Business Value Measurements and the Solution Design Framework

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

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Alignment Topics For Today

•  Foundations –  Guiding Principles –  Frameworks –  Capabilities

•  Solution Design –  Process –  Reviews

•  Solution Scorecards

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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!

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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?"

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Define Architecture

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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.

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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.

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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.

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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.

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An Example – Our EA Framework

Business Architecture

Enterprise Strategy Value Streams Business Capabilities

Core Business Processes

Technology Architecture

Data Technology Collaboration

Systems

Managem

ent

Integration Technology Platforms

Application Technology Network

Information Architecture

Data

Integration

Application

Security

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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

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Value Streams – further defined

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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

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Value Stream Map – V10

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Business Capabilities Map

Products Member Mgmt

Customer Service

Claims Processing

Pricing & Risk Sales Provider

Network Mgmt Health

Care Mgmt Finance

and Regulatory

Information Tech Marketing

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

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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

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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

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3-‐5

>20

0-‐2

5-‐20

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Value Stream + Process + Capability + Applications

Capability Supporting Apps

Channel

Process

Direct (i.e. Retail site) Public Exchange Producer Private 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 Focus Facets Blue/Univera on Demand Facets

Document Services

Stepwise

Paper App Enrollment

ACS

Benefit Focus Benefit Focus

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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.

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Solution Development Lifecycle Portfolio Mgmt SDLC

Planning Business Case Analyze Design Build Test Deploy

BRMs S SA App Dev RAs EA E BA Bus Arch D DA BP BPE I INF A B R

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Solution Design Framework Business Data Application Technology

Stra

tegi

c En

terp

rise

Solu

tion

Dev

elop

men

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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 Diagram BA200 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

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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

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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

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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

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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

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Software Life Cycle – Architecture Artifacts Portfolio Mgmt SDLC


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

E

E E

E

E

E

E E

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

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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.

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Scoring – Architecture Alignment

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Scoring - Value

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Scoring - Risk

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Scoring - Readiness

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Scoring – General Visualization

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Overall Scoring

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Software Life Cycle – Architecture Artifacts Portfolio Mgmt SDLC


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

E

E E

E

E

E

E E

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

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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.

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Questions ?

Business Value Measurements and the Solution Design Framework

Technology

business need

business models

set of architecture

specific business customers

data loss

trustable data

data n

data integrity