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Blue Slate Health IT award winning payer case study

  1. The Road to Transformation Ensuring your infrastructure will meet business vision today and tomorrow December 7, 2010 © Blue Slate Solutions 2010
  2. 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 2 © Blue Slate Solutions 2010
  3. 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? 3 © Blue Slate Solutions 2010
  4. Two tracks; one destination Current State Applications Grounding Technologies Strategy Organization Business Technology 4 © Blue Slate Solutions 2010
  5. Technology Methodology © Blue Slate Solutions 2010
  6. Technology methodology Discover IT organization’s alignment and skills Examine technology capacity and flexibility Assess application functionality and data 6 © Blue Slate Solutions 2010
  7. 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 7 © Blue Slate Solutions 2010
  8. 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... 8 © Blue Slate Solutions 2010
  9. Redundancy creates fragility Corporate data Data System B System C System D System A System E Applications Technology platforms Corporate networks and infrastructure services 9 © Blue Slate Solutions 2010
  10. 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 10 © Blue Slate Solutions 2010
  11. Business Methodology © Blue Slate Solutions 2010
  12. Business methodology Discover and validate strategy Ground leadership in possibility Conduct cross-functional interviews 12 © Blue Slate Solutions 2010
  13. 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 13 © Blue Slate Solutions 2010
  14. 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 14 © Blue Slate Solutions 2010
  15. aligns transformation Definition of future state Iterative roadmap to target architecture 15 © Blue Slate Solutions 2010
  16. 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 16 © Blue Slate Solutions 2010
  17. Operating model: key informer for architecture 17 © Blue Slate Solutions 2010
  18. 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 18 © Blue Slate Solutions 2010
  19. Unified data speeds integration Unique business Medical Review Claims Provider processes Shared data Standard canonical data formats Common, shared data and canonical data formats 19 © Blue Slate Solutions 2010
  20. Channels shouldn’t matter IVR call center email portal One process, many channels / contexts image 20 © Blue Slate Solutions 2010
  21. Avoid the Big Bang Align Architect Iterate Apply 80/20 Measure 21 © Blue Slate Solutions 2010
  22. Actionable 22 © Blue Slate Solutions 2010
  23. Maturity and relative IT spending 23 © Blue Slate Solutions 2010
  24. 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 24 © Blue Slate Solutions 2010
  25. 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 8 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 25 © Blue Slate Solutions 2010
  26. Kick-start techniques Leadership Qualifiers and competes High-value data Key process standardization Commodity technology Meaningful POC opportunities 26 © Blue Slate Solutions 2010
  27. 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 27 © Blue Slate Solutions 2010
  28. What’s on your mind? ? ? 28 © Blue Slate Solutions 2010