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WASHINGTON, D.C. – Despite the passage of five years and the expenditure of $161 million on two information technology initiatives intended to help the federal government protect the fiscal integrity of its Medicare and Medicaid programs, neither initiative has resulted in the accumulation of sufficient data or the establishment of sufficient functionality to do so effectively, according to the recent testimony of a representative with the U.S. Government Accountability Office (GAO).


The Integrated Data Repository (IDR) and the One Program Integrity (One PI) systems are in use but lacking in several areas, explained Joel C. Willemssen, managing director of information technology for the GAO, in testimony before the U.S. Senate Subcommittee on Federal Financial Management, Government Information, Federal Service and International Security (the body that requested a review of the matter). IDR is intended to provide a single source of comprehensive data related to Medicare and Medicaid claims while One PI is a Web-based portal and suite of analytical software tools used to extract data from IDR and enable complex analyses of that data.

Both initiatives were launched by the Centers for Medicare & Medicaid Services (CMS), which operates under the umbrella of the U.S. Department of Health and Human Services, as part of a continuing campaign to curtail the issuance of improper payments – the department reported about $70 billion in improper Medicare and Medicaid payments during the 2010 fiscal year alone.


But not only are the aforementioned IT initiatives falling short in terms of functionality, they are failing to produce anticipated financial benefits as well, officials said. IDR initially was expected to save the federal government $187 million in the form of improper payments CMS hoped to identify and recover as a result of its use (with estimated life-cycle program costs of $90 million through the 2018 fiscal year, the resulting net benefit was projected at $97 million). But as of March 2011, program officials had not identified any actual financial benefits of implementing IDR, officials said.


Willemssen’s testimony, in conjunction with a report released last week, summarized the results of the GAO study that assessed the extent to which IDR and One PI have been developed and implemented – work that was performed at CMS’s Baltimore headquarters from June 2010 through early July of this year. Willemssen noted that CMS and its contractors have used automated software tools to analyze data for more than a decade, but in 2006 the agency decided to expand the scope of a 3-year-old data modernization strategy, thus establishing IDR.


CMS initially envisioned an incremental approach to incorporating data into IDR, according to Willemssen: specifically, he noted, it intended to gather data related to paid claims for all Medicare Part D data by the end of fiscal year 2006, and for Medicare Parts A and B data by the end of fiscal year 2007. The agency also planned to begin to add all Medicaid data for the 50 states in fiscal year 2009 and to complete this effort by the end of fiscal year 2012.


While program officials initially planned to incorporate 20 states’ Medicaid data into IDR by the end of fiscal year 2010, the agency had not incorporated any of the data into the repository as of May 25, 2011, Willemssen testified. Program officials reportedly told the GAO that the original plans and schedules for obtaining Medicaid data did not account for lack of funding for states to provide Medicaid information to CMS, or for the variations in the types and formats of data stored in disparate state Medicaid systems. Consequently, Willemssen explained, officials were not able to collect this information from states as easily as expected.


Still, the GAO’s report urged patience in the matter of possible future financial benefits of IDR and One PI. Because the systems still are not being used as initially planned, CMS officials are not yet in a position to determine the extent to which the systems will provide financial benefits or support the agency’s initiatives to meet program integrity goals and objectives, Willemssen testified. The GAO report recommended that CMS undertake the following actions to ensure that the initiatives get back on track:


· Finalize plans and develop schedules for incorporating additional data into IDR, specifically information that identifies all resources needed to complete tasks and considers risks and obstacles to the IDR program;

· Implement and manage plans for incorporating data into IDR in a structured fashion, meeting scheduling milestones;

· Establish plans and reliable schedules for training all program integrity analysts expected to use One PI;

· Establish and distribute deadlines for program integrity contractors to complete training and start using One PI in their work;

· Define any measurable financial benefits expected to result from the implementation of IDR and One PI; and

· With stakeholder input, establish measurable, outcome-based performance measures for IDR and One PI that gauge progress toward meeting program goals.

In commenting on a draft of the GAO report, CMS agreed with the recommendations and indicated that it plans to take steps to address the challenges and problems identified in the study, Willemssen testified.


In summary, the GAO official said that CMS’s success toward meeting its goals to enhance program integrity will hinge heavily on the agency’s incorporation of all necessary data into IDR, as well as the effective use of the system by the agency’s broad community of program integrity analysts.


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