State of Utah

Department of Health

A Medicaid leader uses Bull Services BI data warehouse solution
to help manage medical assistance programs

Utah has consistently been at the top of the list of states that have introduced innovative ideas and practices to better manage its Medicaid program.   Its most recent and publicized effort involved winning a waiver from the federal government to pare down benefits for existing recipients and use the savings to bring into the program low-income people who were previously not eligible for Medicaid.   The state’s goal: to give more people at least some health care coverage rather than leave a large number of people without any.

For such first-in-the-nation programs to be successful, one of the critical tools Utah relies on is the Business Intelligence data warehouse solution implemented by Bull Services in the Department of Health (DOH).  

Several years ago, when (DOH) officials first sat down to address the critical importance of improving health care assistance across the state, their goal was as vast as the state itself. To meet the needs of the Utah's neediest citizens, DOH staff members wanted to improve the capabilities and management not only of Medicaid, but also of the Utah Medical Assistance Program (UMAP), a state-supported program intended to provide supplemental coverage to those individuals ineligible for Medicaid, together with the Children's Health Insurance Plan (CHIP), a federally funded, state-managed program that provides supplemental healthcare coverage to children who don't qualify for Medicaid assistance.

Following extensive needs analysis and in-depth looks at other states' leading-edge Medicaid decision support/data warehouse solutions, including those of Minnesota, Missouri and California, DOH officials in Utah ultimately determined that the best decision was to integrate Bull's date warehouse system into its core IT infrastructure.

Utah's Medicaid BI data warehouse system is designed to analyze the millions claims that are filed annually by recipients of state aid. The system helps facilitate the exchange of agency information, handles all processed claims and reporting, and plays a critical role in analyzing claims to help improve the overall quality and cost-effectiveness of DOH services.

One of the primary objectives in the development of the new data warehouse was to coordinate all three of the state-managed assistance programs - Medicaid, UMAP, and CHIP. This required the implementation of a number of custom reports that Bull developed specifically for Utah, including reports for the Management and Administrative Reporting System (MARS).

Fraud and abuse detection and prevention are another critical and valuable use of the data warehouse -- not only in Utah, but also in the other large states where Bull Medicaid management solutions are in place. Through complex analysis of detailed historical claim data, the DOH is able to track trends and payment patterns that could indicate misuse of the distribution of Medicaid funds.

The MARS reports help Utah better manage its programs by providing assistance with fiscal planning and control for all measures of Medicaid performance. MARS provides the information required in the review and development of medical assistance policy and regulation, providing critical data for such studies as the state's "Drug Usage Frequency Detail Report" and the "Summary of Medicaid Expenditures".

Utah's data warehouse also helps the DOH analyze service program effectiveness, provide quick responses to legislative inquiries, and deliver enhanced audit control. The BI data warehouse efficiently supplies a wealth of information for monitoring and reporting on the quality of delivered medical services and for forecasting the effects of policy changes.

Finally, and perhaps most importantly, Utah's one-stop-shopping BI solution provides a single source from which extensive report data can be derived, extrapolated and analyzed to improve agency consistency and accuracy and, ultimately, provide improved health care for all of the state's eligible residents.