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 maharshi.desai@oracle.com
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 Business Driven Forward Thinking Best Practices Time to Value
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
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
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, Email, Web Phone, Web IVR Email 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
Architecture Blueprint Plan 90-120 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
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
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
Business Architecture Approach Business Strategy & Value Business Requirements 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 Eligibility & Enrollment (E&E) E&E - Individual Prepare / Update Individual Eligibility Application Accept and Verify Application for Completeness and Accuracy Manual Verification Use Cases
Business Process to Service Mapping 1.1.1.1 Business Activity Services Objects Business Service Business Objects Application Service Application Objects
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
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
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
Business Architecture
Highlights the key architecture capabilities and their alignment
Highlights alignment in greater detail for each business process
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)
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