State of New York 

Department of Health

Bull Services Business Intelligence Solution Helps Launch
A Medicaid Transformation in the Empire State

The New York State Department of Health (DOH) oversees the largest Medicaid program in the nation, one whose scope includes the management of a staggering number of taxpayer dollars and the delivery of services to an enormous cross-section of people.

Administered by the Office of Medicaid Management (OMM), New York ’s Medicaid program provides critical health care services to more than 3.8 million participants – 2.5 million in New York City alone.   To serve this constituency, the state processes and analyzes more than 300 million claims totaling more than $41 billion annually.

A program of this size and magnitude is highly visible, and its effectiveness is of great concern, to many constituencies: the Governor, the State Senate and State Assembly, county officials, federal officials, Medicaid subscribers, and taxpayers.   They all have the goal of delivering high quality services at the most efficient possible cost.  

To achieve these goals, the New York DOH implemented a Bull Services Business Intelligence enterprise data warehouse solution (the “ eMedNY Data Warehouse”) that provides a comprehensive view of the huge volume of Medicaid data stored in disparate databases, and the capability to access and analyze that data rapidly and convert it into valuable information.   With this information, New York is making more rapid, informed decisions about programs, policies, and people across its vast Medicaid system.    

The state has used the BI data warehouse to help New York achieve stunning results, including million of dollars in savings, and major advances in the following areas:

• tracking potential fraud and abuse among providers and participants
• tracking bio-terrorism indicators daily by pharmaceutical purchases with acute illness data from hospital emergency rooms
• determining disease patterns and trends and the best possible treatment
• tracking drug pattern usage to prevent abuse
• analyzing program effectiveness
• analyzing service delivery effectiveness
• delivering enhanced audit control
• forecasting the cost and utilization of expensive prescription drugs
• conducting predictive modeling
• identifying billing overlaps to prevent double dipping
• responding quickly to legislative inquiries

One of the biggest impacts of the new system has been the state’s ability to access and analyze data rapidly – in minutes or hours versus days, weeks, or months.   Nearly 800 staff members from 10 different state offices and agencies, one federal agency, and more than 33 counties have used the data warehouse to access and analyze Medicaid-related data rapidly and securely. The state expects that number to rise to nearly 1,100 as new users and more counties come on board.   The eMedNy data warehouse is expected to help generate millions of dollars in additional savings in the next year.

In the words of one New York eMedNY official: “For the first time in Medicaid history, everyone who is authorized is looking at the same accurate data from the same source, so we can all be on the same page whether we’re discussing cost issues, trends, or any other aspect of the program.   That has never happened before and it has made an enormous difference.   When you add to that the fact that the data is available to us when we need it – rather than having to wait weeks or months – we have a powerful solution that has totally transformed the way we manage Medicaid in New York.