The Road to Transformation
Ensuring your infrastructure will meet business vision
today and tomorrow
December 7, 2010 © Blue Slate Solutions 2010

About Blue Slate Solutions
Clientele
4 of the top 20 health payers including 7 BCBS plans
2 of them in the top 3
Experience
100+ healthcare-specific projects
25+ different healthcare entities
Liz Gaudet Dave Read, CISSP
• Healthcare Leader at Blue Slate • Blue Slate CTO and Chief Solution Architect
• 26 years multi-payer experience • 20+ years tech leadership experience
• Business process and strategy focus • Strategy and technology focus
• Passionate about your success • Passionate about governance and security
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Our client
40 year old US payer, 2500+ employees across multiple
locations serving several million subscribers
Will current architecture serve future business vision?
How can we surpass our competition?
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Two tracks; one destination
Current State Applications
Grounding Technologies
Strategy Organization
Business Technology
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Technology Methodology
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Technology methodology
Discover IT organization’s
alignment and skills
Examine technology
capacity and flexibility
Assess application
functionality and data
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Architectural maturity model: transformational change
Standardized Business
Business Silos Optimized Core
Technology Modularity
Companywide Plug-and-play
Local IT Shared technical
IT Capability standardized business process
applications platforms
process or data modules
ROI of local Cost and quality
Business Speed to market,
business Reduced IT costs of business
Objectives strategic agility
initiatives operations
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Systems and stovepipes
Department 1 – Imaging, Workflow Department 2 – Portal and eServices
LOB 1
Inbound Paper MYSE Core Services (data tier)
Doc WFE Appeals
Inbound Paper – Inbound CORR DDI (current) DDI (rewrite)
Claims EDI
Inbound Paper– Escalation Inquiry Notification Email INV Tracking
Inbound Paper
Finance Tracking Tracking System
COB
Inbound paper – Inbound Corr –
ADI-C#
Enroll Other Call Center Inquiry FIN Tracking
Tracking System System
LOB 2
Portal Services
Claims - Initial Extract NTI Medical Review
Tracking System
NT2
LOB 1 Appeals
System
Claims Processing NT-Agg COB Tracking System
secondary NT2A
DWH- Informatics
EDI Systems Mainframe Systems Call Center Technology
ETL
Mainframe IVR / VRU
EDI Gateway
Programming
Analytics & Stats
Other Corp
Tools...
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Redundancy creates fragility
Corporate data
Data
System B
System C
System D
System A
System E
Applications
Technology
platforms
Corporate networks and infrastructure services
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Manual workflow
Document due dates /timeframes
Summary
Withholding Report Due
Last Date to Enter- Date - 15 Date - Due 45 Demand
Initial Due providers will go on Calendar days after Letter Due
Quarter End Date- Warning days Initial Due Date Date
3/31/2009 4/30/2009 5/15/2009 5/30/2009 6/14/2009 6/29/2009
6/30/2009 7/30/2009 8/14/2009 8/29/2009 9/13/2009 9/28/2009
9/30/2009 10/30/2009 11/14/2009 11/29/2009 12/14/2009 12/29/2009
12/31/2009 1/30/2010 2/16/2010 3/3/2010 3/16/2010 3/31/2010
3/31/2010 4/30/2010 5/16/2010 5/31/2010 6/14/2010 6/29/2010
6/30/2010 7/30/2010 8/15/2010 8/30/2010 9/13/2010 9/28/2010
9/30/2010 10/30/2010 11/15/2010 11/30/2010 12/14/2010 12/29/2010
12/31/2010 1/30/2011 2/15/2011 3/2/2011 3/16/2011 3/31/2011
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Business Methodology
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Business methodology
Discover and validate strategy
Ground leadership in possibility
Conduct cross-functional interviews
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Organizational maturity model: transformational change
Level 1 Level 2 Level 3 Level 4 Level 5
Informal/Ad hoc Formal/Documented Integrated Strategic Optimized
Individual Success Enterprise Collaboration
People “Fire fighting is a way of Highly Agile
life.” Strategically focused
Uncoordinated Rewarded on Enterprise
relationships Success
In competition
Process and Ad Hoc Adaptive
Technology Chaotic Opportunistic
Inconsistent Proactive
Agile
Communication Ad Hoc Preventive
Chaotic Highly Adaptive
No single source of truth Opportunistic
Community based (All
stakeholders)
Measurement Ad Hoc Data is used to evaluate
Manual and select process
People-based improvements
Budget Ad Hoc Opportunistic
Uncoordinated Strategically Focused
Hidden spend
Individual Project based
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Business tract findings
Cascading impact
System count high (2X)
Homegrown % high (70+%)
Process standardization low (1:2 average uses/application)
Process integration low (forced manual tracking/reporting)
Architectural and talent investments not fully leveraged
Opportunities High for Transformation
Scalability
Agility
Reporting
Bottom Line
Business needs not being met today or tomorrow
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aligns transformation
Definition of future state
Iterative roadmap to target
architecture
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building blocks
Target
• Structured EA transformation plan
Industry
• Organizational level work processes (all receipt mediums)
• Single sources of truth (data integrity)
• Organizational Integration / Sourcing
• COTS Component Architecture (ECM, BPM, BRE, BI/DW)
• STP / Exception Processing / DRY/ Case Management
• Program / Change Management /Project Governance
Leverage Mitigate
Functions
Functions
• Deep departmental process understanding • Separation of Work (LOB, Department, etc.)
• Uncover/Redirect current manual process labor • Lack of Document Association (Manual)
• Retain transitional value non-core point solutions • High Pain/Cost Process Decentralization
• Security Breaches, Process/Control Gaps
• Document centric workflow, manual data collection
• Extranet Leadership Organization • Silo-based IT investment, Multitude of systems/apps
Organization
• Diversified LOBs • Disparate Data
• Outsourcing Experience • Redundant Data Entry
• Architecture Limitations and Cost Implication
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Operating model: key informer for architecture
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Target architecture
View
Presentation Tier Layout
Online Provider
WS Services iPhone Android Facebook Security
Application Tier
Request ID Notifiier
NRQT … Aggregation
Tracking MAD
Business Rules
SDO
Services / Business Tier Work Flow
canonical data models Transactions
Security
Security Logging Member Data Provider Data Claim Data Other
Service Service Service Service Service Services…
Integration Tier object domain
Data abstraction
DAO
O-R O-XML O-Unstructured O-API / WS O-Screen Scrape Transactions
Security
native/proprietary domain
Enterprise System Components
EIS Tier
Persistence
Host Systems Document Mgmt Transactions
System
Categorization
OLTP data
sources
Indexing
Workflow Engine Messaging Security
LDAP OLAP data
repositories sources Rules Engine ETL
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Unified data speeds integration
Unique business
Medical Review Claims Provider
processes
Shared data
Standard canonical
data formats
Common, shared data and canonical data formats
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Channels shouldn’t matter
IVR
call
center
email
portal
One process, many
channels / contexts
image
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Avoid the Big Bang
Align
Architect
Iterate
Apply 80/20
Measure
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Actionable
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Maturity and relative IT spending
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The business operates, but how?
Classic Optimized
Mostly human with some static Automated, flexible, DSL with
Rules systems human for exceptions
Manual, escalation by
Automated, SLAs, consistent, cross-
Workflow complaint, process knowledge
department
by experience within department
Electronic repository, single location
Paper-based, curriers, access
Documentation challenges (timeliness, copies)
for all documents, effective retention
and security
Ad-hoc, broadcast, many pull
Communication requests
Just-in-time, targeted
Stove-pipe (department,
purpose and technology), Shared services, integrated data,
Systems redundant functionality, systems of record
duplicated or inaccessible data
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Resulting transformational maturity progression
Level 1 Level 2 Level 3 Level 4 Level 5
Informal/Ad hoc Formal/Documented Integrated Strategic Optimized
Individual Success Roles well understood Program level Collaborative Enterprise Collaboration
“Fire fighting is a way of Coordinated Relationships Coordination Aligned Highly Agile
life.” 2a Commonality driven2b
Performance Measured Data driven Strategically focused
People Uncoordinated Customer focused
Standardized training Thinkers vs Doers Rewarded on
relationships Rules assume low level Enterprise Success
In competition tasks
Ad Hoc Emerging Defined Aligned Adaptive
1
Chaotic Standardized Structured Disciplined Opportunistic
Process and
Inconsistent Isolated Measured Predictable Proactive
Technology
Repeatable 7 Competent 6 Quantitatively Agile
Measured
Ad Hoc Common language Common language Aligned across Preventive
Chaotic emerging 2a Standards Training and outside Highly Adaptive
No single source of truth Gaps understood and Tied to Performance Enterprise Opportunistic
Communication reconciled Systemic Quality Checks Community based (All
Quality checks
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Shift burden to Supplier stakeholders)
Ad Hoc Standardized 2a Proactive Qualitative Data is used to evaluate
Manual Repeatable Aligned assessment and select opportunities
Measurement and People-based Emerging proactively Automated
Control 5
Silo Emerging Automation Enterprise
Portfolio
Ad Hoc Emerging Spend Visibility Clear Spend Visibility Aligned Opportunistic
Uncoordinated Coordinated 2 Program Approach Predictable Strategically Focused
Hidden spend Emerging Control Controlled Agile
Budget
Individual Project based Coordinated Projects ROI visibility
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Kick-start techniques
Leadership
Qualifiers and competes
High-value data
Key process standardization
Commodity technology
Meaningful POC opportunities
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The value of Blue Slate
Blue Slate brings…
External view
Broad experience
Focus
You receive…
The BluePRINT
Enabling greater…
Level of competitiveness
Leverage of existing systems
Efficiency and utilization
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What’s on your mind?
? ?
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