Overview
The Department of Managed Health Care (DMHC) is a regulatory body for Managed Health Care Plans (MHCP) and Risk Bearing Organizations (RBO). DMHC’s Office of Financial Review (OFR) conducts financial examinations of each health plan, holding them accountable through transparency and ensuring consumers get value. DMHC’s Office of Plan Monitoring (OPM) conducts surveys of health plan networks and delivery systems, ensuring the availability and quality of health care delivery throughout California.
The lack of centralization for OFR and OPM to schedule and manage events with MHCPs and RBOs created scheduling conflicts and complicated all regulatory activities. Business processes were time-consuming and paper-driven and consisted of distributed spreadsheets, local databases, and paper records. This reduced DHCS’ processing capacity to meet the growing needs of the department as mandated by new laws and regulations. Unifying the oversight process of OFR and OPM ensures both a reduction in red tape for providers and an increase in oversight effectiveness through the elimination of administrative burdens on both provider and DMHC staff.
Goal
Implement a Phase I Minimum Viable Product (MVP) that enables efficient scheduling, auto-scheduling, data management, and reporting / dashboarding features.
Project Information
- Project #:
- 4150-033
- Total TMF investment amount:
- $912,000
Project Outcome
As part of the larger Necessary Infrastructure Modernization for Business Unified Services (NIMBUS) project this effort unifies the Office of Plan Monitoring’s (OPM) survey process and the Office of Financial Review’s (OFR) examination processes. The resulting tool contains efficient scheduling, auto-scheduling, data management, and reporting and dashboarding features, providing 360-degree visibility into all scheduling events across OPM and OFR.
Key Activities
- Validated selected platform for project readiness
- Configured platform to support OPM and OFR needs
- Developed and provided user training and documentation
- Deployed solution, migrating existing scheduled events into the platform
Impacted audience
DMHC staff
- Provides 360 degree visibility into all scheduling events across OPM and OFR.
- Auto Schedules forecast scheduling events when a survey or exam must be repeated by statute.
- Licensees.
- Collects structured data that enables reporting, analytics and dashboards.
Health Plan Compliance Officers
- Eliminates re-scheduling of events due to conflicts.
- Eliminates re-submission of documents due to re-scheduling.
- Higher visibility of forecast and scheduled events from both OFR and OPM.
Health Plan Members Enrolled in DMHC-licensed plans
This initiative promises significant benefits for the nearly 30 million health plan members enrolled in DMHC-licensed plans through enabling more efficient oversight. This project will better enable OFR to ensure health plan financial stability, and OPM to provide better oversight of health plan
operations. This will help the DMHC to fulfill its mission to protect consumers’ health care rights and ensure a stable health care delivery system in accordance with the Knox-Keene Act.
DMHC Staff
This initiative provides new automated scheduling, auto-scheduling, data management, reporting and dashboarding capabilities for OFR and OPM staff. The new modern solution allows scheduling of survey and examination events more efficiently, allowing OFR and OPM to better meet statutory requirements and deadlines.
DMHC Office of Technology and Innovation (OTI)
OTI will continue to accelerate solution delivery by leveraging low-code, custom application development platform technology deployed to the Cloud. This will provide resiliency and rapid evolution of the solution to include Phase II functionality, and deliver future program requirements “at the speed of need” rather than with the “need for speed”.