arch planning healthcare exchange 1556909

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Iterative Approach to Build an Enterprise

Architecture for Health Insurance Exchange

Maharshi Desai, Director, IT Strategy and Enterprise Architecture

[email protected]

Oracle Enterprise Architecture Oracle Enterprise Architecture

mailto:[email protected]

Copyright ©2012 Oracle Corporation. All rights reserved.

Agenda

• Objectives

• Enterprise Architecture Methodology and Framework

• Applying Principles and Methodology to HIX

– What is Health Insurance Exchange?

– Plan and approach

– Artifacts

• Summary


Objectives

• Understand how to apply iterative methodology to build

Enterprise Architecture

• Understand the Oracle Enterprise Architecture Framework

and Oracle Architecture Development Process

• Use case on how to apply iterative approach to build

exchanges like Health Insurance (HIX)

– Read more on our approach in this posted white paper

– http://www.oracle.com/technetwork/topics/entarch/oea-niem-ia-513961.pdf


Enterprise Architecture

Methodology and Framework


Oracle EA Guiding Principles Agility and Sustainability

Forward Thinking

Business Driven

Time to Value

Best Practices


Oracle Architecture Development Process

Practical Approach,

Proven Methodology

Aligns with customer

and industry standard EA frameworks

Iterative Agile EA Approach

Reuses best practice

business models and reference architectures

Provides Governance


Oracle Enterprise Architecture Framework

Best Practices,

Proven EA Artifacts

• Best Practice Reference Architectures

• Reduces Architecture/Solution

Development Time


Applying Iterative Approach to Build

A Health Insurance Exchange


Health Insurance Exchange Background

• The Patient Protection and Affordable Care Act was

passed on March 23, 2010. The law requires states to

participate in 1 of 3 options:

– Establish and operate a state-run exchange

– Partake in a regional exchange (multi-state)

– Federally-administered exchange

• States must have infrastructure operational by Jan 1, 2014

• A Health Insurance Exchange (HIX) A central marketplace

for citizens to compare:

– Rates, Benefits, Quality of Care


Health Insurance Exchange Background…

Exchanges will help:

• Individuals/families with incomes between 133-400%

of the federal poverty line (2010)

– Up to $43K for an individual; $88k for a family of four

– Cap on premiums and “out-of-pocket spending”

• Small businesses (up to 100 employees)

– Small Business Health Options Program (SHOP)

• About four million small businesses could qualify

• Total of $40 billion in relief for small firms over the next 10 years


Bu

sin

es

s In

tellig

en

ce

Dash

bo

ard

s, O

LP

A/D

ata

min

ing

, A

d H

oc &

Sch

ed

ule

d R

ep

ort

s

Employers Individuals

Web Phone, IVR Email Text Chat Local Office

Eligibility Automation Portal Layer (Customer, Worker, Provider)

MMIS

Systems

De-duplication

Standardization

Matching Services

Master Data Management & Data Quality Services

Fraud Detection

Client Index

Address Cleansing

Providers Workers

Web Phone,

Fax, IVR

Email,

Imaging Text Chat

Local

Office

Se

cu

rity

– Id

en

tity

an

d A

cc

es

s M

an

ag

em

en

t, S

SO

Enrollment

Billing

Plans / Pricing

Issuers

AHBE Access

Health Insurance Exchange Portal

Mobile /

Disconnected

SOA Enterprise Integration Services

IRS

DHS

SSA HHS

DMV

Equifax

Authoritative

Data

CHIP

OSHASP

Medicaid

Data Management

Structured & Unstructured Data

Data Security & Availability

Health Insurance Exchange Functions

Eligibility &

Enrollment

Policy Automation

Eligibility

Determination

Subsidy/Premium Calculation

Enrollment

Plan

Management

E-Commerce/Catalog

Carrier Portal

Plan Certification

Renewal

Customer

Services

Contact Center

Self-Service

Carrier / Employer / Broker Support

Account Management

Financial

Management

Billing

Collection

Premium

Reconciliation

Payment

Communications

Marketing/Outreach

Notices

Escalations

Oversight

Mandatory Reporting

Dashboards & Alerts

Metrics / KPI

SHOP Access Content Other Self-Service

Tools Online

Applications Eligibility Screening

Calculators Request Service

Profile

Management

HIX Vision Architecture


Architecture Blueprint Plan

Business

Architecture

Business – Application Architecture

Business – Information Architecture

Apps/Data – Technology Architecture

Establish

Architecture

Vision

Roadmap

Planning

90-120 Day Plan

Key Development Principles • Rapid Iterative Design (3 Week cycles)

• Map Business to Functional Technology Design

• Collaborative Design with Stakeholders

• Leverage Oracle Reference Architectures


Approach: Level 0 and Level 1 Boundaries

Business

Architecture

Application

Architecture

Data

Architecture

Technology

Architecture

Define the core Business

Capabilities

Identify high level Application

Services required to support

the Business Capabilities

Identify high level Information

Models, Data organization,

and Data governance

Identify high level

Technology Platforms

required to support the

Business Capabilities

Application Diagrams

Application Capability Models

Application tech. Support

Models

Data Object Models

Data Integration Diagrams

Data Context

Technology Capabilities

Technology Support Models

Business Capability Models

Business Process Models

Business Process Support

Models

Oracle Enterprise

Architecture

Framework Layers

Level 0 (L0) Level 1 (L1)


Approach: Level 1 and Level 2 Boundaries

Business

Architecture

Application

Architecture

Data

Architecture

Technology

Architecture

Application Diagrams

Application Capability

Models

Application tech. Support

Models

Data Object Models

Data Integration Diagrams

Data Context

Technology Capabilities

Technology Support

Models

Business Capability Models

Business Process Models

Business Process Support

Models

Level 1 (L1)

Presentation Components

Business Logic Components

Business Data Objects

Integration Services

Data Services

Security Services

1 Model for each App.

Service

Technology Detail Models

Detail Integration Diagram – High

level Canonical Models,

Technology, and Systems

Level 2 (L2)

Next level Entity Models

Data Formats

Data Standards

Data Governance and Security

For each high level

Entity

For each interface

At the entity level

only

Oracle Enterprise

Architecture

Framework Layers


Business Architecture Approach

Business Requirements

Eligibility & Enrollment (E&E)

E&E - Individual

Prepare / Update Individual Eligibility Application

Accept and Verify Application for Completeness and Accuracy

Manual Verification

1 Business Area

1.1 Business Process Group

1.1.1Business Process

1.1.1.1 Business Activity

1.1.1.1.1 Business Tasks

Use Cases

Business Strategy & Value


Business Process to Service Mapping

Services

Business

Service

Application

Service

Objects

Business

Objects

Application

Objects

• 1.1.1.1 Business Activity


Architecture Execution Plan

Project startup

activities

July 2011 August 2011 Sep 2011 Oct 2011 Nov 2011

Plan Management

L1

EE – Individual

L1

EE - SHOP Employer

L1

EE – SHOP Employee

L1

Plan Management

L3

Design

Review

Plan Management

L1-L2

3 Week Cycle

EE – Individual

L1-L2

EE - SHOP Employer

L1-L2


L1-L2

Detailed Design Document

EE – Individual

L3

Dec 2011

EE - SHOP Employer

L3


L3

Financial Management

L1


L1-L2

3 Week Cycle


L3


Running Workshop

Level 1

Level 2

60 Minute session

(3 Days/Week):

• Business Analysts

• Process SME

• Enterprise Architecture

• IT Team (Optional)

90 Minute session to

review Application

Component, UI

Component, Data

Component and

Business Objects:


(Optional)

• Enterprise Architecture

• IT Team (Data & Apps)

Level 3 & 4

90 Minute JAD session:


• IT/Development Team

Business

Process Flow

&

Requirements

Review

Refine

Business

Application

Data

Technology

Architecture Level 1

Level 2


Federal

Requirements State

Requirements

Requirement

Baseline

Architecture Models

Level 1 and Level 2

Use Cases Architecture Models

Level 3 and Level 4

JAD Session Finalize

Product Vision

Iterative

Development Product Demo and Acceptance

Connecting Blueprint Phase to

Development Phase


Business Architecture


Highlights the key architecture capabilities and their alignment


Highlights alignment of Business Services to Application Services


Application Architecture


Highlights how each business services are map to apps services


Highlights how each apps services are map to UI component and BO’s


Data Architecture


Highlights application data object mapping of business data objects


Define overall ERD diagram


Highlights in-a-glance identified HIX data integration touch points


Highlights overall view of how data is supported in its associated context


Technology Architecture


Highlights the required HIX Technology Capabilities


Highlights the focused technology capabilities of a specific component


Map to products required to support the specific capabilities


HIX Logical Architecture

Logical Architecture provides component view of HIX Solution


HIX Technical Architecture

Solution Architecture provides overall physical view of the architecture


Summary

• Develop a top down business-driven architecture

– Design in agility and sustainability

• Use an Agile/Iterative EA approach

– Just-enough, just-in-time method

• Oracle uses an open and practical process and framework

for architecture development

– Oracle Enterprise Architecture Framework (Link)

– Oracle Architecture Development Process (Link)

http://www.oracle.com/technetwork/issue-archive/2010/10-jan/oea-framework-133702.pdf

http://www.oracle.com/technetwork/topics/entarch/whatsnew/oadp-whitepaper-128843.pdf


Join the Oracle EA Community

Oracle.com/goto/EA

Oracle.com/goto/ITStrategies

Twitter twitter.com/OracleEAs

Facebook facebook.com/OracleEA

LinkedIn Oracle Enterprise Architects – A Public Discussion Forum

Oracle’s EA Blog blogs.oracle.com/EnterpriseArchitecture

http://www.linkedin.com/groups/Oracle-Enterprise-Architects-Public-Discussion-4052248?home=&gid=4052248&trk=anet_ug_hm




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