Enterprise Architecture for Health Benefits Plan Manager

One of the nation’s premier managers of self-funded health benefit plans partnered with Software Consortium to develop a holistic plan aligning business functions with information assets.

As a leader in the delivery of customized benefit solutions to employers, employees and service providers, Software Consortium was selected to develop the architecture and infrastructure for the reporting needs of one of the nation’s premier managers of self-funded health benefit plans. Software Consortium analyzed the core administrative processes, application architecture, information technology architecture, enabling architecture applications, and information architecture to develop an Enterprise Architecture Roadmap that aligned technology development with the business direction. A gap-analysis between current and future state defined the standards, technology and best practices to determine future technology investments

The Enterprise Architecture roadmap consisted of the following:

Core Administration Application Technology

The core administration processes included Enrollment and Accounts Receivable, Broker Administration, Provider Administration, Customer Service, Auditing, and Merits Administration processes. Both manual and automated processes were opportunities for improvement and a higher ROI and included in the roadmap planning.

Application Architecture

Application Architecture addressed the foundational areas and technologies within each critical facet of the application architecture. Simplification and consolidation were the major theme of the plan pertaining to this architecture, namely to enable:

• Retirement of unsupported technologies;
• Reduction of the number of disparate skill sets; and
• Reduction of complexity.

Detailed consolidation and simplification efforts were planned for each technology and highlighted the need to create principles, guidelines, and standards for the mainstream technologies.

Information Architecture Technology

Consolidation of disparate technologies was a major goal to enable:

• Retirement of unsupported technologies;
• Reduction of number of disparate skill sets;
• Licensure reduction; and
• Reduction of complexity within the technical environment.

The information architecture was defined as a combination of the following technical components:

• Databases: Data storage for both transactional and analytical usages;
• ETL (Extract Transform Load): Data movement within and outside the environment;
• Translators: Tools that provide parsing and materialization for complex data;
• Data Quality: Means for de-duping and standardizing data to improve the accuracy and reliability of datasets;
• Data Profiling, Modeling, and Subsetting: Efficient development processes for data warehousing related efforts;
• Operational Reporting: Framework for authoring, delivering, and running operational reports; and
• Analytics: Framework for creating and running cubes against dimensionalized datasets.

Enabling Enterprise Applications

The client systems to be supported included:

• Intranet: The enterprise framework for delivering employee content, and also the organizational model for “pushing” applications and tools to the employee based on their role/responsibility;

• Enterprise Content Management: Defined how content is shared throughout the organization;
• Image Management: A storage repository for images and the automation of business processes surrounding images;
• Business Process Management: Historically, single aspects of business processes were encapsulated into workflows within individual applications. Generalized tool sets allowed the organization to extract business processes from individual applications, thereby leading to a new horizontal tool set for processing modeling and execution.

Information Data Architecture

The client possessed a number of transactional systems that contained a matching data store for reporting and integration needs. This resulted in isolated reporting solutions and point-to-point integration between the claim systems’ common third-party vendors and products. The developed roadmap addressed the need to migrate from these data silos toward an Operational Data Store (ODS) for application integration and an Enterprise Data Warehouse (EDW) for historical reporting and analytics. Additionally, this roadmap expressed the need to better embrace the organization’s data through the development of Data Stewardship and Data Retention processes.

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