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The 2015 Blue National Summit is a program of the Blue Cross Blue Shield Association,
an association of independent Blue Cross and Blue Shield companies. © 2015
Business and IT
Alignment
How To Align Business Strategic
Planning With Solution
Development
Leo Barella
VP, EIT Data Intelligence
Blue Cross Blue Shield of Michigan
2
2
3
Alignment Topics For Today
•  Foundations
–  Guiding Principles
–  Frameworks
–  Capabilities
•  Solution Design
–  Process
–  Reviews
•  Solution Scorecards
4
Alignment Topics For Today
•  Foundations
–  Guiding Principles
–  Frameworks
–  Capabilities
•  Solution Design
–  Process
–  Reviews
•  Solution Scorecards
5
Pieces of the Puzzle
•  Define views of architecture that allow you to share information across teams. Provide
multiple perspectives at multiple levels.
•  Structure your resources to support specific business customers. Align multiple roles in
that team.
•  Create repeatable processes for defining solutions.
•  Define a mechanism to communicate how solutions:
–  Impact the technology footprint (cost, redundant software)
–  Create risk (security concerns, data loss, audit)
–  Affect overall costs (delivery, remediation, long term adds)
–  Additional data points important to your business
• Communicate!
6
Communicating - Shoshin (Beginner's Mind)
•  It all starts with solid communication
•  Be open to feedback
•  Have open conversations about
–  Why do we need the solution?
–  What does architecture do?
–  What does the business do?
–  How effective is architecture / IT in helping the business?
–  What does the business need and want from IT?
Architecture is a set of services we provide. Always asking "how can we help you?"
7
Define Architecture
8
People – Who From the Business?
• Critical to identify stake holders.
–  Identify the biggest change agents.
–  Identify the biggest road blocks.
–  Don’t go after titles – Avoid the HiPPO
•  (Highest Paid Person in the Office)
• Candidate Score Cards?
–  Stakeholder Power maps.
9
Alignment Topics For Today
•  Foundations
–  Guiding Principles
–  Frameworks
–  Capabilities
•  Solution Design
–  Process
–  Reviews
•  Solution Scorecards
10
Architecture Principles
•  It is often not efficient, effective, or practical to have every detail of a strategy in
place before implementation can start. (80/20)
•  As a foundation, and as starting guidelines we can define a set of Architecture
Principles.
•  These should be defined at a level that is resistant to change and current
enough to be relevant to the state of our business and IT trends.
•  Subject to governance by a cross representative team from IT and different
business units.
11
Architecture Principles - An Example
•  Template
–  Statement – high level idea that should be consistent over time.
–  Rationale – What factors have impacted us to suggest this is important.
–  Implications – Obvious impacts on our strategies, required skills, and technical and business
models.
•  Data First
–  Data is our most critical asset, it takes priority over application and technology considerations.
–  Rationale: To grow as a company, understand & service our customers as well as make good
decisions, trustable data is key. Data Integrity must not be sacrificed to meet application or
technology constraints.
–  Implications: Applications and technologies will be selected and implemented based on an
approach that first considers data needs. All other design decisions are secondary to those needs.
12
Alignment Topics For Today
•  Foundations
–  Guiding Principles
–  Frameworks
–  Capabilities
•  Solution Design
–  Process
–  Reviews
•  Solution Scorecards
13
Visualizations– Starting Point for Discussion
•  Leverage a high level Framework (build, beg, borrow, steal)
•  Enterprise Frameworks can provide a place to start building a common
language for conversations, designs, and metrics.
•  Make sure it’s at a high enough level to be shared in a short period of time (5
minutes).
•  Make sure it’s decomposable to lower levels of detail.
•  Use, test, and refine it mercilessly.
14
An Example – Our EA Framework
Business Architecture
Enterprise Strategy Value Streams
Business
Capabilities
Core Business
Processes
Technology Architecture
Data Technology Collaboration
Systems
Management
Integration
Technology
Platforms
Application
Technology
Network
Information
Architecture
Data
Integration
Application
Security
15
Definitions
Business Architecture
Enterprise Strategy Value Streams
Business
Capabilities
Value Streams
Business
Capabilities
how value is delivered what is done how work is done
Core Business
Processes
Enterprise Strategy
Assessment of market drivers, where to take the business in the future
Value Streams
Activities that directly impact the experience of and provide benefit to targeted stakeholders
Business Capabilities
High level groupings of skills that describe how we perform our work
Core Business Processes
Well defined tasks that serve singular functions to enable our work
16
Value Streams – further defined
16
Why are Value
Streams important?
A	
  subjec)ve	
  view	
  from	
  the	
  business	
  of	
  high	
  priority	
  ac)vi)es	
  where	
  	
  
value	
  is	
  delivered	
  to	
  stakeholders	
  to	
  support	
  decision	
  making	
  
Value	
  Streams	
  are:	
  
How	
  value	
  is	
  delivered	
  —	
  not	
  specifically	
  how	
  or	
  what	
  is	
  done	
  
Value	
  Streams	
  are	
  not:	
  
Exactly	
  the	
  same	
  as	
  a	
  Process	
  (value	
  stream	
  reads	
  more	
  like	
  a	
  story)	
  
Directly	
  addressing	
  ALL	
  business	
  processes	
  
Always	
  in	
  exact	
  sequen)al	
  order	
  
Hierarchical	
  with	
  subsequent	
  levels	
  of	
  detail	
  	
  
ie.	
  the	
  ac9vi9es	
  that	
  comprise	
  a	
  Value	
  Stream	
  are	
  not	
  necessarily	
  the	
  “top	
  level”	
  business	
  processes	
  from	
  the	
  Business	
  Process	
  Models	
  
	
  
17
Value Stream Map – V10
18
Business Capabilities Map
Products
Member
Mgmt
Customer
Service
Claims
Processing
Pricing &
Risk
Sales
Provider
Network Mgmt
Health
Care Mgmt
Finance
and
Regulatory
Information
TechMarketing
Benefit Management Broker
Programs
Customer
Communication
Group And Broker
Service
Network
Development
Care Management Claim Adjudication Member
Service
Accounting Administrative
Services
Alternate Funding Enterprise
Architecture
Contract
Development
Commercial Sales Lead Management Group Installation Network
Management
Community Health
Management
Claim Adjustment Provider
Service
Accounts Payable
And Receivable
Business Analytics Community Rating Application
Development
Filing And
Regulatory Approval
Customer
Communication
Prospect
Management
Member Enrollment
Management
Interplan
Network
Management
Disease
Management
Claim Receipt Broker
Service
Actuarial Contracts And
Procurement
Experience Rating Infrastructure
Support
Product And Pricing
Strategy
Government Sales Campaign
Management
Member
Management
Pharmacy Admin Healthcare Policy
Management
Claim Triage Group
Service
Budgeting And
Forecasting
Corporate Admin Medicare Risk
Adjustment
Portfolio and
Demand
Management
Product And Service
Development
Renewal
Management
Customer Data
Management
Provider Operations Medical Utilization
Management
Claim Workflow Claims Based Billing
And Invoicing
Corporate
Communication
Rating And
Underwriting
Project Management
Product Lifecycle
Management And
Implement
Sales
Operations
Loyalty
Management
Provider Pricing Quality Health
Informatics
OPL And COB
Processing
Collections Document Services Risk Management Information Security
Product
Management
Sales Performance
Management
Marketing
Analytics
Provider Quality
Management
Wellness Reimbursement And
Notification
Payments
Premium
Reconciliation
Human Resources Data Management
and Integration
Marketing
Resource
Management
Provider
Reimbursement
Support
Reserve
Management
Quality And Data
Governance
Provider Relations Taxation Telecom
Treasury
Support
Business
Functions
19
Value Streams to Capabilities Relationship
and foundation for Heat Map
	
  	
   	
  	
  
Prdct	
  &	
  Svcs	
  
Mgmt	
  
Pricing	
  &	
  
Risk	
   Mktg	
   Sales	
  
Mmbr	
  
Mgmt	
  
Prvd	
  &	
  Ntwk	
  
Mgmt	
   Claim	
  Processing	
  
Health	
  Care	
  
Mgmt	
   Cust	
  Svc	
  
Finance	
  &	
  
Reg	
  
Support	
  Bus	
  
Func	
  
1	
   Idea	
  to	
  Product	
   EHP	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
  
2	
   Lead	
  to	
  Prospect	
   EHP	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
  
3	
   TBD	
   Govt	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
  
4	
   Prospect	
  to	
  Contract	
   Group	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
  
5	
   Prospect	
  to	
  Member	
   Individual	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
  
6	
  
Treatment	
  to	
  Receipt	
  
Documenta)on	
  
Member	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
  
7	
   Prospect	
  to	
  Contract	
   Provider	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
  
8	
   Care	
  to	
  Receipt	
  Documenta)on	
   Provider	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
  
9	
  
State	
  of	
  Healthy	
  Iden)fied	
  to	
  
Savings	
  AZained	
  
Risk	
  
Holders	
  
	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
  
10	
   Support	
  to	
  Resolu)on	
  
Assistance	
  
Seekers	
  
	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
   	
  	
  
Strong	
  Rela)onship	
   Suppor)ng	
  Rela)onship	
  
20
Products
Membership
Mgmt
Customer
Service
Claims
Processing
Pricing & Risk Sales
Provider
Network Mgmt
Health Care
Mgmt
Finance and
Regulatory
Support
Business
Functions
Marketing
Benefit Management Alternate Funding Broker
Programs
Customer
Communications
Group And Broker
Service
Network Development Claim Adjudication Care Management Member
Service
Accounting Administrative Services
Contract Development Community Rating Commercial Sales Lead Management Group Installation Network Management Claim Adjustment Community Health
Management
Provider
Service
Accounts Payable
And Receivable
Business Analytics
Filing And Regulatory
Approval
Experience Rating Customer
Communications
Prospect Management Member Enrollment
Management
Interplan
Network
Management
Claim Receipt Disease Management Broker
Service
Actuarial Contracts And
Procurement
Product And Pricing
Strategy
Medicare Risk
Adjustment
Government Sales Campaign
Management
Member Management Pharmacy Admin Claim Triage Healthcare Policy
Management
Group
Service
Budgeting And
Forecasting
Corporate Admin
Product And Service
Development
Rating And
Underwriting
Renewal Management Customer Data
Management
Provider Operations Claim Workflow Medical Utilization
Management
Claims Based Billing
And Invoicing
Corporate
Communications
Product Lifecycle
Management And
Implement
Risk Management Sales
Operations
Loyalty
Management
Provider Pricing OPL And COB
Processing
Quality Health Informatics Collections Document Services
Product Management Sales Performance
Management
Marketing
Analytics
Provider Quality
Management
Reimbursement And
Notification
Wellness Payments
Premium
Reconciliation
Human Resources
Marketing
Resource
Management
Provider
Reimbursement
Support
Reserve
Management
Information Technology
Provider Relations Taxation Legal
Provider Contracting Treasury Quality And Data
Governance
Telecom
Capability	
  Heatmap	
  
7	
  
3-­‐5	
  
>20	
  
0-­‐2	
  
5-­‐20	
  
1	
  
0	
  
1	
  
2	
  
1	
  
2	
  
0	
  
0	
  
1	
  
0	
  
7	
  
1	
  
1	
  
3	
  
1	
  
3	
  
1	
  
1	
  
6	
  
5	
  
0	
  
3	
  
3	
  
0	
  
0	
  
0	
  
0	
  
7	
  
0	
  
0	
  
1	
  
12	
  
6	
  
3	
  
5	
  
5	
  
1	
  
12	
  
4	
  
12	
  
0	
  
16	
  
13	
  
12	
  
2	
  
3	
  
22	
  
3	
  
51	
  
10	
  
0	
  
13	
  
13	
  
1	
  
5	
  
6	
  
1	
  
2	
  
1	
  
0	
  
15	
  
15	
  
13	
  
3	
  
4	
  
6	
  
28	
  
17	
  
522	
  
9	
  
5	
  
2	
  
0	
  
10	
  
47	
  
4	
  
29	
  
17	
  
0	
  
6	
  
21
Value Stream + Process + Capability + Applications
Capability
Supporting
Apps
Channel
Process
Direct
(i.e. Retail site)
Public Exchange ProducerPrivate Exchange
Value Stream
(Member)
Shop to Card
Determine Eligibility
Shop for
Plans
Receive
Quote
Enroll Confirm Membership Fulfill
Sales Call Center
Sales Enrollment Membership
Mgmt.
Premium
Billing
Payment &
Collections
Fulfillment
NYS Exchange
Siebel
Web
Enrollment
Benefit Focus
Billing Inquiry
Lawson
Trizetto EHP/UHC Benefit Focus
Key: 3rd Party
Facets
Facets
Benefit FocusFacets
Blue/Univera on
Demand Facets
Document
Services
Stepwise
Paper App
Enrollment
ACS
Benefit Focus
Benefit Focus
22
Alignment Topics For Today
•  Foundations
–  Guiding Principles
–  Frameworks
–  Capabilities
•  Solution Design
–  Process
–  Reviews
•  Solution Scorecards
23
Process – Solution Design
Solution Design Practices
•  Must Be Representative of cross team goals
and ownership
•  Shall Be Consistent
•  Shall Be Measurable
•  Shall Be Re-useable
•  Shall Be Aligned to Target State Architecture
•  Should Be Named consistently
•  Should Improve Time To Market
•  Should Provide Familiarity Across Teams
•  Should Be Flexible
•  Should Be Located in a standard repository
The solution design process
encompasses a set of predefined
processes, artifacts, and practices
that drive consistent measurable
outcomes.
The process helps promote strategic
thinking, architecture alignment, risk
awareness, and collaboration.
24
Solution Development Lifecycle
Portfolio Mgmt SDLC
Planning Business Case Analyze Design Build Test Deploy
BRMs	
   S	
   SA	
   App	
  Dev	
   RAs	
   EA	
   BA	
   Bus	
  Arch	
  D	
   DA	
  BP	
   BPE	
  I	
   INF	
   A	
  B	
   R	
  
25
Solution Design Framework
Business Data Application Technology
StrategicEnterpriseSolutionDevelopment
Business Capability
Heat Map Enterprise
Data Entity Heat Map Information Application Architecture Heat Map
BA101
DA100 AA100
Business Process
Decomposition Data Flow Diagram Conceptual Application Components DiagramBA200 DA200 AA200
Business Process Modeling
BA300
Logical Application Component
Diagram AA301 Application to Infrastructure
Component Diagram
TA300
Bus. Requirements
Document BA401
Physical
Infrastructure Diagram
TA400
Value Stream
Heat Map BA102
Req. Traceability
Matrix BA402
Low-Level Detailed Application
Solution Design
AA402
Source to Target
Mapping DA401
Data Dictionary DA402
Physical Data Model /
DDL DA403
Data Entity CRUD
Matrix DA301
Data Profiling Analysis DA302
Logical Data Model DA303
High-Level Detailed
Application Solution AA302
Conceptual Design Doc SDF201
Solution Design Doc SDF301
26
BA101 - Business Capability
Heat Map
Actual example
Core Capabilities Total Proj 1 Proj 2 Proj 3 Proj 4 Proj 5 Proj 6 Proj 7
Product & Service Management 11
Benefit Management 3 X X X
Contract Development 5 X X X X X
Filing / Regulatory Approval 0 X X
Product & Pricing Strategy 3 X X X
Product & Service Development 0
Product Lifecycle Management & Implementation 0
Pricing & Risk Management 15
Alternate Funding 0
Community Rating 3 X X X
Experience Rating 3 X X X
Medicare Risk Adjustment 3 X X X
Rating & Underwriting 4 X X X X
Risk Management 2 X X
Sales 3
Broker Programs 0
Commercial Sales 3 X X X
Customer Communications 0
Government Sales 0
Renewal Management 0
27
BA102 - Value Stream Heat Map
Actual example
Total Proj 1 Proj 2 Proj 3 Proj 4 Proj 5 Proj 6 Proj 7
VS1 – Idea to Product 8
Assess Environment & Analyze the Market 3 X X X
Develop Products & Services 2 X X
Rate & Price Products & Services 1 X
Regulatory Submission 1 X
Manage Product Lifecycle 1 X
VS2 – Lead to Prospect 6
Assess Environment & Analyze the Market 2 X X
Design Campaign 2 X X
Execute Campaign 2 X X
VS3– Prospect to Contract - Group 8
Initiate Sale & Renewal 1 X
Negotiate Proposal 2 X
Obtain Sale or Renew Commitment 2 X
Install New Case 2 X
Maintain Customer Affiliation 1 X
Value Stream & Activities Directly Impacting
Stakeholder Value
28
DA100 – Enterprise Data
Entity Heat Map
Actual example
Data
Entity
Data Access Total Proj 1 Proj 2 Proj 3 Proj 4 Proj 5 Proj 6 Proj 7
Member Total 13
Create 3 X X X
Read 4 X X X X
Update 5 X X X X X
Delete 1 X
Product Total 10
Create 2 X X
Read 4 X X X X
Update 3 X X X
Delete 1 X
Group Total 7
Create 2 X X
Read 2 X X
Update 2 X X
Delete 1 X
Broker Total 5
Create 2 X X
Read 2 X X
Update 1 X
Delete 0
Provider Total 3
Create 0
Read 2 X X
Update 1 X
Delete 0
29
AA100 – Information Application
Architecture Heat map
Actual example
Total Proj 1 Proj 2 Proj 3 Proj 4 Proj 5 Proj 6 Proj 7
Claim Processing
Benefit Accumulator System 6 X X X X X X
Claim Review System 3 X X X
Clinical Editing System 0
Dental Claim Processing System 2 X X
Federal Employee Claim Processing System 4 X X X X
Interplan Claim Processing System 2 X X
Medical Claim Processing System 1 X
Pharmacy Claim Processing System 1 X
Pharmacy EOB System 0
Provider Pricing System 0
Customer Service
Customer Service Inquiry System 0
Employer Inquiry System 3 X X X
ePrescribing System 1 X
Interplan Inquiry System 1 X
Member Inquiry System 0
Protected Health Authorization System 0
Provider Inquiry System 0
Business Applications
30
Alignment Topics For Today
•  Foundations
–  Guiding Principles
–  Frameworks
–  Capabilities
•  Solution Design
–  Process
–  Reviews
•  Solution Scorecards
31
Software Life Cycle – Architecture Artifacts
Portfolio Mgmt SDLC
Planning Business Case Analyze Design Build Test Deploy
BA101	
  
DA100	
  
AA100	
  
BA200	
  
DA302	
  
AA200	
  
DA200	
  
AA301	
  
AA302	
  
TA300/TA400	
  
BA300	
  
DA402	
  
DA403	
  
BRMs	
   S	
   SA	
   App	
  Dev	
   RAs	
  
BA102	
  
DA301	
  
SDR	
  
DA401	
  
BA101	
  
DA100	
  
AA100	
  
BA102	
  
SDR	
  
DA303	
  
BA401/BA402	
  
AA402	
  
EA	
   BA	
   Bus	
  Arch	
  D	
   DA	
  
D	
  
D	
  
D	
  
BP	
   BPE	
  
BP	
  
I	
   INF	
  
I	
  
D	
  
D	
  
SDR	
   SDR	
  
S	
  
S	
  
S	
  
A	
  
A	
  
B	
  
B	
  
B	
  
B	
  
B	
  
BA	
  
BA	
  
BA	
  
BA	
  
BA	
  
BA	
  
BA	
  
R	
  
R	
  
32
Alignment Topics For Today
•  Foundations
–  Guiding Principles
–  Frameworks
–  Capabilities
•  Solution Design
–  Process
–  Reviews
•  Solution Scorecards
33
Process – Solution Design Scorecards
•  Build a set of metrics to evaluate solution options.
•  Communicate aspects of solution options in a variety of ways to show risk, cost,
and alignment.
•  Provide transparency around the trade offs of the various solution options.
•  Document the evolution of the design through the phases of the project and
related score changes.
•  Leverage in discussions around what design will progress to implementation.
34
Scoring – Architecture Alignment
35
Scoring - Value
36
Scoring - Risk
37
Scoring - Readiness
38
Scoring – General Visualization
39
39
Overall Scoring
40
Software Life Cycle – Architecture Artifacts
Portfolio Mgmt SDLC
Planning Business Case Analyze Design Build Test Deploy
BA101	
  
DA100	
  
AA100	
  
BA200	
  
DA302	
  
AA200	
  
DA200	
  
AA301	
  
AA302	
  
TA300/TA400	
  
BA300	
  
DA402	
  
DA403	
  
BRMs	
   S	
   SA	
   App	
  Dev	
   RAs	
  
BA102	
  
DA301	
  
SDR	
  
DA401	
  
BA101	
  
DA100	
  
AA100	
  
BA102	
  
SDR	
  
DA303	
  
BA401/BA402	
  
AA402	
  
EA	
   BA	
   Bus	
  Arch	
  D	
   DA	
  
D	
  
D	
  
D	
  
BP	
   BPE	
  
BP	
  
I	
   INF	
  
I	
  
D	
  
D	
  
SDR	
   SDR	
  
S	
  
S	
  
S	
  
A	
  
A	
  
B	
  
B	
  
B	
  
B	
  
B	
  
BA	
  
BA	
  
BA	
  
BA	
  
BA	
  
BA	
  
BA	
  
R	
  
R	
  
41
Summary
•  Architecture processes are always a work in progress, revise mercilessly.
•  Leverage existing models and artifacts, especially from your industry.
•  Well defined artifacts like Solution Scorecards should be designed to remove
subjectivity when measuring delivery options.
•  Identify the right stakeholders.
•  It’s about supporting the business.
•  Over-communicate.
42
Questions ?

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Business Value Measurements and the Solution Design Framework

  • 1. The 2015 Blue National Summit is a program of the Blue Cross Blue Shield Association, an association of independent Blue Cross and Blue Shield companies. © 2015 Business and IT Alignment How To Align Business Strategic Planning With Solution Development Leo Barella VP, EIT Data Intelligence Blue Cross Blue Shield of Michigan
  • 2. 2 2
  • 3. 3 Alignment Topics For Today •  Foundations –  Guiding Principles –  Frameworks –  Capabilities •  Solution Design –  Process –  Reviews •  Solution Scorecards
  • 4. 4 Alignment Topics For Today •  Foundations –  Guiding Principles –  Frameworks –  Capabilities •  Solution Design –  Process –  Reviews •  Solution Scorecards
  • 5. 5 Pieces of the Puzzle •  Define views of architecture that allow you to share information across teams. Provide multiple perspectives at multiple levels. •  Structure your resources to support specific business customers. Align multiple roles in that team. •  Create repeatable processes for defining solutions. •  Define a mechanism to communicate how solutions: –  Impact the technology footprint (cost, redundant software) –  Create risk (security concerns, data loss, audit) –  Affect overall costs (delivery, remediation, long term adds) –  Additional data points important to your business • Communicate!
  • 6. 6 Communicating - Shoshin (Beginner's Mind) •  It all starts with solid communication •  Be open to feedback •  Have open conversations about –  Why do we need the solution? –  What does architecture do? –  What does the business do? –  How effective is architecture / IT in helping the business? –  What does the business need and want from IT? Architecture is a set of services we provide. Always asking "how can we help you?"
  • 8. 8 People – Who From the Business? • Critical to identify stake holders. –  Identify the biggest change agents. –  Identify the biggest road blocks. –  Don’t go after titles – Avoid the HiPPO •  (Highest Paid Person in the Office) • Candidate Score Cards? –  Stakeholder Power maps.
  • 9. 9 Alignment Topics For Today •  Foundations –  Guiding Principles –  Frameworks –  Capabilities •  Solution Design –  Process –  Reviews •  Solution Scorecards
  • 10. 10 Architecture Principles •  It is often not efficient, effective, or practical to have every detail of a strategy in place before implementation can start. (80/20) •  As a foundation, and as starting guidelines we can define a set of Architecture Principles. •  These should be defined at a level that is resistant to change and current enough to be relevant to the state of our business and IT trends. •  Subject to governance by a cross representative team from IT and different business units.
  • 11. 11 Architecture Principles - An Example •  Template –  Statement – high level idea that should be consistent over time. –  Rationale – What factors have impacted us to suggest this is important. –  Implications – Obvious impacts on our strategies, required skills, and technical and business models. •  Data First –  Data is our most critical asset, it takes priority over application and technology considerations. –  Rationale: To grow as a company, understand & service our customers as well as make good decisions, trustable data is key. Data Integrity must not be sacrificed to meet application or technology constraints. –  Implications: Applications and technologies will be selected and implemented based on an approach that first considers data needs. All other design decisions are secondary to those needs.
  • 12. 12 Alignment Topics For Today •  Foundations –  Guiding Principles –  Frameworks –  Capabilities •  Solution Design –  Process –  Reviews •  Solution Scorecards
  • 13. 13 Visualizations– Starting Point for Discussion •  Leverage a high level Framework (build, beg, borrow, steal) •  Enterprise Frameworks can provide a place to start building a common language for conversations, designs, and metrics. •  Make sure it’s at a high enough level to be shared in a short period of time (5 minutes). •  Make sure it’s decomposable to lower levels of detail. •  Use, test, and refine it mercilessly.
  • 14. 14 An Example – Our EA Framework Business Architecture Enterprise Strategy Value Streams Business Capabilities Core Business Processes Technology Architecture Data Technology Collaboration Systems Management Integration Technology Platforms Application Technology Network Information Architecture Data Integration Application Security
  • 15. 15 Definitions Business Architecture Enterprise Strategy Value Streams Business Capabilities Value Streams Business Capabilities how value is delivered what is done how work is done Core Business Processes Enterprise Strategy Assessment of market drivers, where to take the business in the future Value Streams Activities that directly impact the experience of and provide benefit to targeted stakeholders Business Capabilities High level groupings of skills that describe how we perform our work Core Business Processes Well defined tasks that serve singular functions to enable our work
  • 16. 16 Value Streams – further defined 16 Why are Value Streams important? A  subjec)ve  view  from  the  business  of  high  priority  ac)vi)es  where     value  is  delivered  to  stakeholders  to  support  decision  making   Value  Streams  are:   How  value  is  delivered  —  not  specifically  how  or  what  is  done   Value  Streams  are  not:   Exactly  the  same  as  a  Process  (value  stream  reads  more  like  a  story)   Directly  addressing  ALL  business  processes   Always  in  exact  sequen)al  order   Hierarchical  with  subsequent  levels  of  detail     ie.  the  ac9vi9es  that  comprise  a  Value  Stream  are  not  necessarily  the  “top  level”  business  processes  from  the  Business  Process  Models    
  • 18. 18 Business Capabilities Map Products Member Mgmt Customer Service Claims Processing Pricing & Risk Sales Provider Network Mgmt Health Care Mgmt Finance and Regulatory Information TechMarketing Benefit Management Broker Programs Customer Communication Group And Broker Service Network Development Care Management Claim Adjudication Member Service Accounting Administrative Services Alternate Funding Enterprise Architecture Contract Development Commercial Sales Lead Management Group Installation Network Management Community Health Management Claim Adjustment Provider Service Accounts Payable And Receivable Business Analytics Community Rating Application Development Filing And Regulatory Approval Customer Communication Prospect Management Member Enrollment Management Interplan Network Management Disease Management Claim Receipt Broker Service Actuarial Contracts And Procurement Experience Rating Infrastructure Support Product And Pricing Strategy Government Sales Campaign Management Member Management Pharmacy Admin Healthcare Policy Management Claim Triage Group Service Budgeting And Forecasting Corporate Admin Medicare Risk Adjustment Portfolio and Demand Management Product And Service Development Renewal Management Customer Data Management Provider Operations Medical Utilization Management Claim Workflow Claims Based Billing And Invoicing Corporate Communication Rating And Underwriting Project Management Product Lifecycle Management And Implement Sales Operations Loyalty Management Provider Pricing Quality Health Informatics OPL And COB Processing Collections Document Services Risk Management Information Security Product Management Sales Performance Management Marketing Analytics Provider Quality Management Wellness Reimbursement And Notification Payments Premium Reconciliation Human Resources Data Management and Integration Marketing Resource Management Provider Reimbursement Support Reserve Management Quality And Data Governance Provider Relations Taxation Telecom Treasury Support Business Functions
  • 19. 19 Value Streams to Capabilities Relationship and foundation for Heat Map         Prdct  &  Svcs   Mgmt   Pricing  &   Risk   Mktg   Sales   Mmbr   Mgmt   Prvd  &  Ntwk   Mgmt   Claim  Processing   Health  Care   Mgmt   Cust  Svc   Finance  &   Reg   Support  Bus   Func   1   Idea  to  Product   EHP                                               2   Lead  to  Prospect   EHP                                               3   TBD   Govt                                               4   Prospect  to  Contract   Group                                               5   Prospect  to  Member   Individual                                               6   Treatment  to  Receipt   Documenta)on   Member                                               7   Prospect  to  Contract   Provider                                               8   Care  to  Receipt  Documenta)on   Provider                                               9   State  of  Healthy  Iden)fied  to   Savings  AZained   Risk   Holders                                               10   Support  to  Resolu)on   Assistance   Seekers                                               Strong  Rela)onship   Suppor)ng  Rela)onship  
  • 20. 20 Products Membership Mgmt Customer Service Claims Processing Pricing & Risk Sales Provider Network Mgmt Health Care Mgmt Finance and Regulatory Support Business Functions Marketing Benefit Management Alternate Funding Broker Programs Customer Communications Group And Broker Service Network Development Claim Adjudication Care Management Member Service Accounting Administrative Services Contract Development Community Rating Commercial Sales Lead Management Group Installation Network Management Claim Adjustment Community Health Management Provider Service Accounts Payable And Receivable Business Analytics Filing And Regulatory Approval Experience Rating Customer Communications Prospect Management Member Enrollment Management Interplan Network Management Claim Receipt Disease Management Broker Service Actuarial Contracts And Procurement Product And Pricing Strategy Medicare Risk Adjustment Government Sales Campaign Management Member Management Pharmacy Admin Claim Triage Healthcare Policy Management Group Service Budgeting And Forecasting Corporate Admin Product And Service Development Rating And Underwriting Renewal Management Customer Data Management Provider Operations Claim Workflow Medical Utilization Management Claims Based Billing And Invoicing Corporate Communications Product Lifecycle Management And Implement Risk Management Sales Operations Loyalty Management Provider Pricing OPL And COB Processing Quality Health Informatics Collections Document Services Product Management Sales Performance Management Marketing Analytics Provider Quality Management Reimbursement And Notification Wellness Payments Premium Reconciliation Human Resources Marketing Resource Management Provider Reimbursement Support Reserve Management Information Technology Provider Relations Taxation Legal Provider Contracting Treasury Quality And Data Governance Telecom Capability  Heatmap   7   3-­‐5   >20   0-­‐2   5-­‐20   1   0   1   2   1   2   0   0   1   0   7   1   1   3   1   3   1   1   6   5   0   3   3   0   0   0   0   7   0   0   1   12   6   3   5   5   1   12   4   12   0   16   13   12   2   3   22   3   51   10   0   13   13   1   5   6   1   2   1   0   15   15   13   3   4   6   28   17   522   9   5   2   0   10   47   4   29   17   0   6  
  • 21. 21 Value Stream + Process + Capability + Applications Capability Supporting Apps Channel Process Direct (i.e. Retail site) Public Exchange ProducerPrivate Exchange Value Stream (Member) Shop to Card Determine Eligibility Shop for Plans Receive Quote Enroll Confirm Membership Fulfill Sales Call Center Sales Enrollment Membership Mgmt. Premium Billing Payment & Collections Fulfillment NYS Exchange Siebel Web Enrollment Benefit Focus Billing Inquiry Lawson Trizetto EHP/UHC Benefit Focus Key: 3rd Party Facets Facets Benefit FocusFacets Blue/Univera on Demand Facets Document Services Stepwise Paper App Enrollment ACS Benefit Focus Benefit Focus
  • 22. 22 Alignment Topics For Today •  Foundations –  Guiding Principles –  Frameworks –  Capabilities •  Solution Design –  Process –  Reviews •  Solution Scorecards
  • 23. 23 Process – Solution Design Solution Design Practices •  Must Be Representative of cross team goals and ownership •  Shall Be Consistent •  Shall Be Measurable •  Shall Be Re-useable •  Shall Be Aligned to Target State Architecture •  Should Be Named consistently •  Should Improve Time To Market •  Should Provide Familiarity Across Teams •  Should Be Flexible •  Should Be Located in a standard repository The solution design process encompasses a set of predefined processes, artifacts, and practices that drive consistent measurable outcomes. The process helps promote strategic thinking, architecture alignment, risk awareness, and collaboration.
  • 24. 24 Solution Development Lifecycle Portfolio Mgmt SDLC Planning Business Case Analyze Design Build Test Deploy BRMs   S   SA   App  Dev   RAs   EA   BA   Bus  Arch  D   DA  BP   BPE  I   INF   A  B   R  
  • 25. 25 Solution Design Framework Business Data Application Technology StrategicEnterpriseSolutionDevelopment Business Capability Heat Map Enterprise Data Entity Heat Map Information Application Architecture Heat Map BA101 DA100 AA100 Business Process Decomposition Data Flow Diagram Conceptual Application Components DiagramBA200 DA200 AA200 Business Process Modeling BA300 Logical Application Component Diagram AA301 Application to Infrastructure Component Diagram TA300 Bus. Requirements Document BA401 Physical Infrastructure Diagram TA400 Value Stream Heat Map BA102 Req. Traceability Matrix BA402 Low-Level Detailed Application Solution Design AA402 Source to Target Mapping DA401 Data Dictionary DA402 Physical Data Model / DDL DA403 Data Entity CRUD Matrix DA301 Data Profiling Analysis DA302 Logical Data Model DA303 High-Level Detailed Application Solution AA302 Conceptual Design Doc SDF201 Solution Design Doc SDF301
  • 26. 26 BA101 - Business Capability Heat Map Actual example Core Capabilities Total Proj 1 Proj 2 Proj 3 Proj 4 Proj 5 Proj 6 Proj 7 Product & Service Management 11 Benefit Management 3 X X X Contract Development 5 X X X X X Filing / Regulatory Approval 0 X X Product & Pricing Strategy 3 X X X Product & Service Development 0 Product Lifecycle Management & Implementation 0 Pricing & Risk Management 15 Alternate Funding 0 Community Rating 3 X X X Experience Rating 3 X X X Medicare Risk Adjustment 3 X X X Rating & Underwriting 4 X X X X Risk Management 2 X X Sales 3 Broker Programs 0 Commercial Sales 3 X X X Customer Communications 0 Government Sales 0 Renewal Management 0
  • 27. 27 BA102 - Value Stream Heat Map Actual example Total Proj 1 Proj 2 Proj 3 Proj 4 Proj 5 Proj 6 Proj 7 VS1 – Idea to Product 8 Assess Environment & Analyze the Market 3 X X X Develop Products & Services 2 X X Rate & Price Products & Services 1 X Regulatory Submission 1 X Manage Product Lifecycle 1 X VS2 – Lead to Prospect 6 Assess Environment & Analyze the Market 2 X X Design Campaign 2 X X Execute Campaign 2 X X VS3– Prospect to Contract - Group 8 Initiate Sale & Renewal 1 X Negotiate Proposal 2 X Obtain Sale or Renew Commitment 2 X Install New Case 2 X Maintain Customer Affiliation 1 X Value Stream & Activities Directly Impacting Stakeholder Value
  • 28. 28 DA100 – Enterprise Data Entity Heat Map Actual example Data Entity Data Access Total Proj 1 Proj 2 Proj 3 Proj 4 Proj 5 Proj 6 Proj 7 Member Total 13 Create 3 X X X Read 4 X X X X Update 5 X X X X X Delete 1 X Product Total 10 Create 2 X X Read 4 X X X X Update 3 X X X Delete 1 X Group Total 7 Create 2 X X Read 2 X X Update 2 X X Delete 1 X Broker Total 5 Create 2 X X Read 2 X X Update 1 X Delete 0 Provider Total 3 Create 0 Read 2 X X Update 1 X Delete 0
  • 29. 29 AA100 – Information Application Architecture Heat map Actual example Total Proj 1 Proj 2 Proj 3 Proj 4 Proj 5 Proj 6 Proj 7 Claim Processing Benefit Accumulator System 6 X X X X X X Claim Review System 3 X X X Clinical Editing System 0 Dental Claim Processing System 2 X X Federal Employee Claim Processing System 4 X X X X Interplan Claim Processing System 2 X X Medical Claim Processing System 1 X Pharmacy Claim Processing System 1 X Pharmacy EOB System 0 Provider Pricing System 0 Customer Service Customer Service Inquiry System 0 Employer Inquiry System 3 X X X ePrescribing System 1 X Interplan Inquiry System 1 X Member Inquiry System 0 Protected Health Authorization System 0 Provider Inquiry System 0 Business Applications
  • 30. 30 Alignment Topics For Today •  Foundations –  Guiding Principles –  Frameworks –  Capabilities •  Solution Design –  Process –  Reviews •  Solution Scorecards
  • 31. 31 Software Life Cycle – Architecture Artifacts Portfolio Mgmt SDLC Planning Business Case Analyze Design Build Test Deploy BA101   DA100   AA100   BA200   DA302   AA200   DA200   AA301   AA302   TA300/TA400   BA300   DA402   DA403   BRMs   S   SA   App  Dev   RAs   BA102   DA301   SDR   DA401   BA101   DA100   AA100   BA102   SDR   DA303   BA401/BA402   AA402   EA   BA   Bus  Arch  D   DA   D   D   D   BP   BPE   BP   I   INF   I   D   D   SDR   SDR   S   S   S   A   A   B   B   B   B   B   BA   BA   BA   BA   BA   BA   BA   R   R  
  • 32. 32 Alignment Topics For Today •  Foundations –  Guiding Principles –  Frameworks –  Capabilities •  Solution Design –  Process –  Reviews •  Solution Scorecards
  • 33. 33 Process – Solution Design Scorecards •  Build a set of metrics to evaluate solution options. •  Communicate aspects of solution options in a variety of ways to show risk, cost, and alignment. •  Provide transparency around the trade offs of the various solution options. •  Document the evolution of the design through the phases of the project and related score changes. •  Leverage in discussions around what design will progress to implementation.
  • 38. 38 Scoring – General Visualization
  • 40. 40 Software Life Cycle – Architecture Artifacts Portfolio Mgmt SDLC Planning Business Case Analyze Design Build Test Deploy BA101   DA100   AA100   BA200   DA302   AA200   DA200   AA301   AA302   TA300/TA400   BA300   DA402   DA403   BRMs   S   SA   App  Dev   RAs   BA102   DA301   SDR   DA401   BA101   DA100   AA100   BA102   SDR   DA303   BA401/BA402   AA402   EA   BA   Bus  Arch  D   DA   D   D   D   BP   BPE   BP   I   INF   I   D   D   SDR   SDR   S   S   S   A   A   B   B   B   B   B   BA   BA   BA   BA   BA   BA   BA   R   R  
  • 41. 41 Summary •  Architecture processes are always a work in progress, revise mercilessly. •  Leverage existing models and artifacts, especially from your industry. •  Well defined artifacts like Solution Scorecards should be designed to remove subjectivity when measuring delivery options. •  Identify the right stakeholders. •  It’s about supporting the business. •  Over-communicate.