Rick Sweeney Chief Architect Blue Cross Blue Shield Massachusetts

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Rick SweeneyChief ArchitectBlue Cross Blue
Shield Massachusetts
SOA and Health plans
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Topic

• The Changing Business Landscape
• Expansion of external interaction
• Expansion of interaction channels
• HIPAA and other regulatory impacts
• How many Enrollment Systems does it take to?
• Solving the cost and time to market dilemma
• Technology advancements fueling SOA
• SOA Adaptability, Flexibility, Affordability
• SOA A paradigm shift

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Changing Business Landscape

• Expansion of external interaction
• Competitive and regulated partnerships are
  increasing
• Accounts and members playing increased role in
  managing and monitoring their health benefits
• Incentives and rewards as well as deductibles and
  co-pays are increased factors in the health
  coverage decision
• Ability to deliver increased health and benefit
  information at the POS influences the health
  product purchase decision

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Changing Business Landscape

• Expansion of interaction Channels
• Paper and Batch feeds being replaced with real
  time updates and on-line enrollment
• Telephone Customer Service being replaced with
  IVR and Web Self Service.
• Mobility and technology are driving demand for
  anytime, anywhere access

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Changing Business Landscape

• HIPAA and other Regulatory Impacts
• HIPAA
• Standardization of transactions
• Privacy
• Massachusetts Health Care Reform
• New Products
• New Channels
• New Markets

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How many Enrollment Systems does it take to?

• Treating each transaction source and the channel
  its received on as a separate stove-pipe
  application is
• Costly
• Highly redundant
• Extremely inflexible
• Not adaptable

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How many Enrollment Systems does it take to?

• The bottom line is
• no matter who submits the transaction
• How they submit the transaction (batch, real
  time)
• Or what channel they use (Web, IVR, FTP)
• The same data needs to effect the system of
  record
• The same edits and validation business rules apply

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How many Enrollment Systems does it take to?

• Each stove-pipe solution is monolithic in that it
  redundantly
• Replicates the business logic
• Replicates authentication and authorization
• Manages the presentation and flow of the process

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How many Enrollment Systems does it take to?

• The Result
• Costs go through the roof money is wasted
• Time to market for changes that effect all
  sources is extended as each application is
  assessed and modified
• Ability to support competitive and value added
  capabilities like multi-lingual support become
  cost prohibitive to implement

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The Solution - SOA

• What does SOA mean to me?
• Turning physical implementations into logical
  implementations that
• Insulate and manage processing to the systems of
  record
• Encompass the capability to support deployment
  through multiple channels
• Tie to an Enterprise Entitlement Framework for
• Security (authentication and authorization)
• Profiling (Language, Account SLA)
• Personalization (e.g., response channel)

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Technology Advances
I can connect to anyone, anywhere.
I can interact with anyone, anywhere.
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Business Conceptual view of Architecture
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Service efficiency through SOA

• While a constituent may use any of the available
  channels to access services the underlying
  service is the same!
• An Architecture that focuses on building the
  service once and deploying it through multiple
  channels
• Saves time and Money
• Increases Flexibility and adaptability
• Provides consistency to the consumer and control
  over the process

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Even more valuable to our Line of Business

• Reason 1
• Most of our business activity (and systems) focus
  around our core membership and claims systems
• This Hub and Spoke effect tells us there is
  significant opportunity for reuse at the
  Integration Layer

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Hub and Spoke Model
Constituent Portals
UM
CRMS
Member ship
Claims
New
CM
Enrollment
Partner Channels
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And Our Business Model

• Reason 2
• Multiple constituents want to use the same
  services
• Claim Status Provider, Member, MSR PSR
  Associate
• Enrollment Account, Broker, Connector, ASR
  Associate
• Wellness results Member, Provider, Account,
  Case Manager

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Enterprise View
Step 1 in SOA Adoption
Layered Architecture
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Enterprise View

• Requirements gathered and assessed in the context
  of the enterprise
• What constituents will/could use the requested
  functionality?
• What channels will they use to access the
  functionality?
• Assessment of solution performed in the context
  of the SOA Stack
• What existing assets can be used to deliver the
  functionality?

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SOA Assessment Template
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Legacy Systems of Record

• These are core processing legacy systems.
• SOA does not replace them
• SOA service enables them

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Enterprise Application Integration
Insulate and manage processing to the systems of
record i.e., CRUD data service layer
Real Time
Batch
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Enterprise Business Service Layer
Layer where business logic and business
processes are created i.e, Business services
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Delivery Channel Layer
SFTP, EDI, WS, Portlets, IVR, etc.
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Consumer Layer
Enterprise SOA Entitlement Framework
Transaction Service Authentication Author
ization Authorization Profiling Personalization

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SOA definition revisited

• What does SOA mean to me?
• Turning physical implementations into logical
  implementations that
• Insulate and manage processing to the systems of
  record (EAI Layer)
• Encompass the capability to support deployment
  through multiple channels (Channel Layer)
• Tie to an Enterprise Entitlement Framework for
• Security (authentication and authorization)
• Profiling (Health Status, Account SLA)
• Personalization (e.g., Language, response
  channel)
• (Entitlement Framework)

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The Paradigm Shift Its One System!

• How the business describes their need
• Shifts from stove-pipe application view to
  enterprise service view
• How the solution is developed
• Shifts from Monolithic code to modular component
  builds, enhancements or consumptions
• New, enhanced or reused channels
• New, enhanced or reused Business services
• New, enhanced or reused Data services
• New, enhanced or reused Entitlement services

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Business Value

• Rapidly support new channels for delivery based
  on constituent demand
• Common, shared business logic makes changes to
  process or value added enhancements
  (Personalization, Profiling) achievable
• Shifts significant amount of IT spend over time
  from maintenance and support to new and enhanced
  functionality
• Flexibility and adaptability as well as reuse
  rapidly accelerate time to market

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Contact Information

• Rick Sweeney
• Richard.sweeney_at_bcbsma.com
• 617-246-4580