1999 Unit Supervisor, Systems Monitoring Unit July 1988 – October 1994 Program and Planning Analyst 4/5, Policy and Planning Section February 1985 – July 1988 Wisconsin Physicians Service (), Medicare Part B Carrier Assistant Manager - Medical Review, Policy and Reimbursement May 1984 – February 1985 Supervisor – Medicare Policy, Medical Review and Reimbursement Profile Unit May 1981 – May 1984 Education Bachelor of Business Administration, Majors in Personnel Management and Risk/Insurance, University of Wisconsin - Madison 1981