Iterative Approach to Build an Enterprise Architecture for Health Insurance Exchange

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1 Oracle Enterprise Architecture Oracle Enterprise Architecture <Insert Picture Here> Iterative Approach to Build an Enterprise Architecture for Health Insurance Exchange Maharshi Desai, Director, IT Strategy and Enterprise Architecture

2 Agenda Objectives Enterprise Architecture Methodology and Framework Applying Principles and Methodology to HIX What is Health Insurance Exchange? Plan and approach Artifacts Summary

3 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

4 Enterprise Architecture Methodology and Framework

5 Oracle EA Guiding Principles Agility and Sustainability Business Driven Forward Thinking Best Practices Time to Value

6 Oracle Architecture Development Process Iterative Agile EA Approach Aligns with customer and industry standard EA frameworks Reuses best practice business models and reference architectures Practical Approach, Proven Methodology Provides Governance

7 Oracle Enterprise Architecture Framework Best Practices, Proven EA Artifacts Best Practice Reference Architectures Reduces Architecture/Solution Development Time

8 Applying Iterative Approach to Build A Health Insurance Exchange

9 Health Insurance Exchange Background The Patient Protection and Affordable Care Act was passed on March 23, 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

10 Health Insurance Exchange Background Exchanges will help: Individuals/families with incomes between % 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

11 Security Identity and Access Management, SSO Business Intelligence Dashboards, OLPA/Data mining, Ad Hoc & Scheduled Reports HIX Vision Architecture Individuals Workers Providers Employers Mobile / Phone, , Web Phone, Web IVR Text Chat Text Local Chat Disconnected Fax, IVR Imaging Office Eligibility Automation Portal Layer (Customer, Worker, Provider) AHBE Access SHOP Access Online Applications Health Insurance Exchange Portal Profile Management Eligibility Screening Calculators Request Service Content Local Office Other Self-Service Tools Health Insurance Exchange Functions Eligibility & Enrollment Plan Management Customer Services Financial Management Communications Oversight Policy Automation Eligibility Determination Subsidy/Premium Calculation E-Commerce/Catalog Carrier Portal Plan Certification Contact Center Self-Service Carrier / Employer / Broker Support Billing Collection Premium Reconciliation Marketing/Outreach Notices Escalations Mandatory Reporting Dashboards & Alerts Metrics / KPI Enrollment Renewal Account Management Payment SOA Enterprise Integration Services Authoritative Data MMIS Systems Issuers Master Data Management & Data Quality Services Data Management IRS DMV Medicaid Plans / Pricing Matching Services Address Cleansing Structured & Unstructured Data SSA HHS CHIP Enrollment De-duplication Fraud Detection Data Security & Availability DHS Equifax OSHASP Billing Standardization Client Index

12 Architecture Blueprint Plan Day Plan Business Application Architecture Establish Architecture Vision Business Architecture Business Information Architecture Roadmap Planning Apps/Data Technology Architecture Key Development Principles Rapid Iterative Design (3 Week cycles) Map Business to Functional Technology Design Collaborative Design with Stakeholders Leverage Oracle Reference Architectures

13

14 Approach: Level 0 and Level 1 Boundaries Oracle Enterprise Architecture Framework Layers Level 0 (L0) Level 1 (L1) Business Capability Models Business Process Models Business Architecture Define the core Business Capabilities Business Process Support Models Application Diagrams Application Architecture Identify high level Application Services required to support the Business Capabilities Application Capability Models Application tech. Support Models Data Architecture Technology Architecture Identify high level Information Models, Data organization, and Data governance Identify high level Technology Platforms required to support the Business Capabilities Data Object Models Data Integration Diagrams Data Context Technology Capabilities Technology Support Models

15 Approach: Level 1 and Level 2 Boundaries Oracle Enterprise Architecture Framework Layers Level 1 (L1) Business Capability Models Level 2 (L2) Business Architecture Business Process Models Business Process Support Models 1 Model for each App. Service Presentation Components Business Logic Components Business Data Objects Integration Services Data Services Application Diagrams Security Services Application Architecture Application Capability Models Application tech. Support Models For each high level Entity Data Architecture Technology Architecture Data Object Models Data Integration Diagrams Data Context Technology Capabilities For each interface Next level Entity Models Detail Integration Diagram High level Canonical Models, Technology, and Systems Data Formats Data Standards Data Governance and Security At the entity level only Technology Support Models Technology Detail Models

16 Business Architecture Approach Business Strategy & Value Business Requirements 1 Business Area 1.1 Business Process Group 1.1.1Business Process Business Activity Business Tasks Eligibility & Enrollment (E&E) E&E - Individual Prepare / Update Individual Eligibility Application Accept and Verify Application for Completeness and Accuracy Manual Verification Use Cases

17 Business Process to Service Mapping Business Activity Services Objects Business Service Business Objects Application Service Application Objects

18 Architecture Execution Plan July 2011 August 2011 Sep 2011 Oct 2011 Nov 2011 Dec 2011 Project startup activities 3 Week Cycle Plan Management L1 3 Week Cycle Plan Management L1-L2 Design Review Plan Management L3 EE Individual L1 EE - SHOP Employer L1 EE Individual L1-L2 EE - SHOP Employer L1-L2 EE Individual L3 EE - SHOP Employer L3 EE SHOP Employee L1 EE SHOP Employee L1-L2 EE SHOP Employee L3 Financial Management L1 Financial Management L1-L2 Financial Management L3 Detailed Design Document

19 Running Workshop Level 1 Business Process Flow & Requirements Review Refine Level 2 Architecture Business Application Data Technology Level 1 Level 2 Level 3 & 4 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: Business Analysts (Optional) Enterprise Architecture IT Team (Data & Apps) 90 Minute JAD session: Business Analysts IT/Development Team

20 Connecting Blueprint Phase to Development Phase Federal Requirements State Requirements Requirement Baseline Architecture Models Level 1 and Level 2 JAD Session Finalize Product Vision Use Cases Architecture Models Level 3 and Level 4 Iterative Development Product Demo and Acceptance

21 Business Architecture

22 Highlights the key architecture capabilities and their alignment

23 Highlights alignment in greater detail for each business process

24 Highlights alignment of Business Services to Application Services

25 Application Architecture

26 Highlights how each business services are map to apps services

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

28 Data Architecture

29 Highlights application data object mapping of business data objects

30 Define overall ERD diagram

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

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

33 Technology Architecture

34 Highlights the required HIX Technology Capabilities

35 Highlights the focused technology capabilities of a specific component

36 Map to products required to support the specific capabilities

37 HIX Logical Architecture Logical Architecture provides component view of HIX Solution

38 HIX Technical Architecture Solution Architecture provides overall physical view of the architecture

39 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)

40 Join the Oracle EA Community Twitter twitter.com/oracleeas Facebook facebook.com/oracleea LinkedIn Oracle Enterprise Architects A Public Discussion Forum Oracle s EA Blog blogs.oracle.com/enterprisearchitecture Oracle.com/goto/EA Oracle.com/goto/ITStrategies

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