Business Value Measurements and the Solution Design Framework
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Transcript of 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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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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Alignment Topics For Today
• Foundations – Guiding Principles – Frameworks – Capabilities
• Solution Design – Process – Reviews
• Solution Scorecards
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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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Alignment Topics For Today
• Foundations – Guiding Principles – Frameworks – Capabilities
• Solution Design – Process – Reviews
• Solution Scorecards
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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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Alignment Topics For Today
• Foundations – Guiding Principles – Frameworks – Capabilities
• Solution Design – Process – Reviews
• Solution Scorecards
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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
t
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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Alignment Topics For Today
• Foundations – Guiding Principles – Frameworks – Capabilities
• Solution Design – Process – Reviews
• Solution Scorecards
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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
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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Alignment Topics For Today
• Foundations – Guiding Principles – Frameworks – Capabilities
• Solution Design – Process – Reviews
• Solution Scorecards
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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
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
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 ?