Speaker: IBM Interconnect 2016 Process Innovation and Enterprise Architecture as foundation for operational excellence Abstract: With ever increasing drive to make healthcare more affordable, personalized and accessible, Healthcare Insurance industry has to discover true opportunities for innovation, automation and improvement. Transitioning away from a complex-costly traditional environment to a modernized-digitized operation needs informed decision making. The talk will focus on how Process Innovation, Enterprise Architecture methods and value-driven planning are used to lay out the foundation for innovation and strategic decision making in this high impact transformative journey to create alignment b/w strategy and execution. The talk will also focus on the powerful ways IBM Blueworks Live is leveraged to gauge business operations for strategic road mapping

1. CONNECT WITH US:
2468: Process Innovation & Enterprise
Architecture
Building a Foundation for Operational Excellence
Ravi Sarkar
Enterprise Architect, Manager- Service Delivery Excellence
Prolifics Advisory & Consulting Practice

2. CONNECT WITH US:
Speaker’s Introduction
2
Ravi Sarkar
Enterprise Architect, Manager- Service Delivery
Prolifics Advisory & Consulting Practice
Ravi Sarkar specializes in Enterprise Architecture, SOA, Lean Six Sigma and Digital
Transformation. He has proven track record of building technology solutions and
providing strategic advisory to tier-1 banks and healthcare insurance companies. Ravi
has a keen focus on emerging technology enablement, cognitive computing, IoT and
enterprise technology research and is an Open Group Certified EA and Lean Six Sigma
Black Belt

3. CONNECT WITH US:
Public | Copyright © 2016 Prolifics
3
5-Years Compound
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19%
Employees
Worldwide
1,600+
Global Presence
United States, Canada, United Kingdom, Germany, India
80+
Technology
Accelerators
700+
Technical
Certifications
Over 20 Technology and
Solutions Awards since 2009
including Business Agility,
Customer Integration, Information
Management and Digital
Experience
Over 100 global customers
are currently Fortune
1000 companies
Best-in-class architects and
specialty experts:
BPM, Integration, Digital
Experience, Security, Testing,
Information Management,
Analytics and Enterprise Content
Management
Defect Removal Efficiency
97%
Rate of Repeat
Engagements*
91%
Prolifics at a Glance
Years in
Business
37+
Offices
14
Awards
Technology Expertise
Fortune 1000
*based on % revenue Source – December 2013 internal revenue metrics

4. CONNECT WITH US:
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Industry Expertise
Banking &
Financial Services
Energy &
Utilities
Government
& Education
Healthcare &
Pharmaceuticals
Manufacturing
Media &
Entertainment
MortgageLegal Retail
Insurance Technology Telecommunications
Travel &
Transportation

5. CONNECT WITH US:
What makes Prolifics Different
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5
Global Delivery Advantage
From offices throughout North America, Europe, and Asia, we deliver
solutions across the world.
Core Values
Industry Focus
Prolifics has deep business acumen in several industry
domains. We utilize our wealth of expertise to provide
comprehensive business solutions to all major industries.
Technical Excellence
Combining business flexibility and cost
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Prolifics drives success.
Thought Leadership & Innovation:
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We establish long term partnerships with our clients
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Our reputation and employees are our most
important assets

6. CONNECT WITH US:
Prolifics Global Presence
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7. CONNECT WITH US:
Our Vision, Mission, and Value
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To be one of the most
admired global technology
consulting companies
delivering competitive
advantage to our clients.
Vision
To be a trusted advisor and
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Mission
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Value

8. CONNECT WITH US:
Disclaimer:
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9. CONNECT WITH US:
Agenda
9
+
☞ Healthcare Ecosystem: It’s Evolution, Opportunities & Challenges
☞ Strategic Objectives of the Healthcare Industry
☞ How Technology can Help
☞ Enterprise Architecture as a Foundation for Transformation
☞ A Customized Approach for Building the Strategic Foundation for Operational Excellence
☞ Useful Tools and Techniques for Transformation
☞ Ways to Help Business Stakeholders Realize the Value in Strategic Technology Innovation
☞ Key Takeaways
Enterprise
Agility
Operation
Modernization
Business
Model
Innovation
Architecture360
EA

10. CONNECT WITH US:
What If ?
10
 You go to a restaurant (chosen randomly with no Zagat
guide or Yelp reviews).
 Go through a menu that you don’t understand, take your
server’s suggestions without questions, and order a
meal.
 But the menu has no prices and you have no idea what
you will pay until the bill arrives a few weeks later.
 And it doesn’t matter if the food or service or ambience
were great, or ok, or terrible – you pay anyway.
Does this sound similar to your experience of visiting a healthcare
provider?

11. CONNECT WITH US:
The Healthcare Ecosystem
11
Governments
& Regulatory
Bodies
Pharmacies
Hospitals &
Home Cares
Doctors,
Nurses &
Physicians
Laboratories
Employers
Healthcare
Insurers &
Payers
Technology and the digitally connected global communities are
rapidly disrupting the traditional ecosystems.
Wearables/Tech
Manufacturers
Software &
Application
Developers
Healthcare
Information
Exchanges
Digitally
Connected
Communities
Patients are fast transforming into
healthcare consumers.
Patients

12. CONNECT WITH US:
The Evolving Healthcare Landscape
12
Key
Industry
Trends
Health
System
Evolution
IT
System
Evolution
IT
Role
Evolution
Fee For Service
Fee For Service, Shared
Risk, Bundled Payments, etc,
Full Risk, Integrated Health
Plan & Care Delivery System
Value, Care Management,
Population Management
Personalized Medicine,
Wellness Management
Volume
based/managed care
Multi-Specialty Care Clinic & Hospital Integrated Healthcare Network Integrated Healthcare EcosystemIntegrated Healthcare System
Integrated
EHR
Ancillary Systems
(Lab/Rad/Pharmacy, et.)
Enterprise Resource
Planning (HR, GL, SCM)
Revenue
Cycle
Ambulatory EHR
Hospital EHR
Health Information
Exchange (HIE)
Enterprise Data
Warehouse (EDW)
Patient
Engagement
Advanced
Informatics
Mobile Health
Wellness
Management
Connected
Care
Personalized
Medicine
Patient Access
Installer Integrator Enabler Innovator
PAST PRESENT FUTURE

13. CONNECT WITH US:
Strategic Objectives of Healthcare Industry
The question is, how to achieve these
strategic objectives?
Need to innovate and redesign the
entire business model.

14. CONNECT WITH US:
PROCESS
PEOPLE
(Knowledge
Workers)
TECHNOLOGY
Need to Redesign the Business
Model
Augment Human
Intelligence with
Cognitive
Computing
Smarter Processes
 Markets
 Industries
 Customers
 Market Segment
 Channels
 Customer
Relationship
 Value Proposition
 Offering:
Products/Services
 Capabilities
 Processes / Value
Chains
 Business Services
 Functions
 Data
 Applications
 Technology
MARKET MODEL
PRODUCTS AND
SERVICE MODEL
OPERATING
MODEL
THE NEW BUSINESS MODEL

15. CONNECT WITH US:
Loss of Context: Need for a Bridge
15
STRATEGY EXECUTION
o Define ambition, purpose &
values
o Where to play and how to
win
o Specify the strategy
elements to optimize
• Customer
Engagement
• Operations Cost
• Customer Intimacy
Context Drain
Architecture Bridge
o Implement
roadmap
o Deliver Smarter
Process
Management
capabilities
o Create Cognitive
Business
Operations
o Modernize
operations to
reduce time to
market

16. CONNECT WITH US:
The EA Solutions Framework
16
• Based on the Enterprise
Architecture framework
• Process innovation
approach
• Design thinking &
problem solving mindset
Build Advantages
Prolong
Advantages
Reduce
Disadvantages
Innovate Assemble Mix
Utility
(Foundation)
• Designed to bridge the gap
between strategy and execution
• Helps in reconfiguring the
business
• Acts as the foundational building
block
Capability 1
Capability 2
Capability 3
Service 1
Service 2
Service 3
Stakeholders/Suppliers
Target Operating Model
Capability 1
Capability 2
Capability 3
Service 1
Service 2
Service 3
Stakeholders/Suppliers
Current Operating Model
TRANSFORMATION
Enterprise Architecture Solutions Framework
Influencesthis

17. CONNECT WITH US:
EA as Innovation Enabler
 EA approach is like the ‘lens’
that helps avoid the myopia in
strategic vision.
 Futuristic proactive approach
 Facilitates informed decision
making
 Build holistic architecture:
1. Business Architecture
2. Application Architecture
3. Data Architecture
4. Technology Architecture
17

18. CONNECT WITH US: 18
Technology
The Solutions Framework
*** 4 Action Framework for Value Innovation
PROBLEMS & NEEDS Intuition
Data
SOLUTIONS
Business Context
Business Vision
Strategy Map
Customer
Experience Map
Value Stream
Business Vision
Business
Context
Customer
Experience Map
Capability Models
Capability
Models
Demo/Prototype
on Cloud
Business Model
Discovery
Business Model
Discovery
Strategy Map
Process
Design
Value Stream
Analysis
Business Context
Quantify Value &
ROI
A
C
D
E
F
B
G
H K
J
+VALUE- COST
VALUE INNOVATION
POINT
RAISE
REDUCE CREATE
ELIMINATE
WHAT FACTORS CAN BE
ELIMINATED
WHICH FACTORS SHOULD
BE RAISED
WHAT FACTORS CAN BE
REDUCED
WHICH FACTORS SHOULD
BE CREATED
Roadmap &
Transition
Plan
L
DataApplication
Solution
Design
I

19. CONNECT WITH US:
B: Strategy Map
19
Improve
Operational
Efficiency
Create personalized & affordable
care delivery system that is more
effective and efficient than any
other insurance provider
Improve
Customer
Engagement
Improve Risk
Management
Improve
Operational
Effectiveness
Self
Service
Accurate
Doc info
Transparent
Process
Consistent
Market
Based Fees
Leadership Alignment TeamworkCulture
Financial
Perspective
Customer
Perspective
Internal
Operations
Perspective
Learning&
Growth
Perspective
DESCRIPTION
What:
A Strategy Map is a diagram that describes
how an organization creates value by
connecting strategic objectives in explicit
cause-and-effect relationship with each
other in the four balanced scorecard
objectives (financial, customer, processes,
learning and growth).
By connecting such things as stakeholder
value creation, customer management,
process management, core capabilities,
innovation, IT, organization design and
learning in one graphical representation,
strategy mapping helps greatly in describing
and communicating the strategy among
executives and to their employees. In this
way alignment can be created around the
strategy, which makes a successful
implementation of the strategy more easy.
Who:
Executives, Employees
Key Messages:
Company A has a balanced set of strategic
change activities that support its goals for
value creation.
References:
Strategy Maps: Converting intangible
Assets into Tangible Outcomes. Kaplan,
Robert, Harvard Press

20. CONNECT WITH US:
C: Business Vision (Principle Map)
20
Operational
Excellence
Consumer
Intimacy
Stakeholder
Value
Maximization
Enhance
Decision
Making
Integrate
Physician
Data
Flexible/Agile
Processes
Enhance
Provider
Relationship
Innovate
Payment
Model
Increase
Speed
to
Market
Reduce
Inconsistency
in Product
delivery
Reduce
wastes &
increase
Productivity
Reusable
Components
Automated
Operational
Decision
Management
Increase
Operational
Intelligence
Adopt Data
Driven
Health
Intelligence
(HIX, HIE)
Connect
Channels
of
interaction
Increase
Operations
Transparency
Increase
Speed of
awareness
Real Time
Operations
Update
Automated
& Cognitive
workflow
System of
Knowledge
worker
engagement
Single
Version of
Truth
Data
Accuracy
Data
Completeness
Data
Timeliness
&
Availability
Measure
for
Quality
Metadata
Driven
Information/
Data
Businessand
ApplicationTechnology
Scalability
Minimize
Complexity
Maintainability Interoperability
Transformation
Objectives
Business
Strategies
Smarter
Process
IBM
Watson
Business
Activity
Monitoring
IBM
Integration
Bus
ETL/ELT
CLOUD (PaaS, IaaS, SaaS
Facilitates informed decision making

21. CONNECT WITH US:
D: Business Model Discovery
21
Powerful tool to outline the entire business on one page
 Markets
 Industries
 Customers
 Market Segment
 Channels
 Customer
Relationship
 Value Proposition
 Offering:
Products/Services
 Capabilities
 Processes / Value
Chains
 Business
Services
 Functions
 Data
 Applications
 Technology
MARKET MODEL
PRODUCTS AND
SERVICE MODEL
OPERATING
MODEL

22. CONNECT WITH US:
E: Customer Experience Mapping
22

23. CONNECT WITH US:
F: Value Stream Analysis
23
Measure the current state
of the business operations
using Value Stream
Analysis.

24. CONNECT WITH US:
G: Capability Model
Ravi Sarkar Certified Enterprise Architect
Ensures end-to-end alignment and traceability

25. CONNECT WITH US:
Measurable Capability Model: A Visual
25
“What gets measured gets
managed.”
~ Peter Drucker

26. CONNECT WITH US:
H: Process Design Using Cloud Based
IBM Blueworks Live
 Cloud based collaboration
 Single source of truth for all operations processes
 Extracts tribal knowledge into operations decision discovery &
mapping
 Gives end-to-end awareness of operations about how they do what
they do
 Identifies wastes in the business operations
 Identifies constraints and bottle necks
 BPMN compliant to facilitate direct import and rapid deployment
using
model driven development
26
COLLABORATE INNOVATE ANALYZE OPTIMIZE

27. CONNECT WITH US:
Process Innovation
27
THE TAO OF
BUSINESS PROCESS INNOVATION
Outside-In
Passive/Receptive
Inside-Out
Active/Creative
 Look at your business Outside-In  Look at your business Inside-out
 Adapt your process to the needs
of your customers
 Innovate to exceed expectations
of your customers
 Make it easy for your customers
to do business with you
 Help your customers and
suppliers benefit from your
innovation
Why Process Innovation?
Process innovations increase
bottom-line profitability, reduce
costs, improve efficiency, improve
productivity and increase employee
job satisfaction.
It also delivers enhanced product or
service value to the customer.
Process innovations focus on building an adaptive business process management system (BPMS).
For manufacturing companies, process innovation include things as integrating new production methods and technologies that lead to improved
efficiency, quality, or time-to-market, and services that are sold with those products.
For service companies, process innovations enable them to introduce "front office" customer service improvements and add new services.
"We know where most of the creativity, the innovation, the stuff
that drives productivity lies – in the minds of those closest to
the work." ~ Jack Welch

28. CONNECT WITH US:
Create Discovery Map
 Outline business goals based milestone in the end to end
process
 Identify activities required to complete the milestones
 Identify tasks required to complete the activities
28

29. CONNECT WITH US:
Add Information to Discovery Map
 Identify problems associated with activities, tasks
 Obtain team inputs and comments real time
29

30. CONNECT WITH US:
Discover Decision Points
July 4, 2016
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30

31. CONNECT WITH US:
Analyze Cycle Time
31

32. CONNECT WITH US:
Identify Bottlenecks
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32

33. CONNECT WITH US:
I: Create Conceptual & Logical
Solution Design
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33
Presentation & Interaction Layer
Business Process Layer
PROCESS4: Update…...
PROCESS3: Update…...
PROCESS2: Update Contract
Business Services Layer
(Atomic & Composite)
Operational Systems
(Applications & Data)
CPF
Mainframe
Authorized user base
Browser based access
PROCESS1: --- LOAD NEW HCP CONTRACT
Enter Market
Guidebook data
Enter New Rates
CONTRACTORS
Fee
Type
Decision
CONTRACT ASSESSOR
Fee loader
Service
FSS SANP
Enter Contract Assessment
Outcomes
Retrieve data
for TINs based
on Criteria
Apply Business
Rules
Apply Market
Business Rules
Apply Product
Business Rules
Apply Provider
Business Rules
Determine Business
Scenarios for Straight
Through Processing
Apply Rules for
Straight Through
Processing Scenarios
STP Contract
Loading Service
Apply Contract
Specific Rules
Exception Scenario
Contract Loading
Contract Loader
Load Contract in HCPM
HCPM
Contract Inventory
PDX Load Component Services HAL Processor Component
Load Post PNCR dataLoad Network
Pro-Prac Nwt
Relationship
loading Service
IBM & BPM
Active
Directory
Interface
IBM BPM
COACHES
IBM BPM
PROCESS
MANAGER
IBM ODM
Business Rules
Engine
IBM
INTEGRATION
BUS
Contract Inventory
Service Bus
Service Component Layer
NETWORK MANAGER
HBoR OPS Mgmt
DB
RDS
Load Network &
CriteriaService
Contract Inventory
HBoR OPS Business Process
Implementation Stack

34. CONNECT WITH US:
Application Focused Silos are Driving
Data Silos
34
Healthcare Operations Management Systems
Operations
Intake App
Clinical
Apps
Patient
Apps
Consumer/ Partner Systems
Poor data integration
across application bases
Silos of information exists across
groups (duplication, little sharing)
Application focused IT instead of Data-focused IT is causing business problems

35. CONNECT WITH US:
Patient
Apps
Need to Modernize Integration
35
Operations
Intake App
Contract
Managem
ent App
Physician
Apps
Need to get existing applications to share data through modern integration techniques
Master Data Management, Entity Resolution and Data Integration
Consumer/ Partner Systems
Improved integration by services that can communicate b/w applications
Clinical
Apps
Healthcare Operations Management Systems

36. CONNECT WITH US:
Identify Technology Components for
Solution Implementation
36
 BPM
 ESB
 ETL
 MDM
 Advanced Data Visualization
 Big Data
 Cloud
 Internet of Things
 Advanced Business Rules
 Cognitive & Social computing solutions

37. CONNECT WITH US:
J: Quantify Solution Benefits & ROI
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37

38. CONNECT WITH US:
Quantify ROI: Following IBM BVA
Approach
38
Referenced from IBM Business Value Center of Competency

39. CONNECT WITH US:
Clear Quantification of Solution
Benefits
39
Estimate the full cost
associated with
target solution.
Quantify the
business benefits.

40. CONNECT WITH US:
Estimate the Full Cost Associated
with Target Solution
40

41. CONNECT WITH US:
ROI and Cash Flow Calculation
41

42. CONNECT WITH US: 42
K: Create Prototype
(Day-In-Life of the Proposed Solution)
Helps stakeholders visualize how the future
modernized platforms would look like.

43. CONNECT WITH US:
Create Prototype Demo for
Stakeholder Visualization
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43

44. CONNECT WITH US:
Progressive Workflow Display
July 4, 2016
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44

45. CONNECT WITH US:
Display Power of Data Visualization to
Business Stakeholders
July 4, 2016
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45

46. CONNECT WITH US:
Integrating Google Map with Internal
Data
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46
Display to business
users how the future
world will look like.

47. CONNECT WITH US:
Analyze and Optimize
47

48. CONNECT WITH US:
Analyze and Optimize
48

49. CONNECT WITH US:
Real Time Collaboration b/w
Knowledge Workers
July 4, 2016
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49

50. CONNECT WITH US:
L: Create Roadmap & Transition Plan
 Create transition plan and roadmap to move from current
state to target state
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50

51. CONNECT WITH US:
Key Takeaways
51

52. CONNECT WITH US:
Healthcare Insurance Industry can Play
a Big Role in Healthcare Transformation
 Be more technology driven and align the strategic
objectives with the new technology initiatives.
 Modernize the application portfolio.
 Better understand individual member needs and tailor
the healthcare plans to meet the individual healthcare
needs.
 Gather patients’ data and utilize it to drive improvements
in future care delivery.
 Innovate/reinvent, and not just improve business
processes.
 Apply a blend of human centric and machine driven
approach.
 PREPARE, NOT REPAIR
52

53. CONNECT WITH US:
Conclusion
“The beginning is the most important part of the work.”
~ Plato
A sound Strategic Business Architecture is key to ensuring a
successful translation of strategy to its execution.
“The secret to success is to start from scratch and keep on
scratching.”
~ Dennis Green
A holistic, comprehensive, end-to-end approach is the best
approach.
“Doing the best at this moment puts you in the best place for
the next moment.”
~ Oprah Winfrey
Follow an approach that is innovative and proactive, rather than
responsive and reactive.
Think, innovate and design!
53

54. CONNECT WITH US:
Conclusion
54
July 4, 2016
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55. CONNECT WITH US:
Questions, Answers, Next Steps
Public | Copyright © 2016 Prolifics 55
www.prolifics.com
+1 214 681 7218
Ravi.Sarkar@prolifics.com
July 4, 2016