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SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
SOA and Health Plans: Driving Business Value Through ...
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SOA and Health Plans: Driving Business Value Through ...

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  1. Rick Sweeney Chief Architect Blue Cross Blue Shield Massachusetts SOA and Health plans
  2. Topic <ul><li>The Changing Business Landscape </li></ul><ul><ul><li>Expansion of external interaction </li></ul></ul><ul><ul><li>Expansion of interaction “channels” </li></ul></ul><ul><ul><li>HIPAA and other regulatory impacts </li></ul></ul><ul><li>“ How many Enrollment Systems does it take to…?” </li></ul><ul><ul><li>Solving the cost and time to market dilemma </li></ul></ul><ul><li>Technology advancements fueling SOA </li></ul><ul><li>SOA Adaptability, Flexibility, Affordability </li></ul><ul><li>SOA = A paradigm shift </li></ul>
  3. Changing Business Landscape <ul><li>Expansion of external interaction: </li></ul><ul><ul><li>Competitive and regulated partnerships are increasing </li></ul></ul><ul><ul><li>Accounts and members playing increased role in managing and monitoring their health benefits </li></ul></ul><ul><ul><ul><li>Incentives and rewards as well as deductibles and co-pays are increased factors in the health coverage decision </li></ul></ul></ul><ul><ul><li>Ability to deliver increased health and benefit information at the POS influences the health product purchase decision </li></ul></ul>
  4. Changing Business Landscape <ul><li>Expansion of interaction “Channels” </li></ul><ul><ul><li>Paper and Batch feeds being replaced with real time updates and on-line enrollment </li></ul></ul><ul><ul><li>Telephone Customer Service being replaced with IVR and Web Self Service. </li></ul></ul><ul><ul><li>Mobility and technology are driving demand for anytime, anywhere access </li></ul></ul>
  5. Changing Business Landscape <ul><li>HIPAA and other Regulatory Impacts: </li></ul><ul><ul><li>HIPAA </li></ul></ul><ul><ul><ul><li>Standardization of transactions </li></ul></ul></ul><ul><ul><ul><li>Privacy </li></ul></ul></ul><ul><ul><li>Massachusetts Health Care Reform </li></ul></ul><ul><ul><ul><li>New Products </li></ul></ul></ul><ul><ul><ul><li>New Channels </li></ul></ul></ul><ul><ul><ul><li>New Markets </li></ul></ul></ul>
  6. “ How many Enrollment Systems does it take to…?” <ul><li>Treating each transaction source and the channel its received on as a separate “stove-pipe” application is: </li></ul><ul><ul><li>Costly </li></ul></ul><ul><ul><li>Highly redundant </li></ul></ul><ul><ul><li>Extremely inflexible </li></ul></ul><ul><ul><li>Not adaptable </li></ul></ul>
  7. “ How many Enrollment Systems does it take to…?” <ul><li>The bottom line is: </li></ul><ul><ul><li>no matter who submits the transaction </li></ul></ul><ul><ul><li>How they submit the transaction (batch, real time) </li></ul></ul><ul><ul><li>Or what channel they use (Web, IVR, FTP) </li></ul></ul><ul><li>The same data needs to effect the system of record </li></ul><ul><li>The same edits and validation business rules apply </li></ul>
  8. “ How many Enrollment Systems does it take to…?” <ul><li>Each stove-pipe solution is monolithic in that it redundantly : </li></ul><ul><ul><li>Replicates the business logic </li></ul></ul><ul><ul><li>Replicates authentication and authorization </li></ul></ul><ul><ul><li>Manages the presentation and flow of the process </li></ul></ul>
  9. “ How many Enrollment Systems does it take to…?” <ul><li>The Result: </li></ul><ul><ul><li>Costs go through the roof; money is wasted </li></ul></ul><ul><ul><li>Time to market for changes that effect all sources is extended as each application is assessed and modified </li></ul></ul><ul><ul><li>Ability to support competitive and value added capabilities like multi-lingual support become cost prohibitive to implement </li></ul></ul>
  10. The Solution - SOA <ul><li>What does SOA mean to me? </li></ul><ul><ul><li>Turning physical implementations into logical implementations that: </li></ul></ul><ul><ul><ul><li>Insulate and manage processing to the systems of record </li></ul></ul></ul><ul><ul><ul><li>Encompass the capability to support deployment through multiple channels </li></ul></ul></ul><ul><ul><ul><li>Tie to an “Enterprise Entitlement Framework” for: </li></ul></ul></ul><ul><ul><ul><ul><li>Security (authentication and authorization) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Profiling (Language, Account SLA) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Personalization (e.g., response channel) </li></ul></ul></ul></ul>
  11. Technology Advances I can connect to anyone, anywhere. I can interact with anyone, anywhere. IP, SNA, IPX. It doesn’t matter. Network Layer Ethernet, Packet, TDM. It doesn’t matter. Link Layer TP, Coax, Wireless. It doesn’t matter. Physical Layer Universal Connectivity Internet Universal Code Delivery SOAP Universal Security SSL/SAML Universal Code Recognition WS Universal Service Aggregator Portals Universal Data Recognition XML Universal User Display HTML, Browser
  12. Business Conceptual view of Architecture
  13. Service efficiency through SOA <ul><li>While a constituent may use any of the available channels to access services the underlying service is the same ! </li></ul><ul><li>An Architecture that focuses on building the service once and deploying it through multiple channels : </li></ul><ul><ul><li>Saves time and Money </li></ul></ul><ul><ul><li>Increases Flexibility and adaptability </li></ul></ul><ul><ul><li>Provides consistency to the consumer and control over the process </li></ul></ul>
  14. Even more valuable to our Line of Business <ul><li>Reason # 1: </li></ul><ul><li>Most of our business activity (and systems) focus around our core membership and claims systems </li></ul><ul><li>This “Hub and Spoke” effect tells us there is significant opportunity for reuse at the Integration Layer </li></ul>
  15. Hub and Spoke Model Member ship Claims UM CM CRMS Enrollment Partner Channels Constituent Portals New
  16. And Our Business Model <ul><li>Reason # 2: </li></ul><ul><li>Multiple constituents want to use the same services </li></ul><ul><ul><li>Claim Status – Provider, Member, MSR & PSR Associate </li></ul></ul><ul><ul><li>Enrollment – Account, Broker, Connector, ASR Associate </li></ul></ul><ul><ul><li>Wellness results – Member, Provider, Account, Case Manager </li></ul></ul>
  17. Enterprise View Step 1 in SOA Adoption: Layered Architecture
  18. Enterprise View <ul><li>Requirements gathered and assessed in the context of the enterprise </li></ul><ul><ul><li>What constituents will/could use the requested functionality? </li></ul></ul><ul><ul><li>What channels will they use to access the functionality? </li></ul></ul><ul><li>Assessment of solution performed in the context of the “SOA Stack” </li></ul><ul><ul><li>What existing “assets” can be used to deliver the functionality? </li></ul></ul>
  19. SOA Assessment Template
  20. Legacy “Systems of Record” <ul><li>These are core processing legacy systems. </li></ul><ul><li>SOA does not replace them </li></ul><ul><li>SOA “service enables” them </li></ul>
  21. Enterprise Application Integration Insulate and manage processing to the systems of record i.e., “CRUD” data service layer Batch Real Time
  22. Enterprise “Business Service” Layer Layer where business logic and business processes are created i.e, Business services
  23. Delivery Channel Layer SFTP, EDI, WS, Portlets, IVR, etc.
  24. Consumer Layer Enterprise SOA Entitlement Framework Transaction Service Authentication Authorization Authorization Profiling Personalization
  25. SOA definition revisited <ul><li>What does SOA mean to me? </li></ul><ul><ul><li>Turning physical implementations into logical implementations that: </li></ul></ul><ul><ul><ul><li>Insulate and manage processing to the systems of record (EAI Layer) </li></ul></ul></ul><ul><ul><ul><li>Encompass the capability to support deployment through multiple channels (Channel Layer) </li></ul></ul></ul><ul><ul><ul><li>Tie to an “Enterprise Entitlement Framework” for: </li></ul></ul></ul><ul><ul><ul><ul><li>Security (authentication and authorization) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Profiling (Health Status, Account SLA) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>Personalization (e.g., Language, response channel) </li></ul></ul></ul></ul><ul><ul><ul><ul><li>(Entitlement Framework) </li></ul></ul></ul></ul>
  26. The Paradigm Shift – “It’s One System!” <ul><li>How the business describes their need… </li></ul><ul><ul><li>Shifts from “stove-pipe” application view to enterprise service view </li></ul></ul><ul><li>How the solution is developed… </li></ul><ul><ul><li>Shifts from Monolithic code to modular component builds, enhancements or consumptions: </li></ul></ul><ul><ul><ul><li>New, enhanced or reused channels </li></ul></ul></ul><ul><ul><ul><li>New, enhanced or reused Business services </li></ul></ul></ul><ul><ul><ul><li>New, enhanced or reused Data services </li></ul></ul></ul><ul><ul><ul><li>New, enhanced or reused Entitlement services </li></ul></ul></ul>
  27. Business Value <ul><li>Rapidly support new channels for delivery based on constituent demand </li></ul><ul><li>Common, shared business logic makes changes to process or value added enhancements (Personalization, Profiling) achievable </li></ul><ul><li>Shifts significant amount of IT spend over time from maintenance and support to new and enhanced functionality </li></ul><ul><li>Flexibility and adaptability as well as reuse rapidly accelerate time to market </li></ul>
  28. Contact Information <ul><li>Rick Sweeney </li></ul><ul><li>[email_address] </li></ul><ul><li>617-246-4580 </li></ul>

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