Open Group Presentation Iterative Approach To Build An Ea For Hix Final

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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


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)

3


Methodology and Framework


Oracle EA Guiding PrinciplesAgility and Sustainability

Forward Thinking

Business Driven

Time to Value

Best Practices

5


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

6


Oracle Enterprise Architecture Framework

Best Practices,Proven EA Artifacts

• Best Practice Reference Architectures• Reduces Architecture/Solution

Development Time

7


Applying Iterative approach to build

Health Insurance Exchange


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


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

10


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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

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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

11


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

12


Approach: Level 0 and Level 1 Boundaries


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)

14


Approach: Level 1 and Level 2 Boundaries


Application Architecture

Data 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

15


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

16


Business Process to Service Mapping

Services

Business Service

ApplicationService

Objects

BusinessObjects

Application Objects

• 1.1.1.1 Business Activity

17


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

18


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

19


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

20


Business Architecture Artifacts

21


Highlights the key architecture capabilities and their alignment

22

Copyright ©2011 Oracle Corporation. All rights reserved.Highlights alignment in greater detail for each business process

23

Copyright ©2011 Oracle Corporation. All rights reserved. 24

Highlights alignment of Business Services to Application Services


Application ArchitectureArtifacts


Highlights how each business services are map to apps services

26


Highlights how each apps services are map to UI component and BO’s

27


Data ArchitectureArtifacts


Highlights application data object mapping of business data objects

29


Define overall ERD diagram

30


Highlights in-a-glance identified HIX data integration touch points

31


Highlights overall view of how data is supported in its associated context


Highlights the required HIX Technology Capabilities

34


Highlights the focused technology capabilities of a specific component

35


Map to products required to support the specific capabilities

36


HIX Logical Architecture

Logical Architecture provides component view of HIX Solution

37


HIX Technical Architecture

Solution Architecture provides overall physical view of the architecture

38


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


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

Open Group Presentation Iterative Approach To Build An Ea For Hix Final

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