Data Analytics Platform

The vendor is required to provide data platform is a multi-payer system used by department users, primarily by the medicaid business intelligence and analytics team, to produce analytics, reports, and dashboards that support the program oversight, evaluation, policy development, operations, and informed decision making across the organization.
- The data platform consists of the following components:
• Data warehouse - serves as a repository for the medicaid data supplied from disparate systems, including medical and pharmacy fee-for-service (FFS), claims, managed care encounter data, provider data, member demographics, member eligibility and enrollment, electronic visit verifications, financial data, prior authorization, reference data, and other data elements. 
• Currently, the data warehouse holds approximately 72tb of data and is expected to grow by about 10% annually as program data increases and reporting needs expand.
• Integrated reporting and analytics platform - supports data exploration, reporting, and visualizations to extract meaningful insights and inform decision-making.
• Surveillance and utilization review subsystem (SURS) - provides payment integrity support, including the detection of fraud, waste, and abuse.
• Committee certified healthcare effectiveness data and information set (HEDIS) quality metric reporting.
• Parameterized queries - allow quick and easy access to data by department
• Managed file transfer solution - ensures the data files from source systems are securely transferred to the data platform for processing
• Pre-defined analytical models – includes tools such as the quality rules engine;
• Physician/health plan focus; inpatient admissions grouper; outpatient event grouper; and
• Service categories, which provide the state with deeper insights into the patient care provided by prepaid health plans (PHPS) and FFS providers
• User access - integrated with the state
• Access to easy-to-use data marts and self-service tools
• Shared glossary and migrated analytics models to ensure consistent reporting
• Promote coding standards, reusable components, and guided logic recommendations
• Use of prepared templates and past report logic to reduce duplication
• Searchable metadata and KPI lineage to improve visibility and reduce redundancy
• Use of and customization of medicaid-ready dashboards and templates using bi tools
• Agency compliant to calculate quality measures and integration of claims, pharmacy, and clinical data to offer real-time gap alerts
• Data model alignment with CMS standards and support evolving medicaid needs
• Mapping, validation, and preservation of historical data from legacy systems
• Provide scalability for both computation and storage independently and support cloud-native design
• Use APIS and FHIR/hl7 standards for integration and middleware will replace point-to-point setups
• Strong governance to track data lineage and support federated models
• Secure, role-based access with department SSO integration
• Support fraud detection using rules and predictive models
• Offer dashboards, workflows, and peer comparisons
• Offer and support ml/AI, predictive modeling, and real-time insights
• Support external data integration and model deployment
• Accelerate insights, reduce reporting delays, and improve compliance.
- Contract Period/Term: 1 year