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Iterative approach to build an Enterprise Architecture for Health Insurance Exchange Speaker Name: Maharshi Desai, Director, IT Strategy and Enterprise Architecture
Oracle Enterprise ArchitectureOracle Enterprise Architecture
Copyright ©2011 Oracle Corporation. All rights reserved.
Agenda
Topics
Objective
EA Methodology and Framework• EA Guiding Principles • Discuss Oracle’s EA methodology and framework
Applying Principles and Methodology to HIX• What is Health Insurance Exchange?• Discuss Plan and approach• Discuss artifacts
Summary
Open Discussion and Q/A
2
Copyright ©2011 Oracle Corporation. All rights reserved.
Objectives
• Understand how to apply iterative methodology to build Enterprise Architecture
• Understand the Oracle Enterprise Architecture Framework and Oracle Architecture Development Process
• Use case on how to apply iterative approach to build exchanges like Health Insurance (HIX)
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Copyright ©2011 Oracle Corporation. All rights reserved.
Methodology and Framework
Copyright ©2011 Oracle Corporation. All rights reserved.
Oracle EA Guiding PrinciplesAgility and Sustainability
Forward Thinking
Business Driven
Time to Value
Best Practices
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Copyright ©2011 Oracle Corporation. All rights reserved.
Oracle Architecture Development Process
Practical Approach, Proven Methodology
Aligns with customer and industry standard EA frameworks
IterativeAgile EA Approach
Reuses best practice business models and reference architectures
Provides Governance
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Oracle Enterprise Architecture Framework
Best Practices,Proven EA Artifacts
• Best Practice Reference Architectures• Reduces Architecture/Solution
Development Time
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Applying Iterative approach to build
Health Insurance Exchange
Copyright ©2011 Oracle Corporation. All rights reserved.
Health Insurance Exchange Background
• The Patient Protection and Affordable Care Act was passed on March 23, 2010. The law requires states to participate in 1 of 3 options:– Establish and operate a state-run exchange
– Partake in a regional exchange (multi-state)
– Federally-administered exchange
• States must have infrastructure operational by January 1, 2014
• A Health Insurance Exchange (HIX) A central marketplace for citizens to compare:– Rates
– Benefits
– Quality of Care
9
Copyright ©2011 Oracle Corporation. All rights reserved.
Health Insurance Exchange Background…
Exchanges will help:– Individuals/families with incomes between 133-400% of the federal poverty
line (2010)• Up to $43k for an individual; $88k for a family of four• Cap on premiums and “out-of-pocket spending”
– Small businesses (up to 100 employees)• Small Business Health Options Program (SHOP)
• About four million small businesses could qualify• Total of $40 billion in relief for small firms over the next 10 years
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Copyright ©2011 Oracle Corporation. All rights reserved.
Bu
sin
ess
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llig
ence
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ds,
OL
PA
/Dat
a m
inin
g, A
d H
oc &
Sch
ed
ule
d R
epo
rts
EmployersIndividuals
Web Phone, IVR Email Text Chat Local Office
Eligibility Automation Portal Layer (Customer, Worker, Provider)
MMIS Systems
De-duplication
Standardization
MatchingServices
Master Data Management& Data Quality Services
Fraud Detection
Client Index
AddressCleansing
ProvidersWorkers
WebPhone, Fax, IVR
Email,Imaging Text Chat
LocalOffice
Sec
uri
ty –
Iden
tity
an
d A
cces
s M
anag
emen
t, S
SO
Enrollment
Billing
Plans / Pricing
Issuers
AHBE Access
Health Insurance Exchange Portal
Mobile /Disconnected
SOA Enterprise Integration Services
IRS
DHS
SSA HHS
DMV
Equifax
AuthoritativeData
CHIP
OSHASP
Medicaid
Data Management
Structured &Unstructured Data
Data Security &Availability
Health Insurance Exchange Functions
Eligibility & Enrollment
Policy Automation
Eligibility Determination
Subsidy/PremiumCalculation
Enrollment
PlanManagement
E-Commerce/Catalog
Carrier Portal
Plan Certification
Renewal
Customer Services
Contact Center
Self-Service
Carrier / Employer / Broker Support
Account Management
Financial Management
Billing
Collection
Premium Reconciliation
Payment
Communications
Marketing/Outreach
Notices
Escalations
Oversight
MandatoryReporting
Dashboards & Alerts
Metrics / KPI
SHOP Access Content Other Self-ServiceTools
Online Applications
Eligibility Screening Calculators Request
ServiceProfile
Management
HIX Vision Architecture
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Architecture Blueprint Plan
Business Architecture
Business – Application Architecture
Business – Information Architecture
Apps/Data – Technology Architecture
Establish Architecture
Vision
Roadmap Planning
90-120 Day Plan
Key Development Principles• Rapid Iterative Design (3 Week cycles) • Map Business to Functional Technology Design• Collaborative Design with Stakeholders• Leverage Oracle Reference Architectures
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Approach: Level 0 and Level 1 Boundaries
Business Architecture
Application Architecture
Data Architecture
Technology Architecture
Define the core Business Capabilities
Identify high level Application Services required to support the Business Capabilities
Identify high level Information Models, Data organization, and Data governance
Identify high level Technology Platforms required to support the Business Capabilities
Application Diagrams
Application Capability Models
Application tech. Support Models
Data Object Models
Data Integration Diagrams
Data Context
Technology Capabilities
Technology Support Models
Business Capability Models
Business Process Models
Business Process Support Models
Oracle Enterprise Architecture
Framework Layers
Level 0 (L0) Level 1 (L1)
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Copyright ©2011 Oracle Corporation. All rights reserved.
Approach: Level 1 and Level 2 Boundaries
Business Architecture
Application Architecture
Data Architecture
Technology Architecture
Application Diagrams
Application Capability Models
Application tech. Support Models
Data Object Models
Data Integration Diagrams
Data Context
Technology Capabilities
Technology Support Models
Business Capability Models
Business Process Models
Business Process Support Models
Level 1 (L1)
Presentation Components
Business Logic Components
Business Data Objects
Integration Services
Data Services
Security Services
1 Model for each App. Service
Technology Detail Models
Detail Integration Diagram – High level Canonical Models, Technology, and Systems
Level 2 (L2)
Next level Entity Models
Data Formats
Data Standards
Data Governance and Security
For each high level Entity
For each interface
At the entity level only
Oracle Enterprise Architecture
Framework Layers
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Business Architecture Approach
Business Requirements
Eligibility & Enrollment (E&E)
E&E - Individual
Prepare / Update Individual Eligibility Application
Accept and Verify Application for Completeness and Accuracy
Manual Verification
1 Business Area
1.1 Business Process Group
1.1.1Business Process
1.1.1.1 Business Activity
1.1.1.1.1 Business Tasks
Use Cases
Business Strategy & Value
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Business Process to Service Mapping
Services
Business Service
ApplicationService
Objects
BusinessObjects
Application Objects
• 1.1.1.1 Business Activity
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Architecture Execution Plan
Project startup activities
July 2011 August 2011 Sep 2011 Oct 2011 Nov 2011
Plan Management L1
EE – IndividualL1
EE - SHOP EmployerL1
EE – SHOP EmployeeL1
Plan Management L3
DesignReview
Plan Management L1-L2
3 Week Cycle
EE – IndividualL1-L2
EE - SHOP EmployerL1-L2
EE – SHOP EmployeeL1-L2
Detailed Design Document
EE – IndividualL3
Dec 2011
EE - SHOP EmployerL3
EE – SHOP EmployeeL3
Financial ManagementL1
Financial ManagementL1-L2
3 Week Cycle
Financial ManagementL3
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Copyright ©2011 Oracle Corporation. All rights reserved.
Running Workshop
Level 1
Level 2
60 Minute session (3 Days/Week):• Business Analysts• Process SME• Enterprise
Architecture• IT Team (Optional)90 Minute session to review Application Component, UI Component, Data Component and Business Objects:• Business Analysts
(Optional)• Enterprise
Architecture• IT Team (Data &
Apps)Level 3 & 4
90 Minute JAD session:• Business Analysts• IT/Development Team
BusinessProcess Flow
& Requirements
Review
Refine
Business
Application
Data
Technology
Architecture
Level 1Level 2
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Copyright ©2011 Oracle Corporation. All rights reserved.
FederalRequirements
StateRequirements
RequirementBaseline
Architecture ModelsLevel 1 and Level 2
Use CasesArchitecture ModelsLevel 3 and Level 4
JAD SessionFinalize
Product Vision
IterativeDevelopment
Product Demo and Acceptance
Connecting Blueprint Phase to Development Phase
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Business Architecture Artifacts
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Highlights the key architecture capabilities and their alignment
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Copyright ©2011 Oracle Corporation. All rights reserved.Highlights alignment in greater detail for each business process
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Highlights alignment of Business Services to Application Services
Copyright ©2011 Oracle Corporation. All rights reserved.
Application ArchitectureArtifacts
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Highlights how each business services are map to apps services
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Highlights how each apps services are map to UI component and BO’s
27
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Data ArchitectureArtifacts
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Highlights application data object mapping of business data objects
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Define overall ERD diagram
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Highlights in-a-glance identified HIX data integration touch points
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Highlights overall view of how data is supported in its associated context
Copyright ©2011 Oracle Corporation. All rights reserved.
Technology Architecture
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Highlights the required HIX Technology Capabilities
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Highlights the focused technology capabilities of a specific component
35
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Map to products required to support the specific capabilities
36
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HIX Logical Architecture
Logical Architecture provides component view of HIX Solution
37
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HIX Technical Architecture
Solution Architecture provides overall physical view of the architecture
38
Copyright ©2011 Oracle Corporation. All rights reserved.
Summary• Agile/Iterative EA approach works for effective
solution• Provides agility and sustainability• Oracle uses Oracle Enterprise Architecture
Framework (OEAF) and Oracle Architecture Development Process (OADP)to build Agile/Iterative Architecture
• OEAF creates top down business driven architecture solution
• Its based on just-enough, just-in-time method• Oracle also provides Complete Solution with
Complete Enterprise Architecture services
39
Copyright ©2011 Oracle Corporation. All rights reserved.
EA can make it Possible If You Believe in them
Be Prepared For The Challenge for Business Driven Approach
Organization need to Focused on Business Goal
Enjoy your success
Q&A
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