it transformation plan executive summary · bcbsnc senior vice president and cio alan hughes....
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An independent licensee of the Blue Cross and Blue Shield Association. U7430b, 2/11
Healthcare Transformation with Business Architecture March, 2012
Business Architecture
Office of the CIO © 2012 BCBSNC. All Rights Reserved.
Steve Dean Chief Business Architect, VP Technology Planning
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Executive Summary
Unrelenting pressures of:
– cost, quality and access to information through every channel, to drive
higher operating efficiencies, fuel business growth and enhance customer
value, are challenging Strategic Thought Leadership.
Recognition that current complexity chokes innovation, increases cost, threatens margins, and stifles market responsiveness.
IT is critical (as a catalyst and enabler) to transforming and meeting the evolving business requirements, strategy, planning and capabilities.
Today‟s IT deficit leaves companies unresponsive to the market. A new approach is required to transform the business model and business platform to one that enables business growth, reduces cost and facilitates market responsiveness.
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Introduction
Analyzing the Portfolio
Developing Scenarios
Transition – Roadmap for Success
Conclusion
High-level Outline
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Introduction
Why Enterprise Architecture? The journey began years ago with the construction of the Enterprise Architecture (EA) practice. The EA practice is the management of architecture for the enterprise and is comprised of views and disciplines. The three views: Technical, Information, & Business. EA used the framework to increase standardization by focusing on the Technology facet. The same framework was used for the creation of the Information facet. While substantial achievements were realized with the technology and Information facets, the greatest opportunity to impact cost and complexity is with a focus on the Business facet.
Why Business Capabilities? Capabilities are the functions or disciplines that deliver demonstrable value to the enterprise. They represent the abilities, talents or capacities of an enterprise. Capabilities provide the connective tissue among strategy, processes, and resources.
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Develop capability hierarchy (4 levels) – Levels 0 & 1 are used for Strategy
– Levels 2 & 3 are used for Operations
Identify key relationships between capabilities and other elements (process, information, technology, segments, LOB)
Develop demand models for capabilities
Develop financial models for capabilities
Identify key resources / stakeholders
Determine importance & relative strength
Determine key operational weaknesses
Capability Modeling
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Does your portfolio align to your strategy? – Map project portfolio against the capability model
– Determine dependencies
Has your Sr. Leadership Team provided their assessment on capabilities?
– Map investment forecasts against the capability
model - „Parity‟, „Above Parity‟ or „Market
Leading?‟
What is your competition investing in? – Map competition investments against the
capability model
Are there additional observations? – Map additional observations against the
capability model
Determine if the correct investments are being made
– Report findings
Analyzing the Portfolio
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L1 Capability
“Draft” capabilities
Vendor 1 Vendor 2 Vendor 3 Level 2 Level 3
Network Mgmt. Develop Network strategies
Market analysis
Modeling x x
Define and manage the Network Management strategy
Develop and Manage Provider Networks
Define composition and size of network
x
Recruit providers (establishing the network)
x
Maintain provider data
x x
Provider credentialing Gather credential information
x
Internal Administration Compliance management
x
Staff training
Contract management Evaluate & negotiate contacts x x x
Renew contracts x x x
Store and manage contracts x x x
Create contract models that meet legal & regulatory
requirements x x x
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Determine future state scenarios – typically 4 – Map to quadrants
– Reflect trends from portfolio analysis against scenarios
Highlight drivers of each scenario – Map drivers against strategic capabilities
Determine impact of existing platform – Map future state optimal scenario to determine gap(s)
– Identify gaps against strategy & future capabilities
Developing Scenarios
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Transition
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Create Roadmap and maturity model – Use aggregate of information to represent journey
– Enable Executives to modify weighting
– Use Stars to represent maturity level if funded as proposed
– Don‟t need to complete one level before investing in the next
DistinguishedAchieved ExpectationsMore is Expected
Level 5
Optimized
Aligns Plans to Enterprise
Commitment to Results
Creates Commitment
Matrix Collaboration
Level 4
Quantitatively Managed
Addresses Complexity
Conveys Expectations
Encourages Engagement
Adapts Leadership Style
Level 3
Defined
Long-term & Big-picture
Meets Deadlines
Quickly Adapts Plans
Timely Goals & Objectives
Level 2
Managed
Thinks Locally
Process Focus vs. Results
Unclear Goals
Little Feedback
Level 1
Initial
Rarely Long-Term Plan
Some Deadlines Met
Resists Change
Inconsistent Goals
Acting Strategically & Corporate Wide
Creating Innovative Solutions
Driving Results
Managing Change
Managing Performance
2010 Assessment & 2011 Plan
Influences DecisionsBuilds ConsensusShared BenefitsDepartment CommunicationLocal Communication
Eliminates non-value TasksEncourages OthersWorkable SolutionsRare SuggestionsStuck on ‘Old Ways’
Mentor & CoachProactiveDevelopmental PlansLittle feedbackNo Developmental Plans
2010
2011
2010
2010 2011
2010 2011
Force Conflict ResolutionSound Timely DecisionsTimely DecisionsAnalysis ParalysisIndecision
Acting Decisively
Information-drivenProactively EngagesAligns MetricsService Deliver GapsQuick Fix FocusCustomer Expectations 2010
Enterprise Risk SensitiveEnables Risk TakingPractical DecisionsProceeds cautiously“No Mistake” Zone
Risk Management 2010
Collaborating & InfluencingOthers
Developing People
Long-term & Big-pictureLogical ApproachShares InformationDifficulty w/non-routineFaulty ConclusionsAnalytical & ConceptualThinking 2010
Discourages DisrespectAccepts FeedbackActive ListenerInconsistent ResponseInconsiderate of Time
Respect 2010
2010
2010
2010
2010
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Press Releases: – Topaz Shared Services, LLC
– The state's largest health insurer has formed a joint venture, Topaz Shared Services, with Blue Cross and Blue Shield of Kansas City.
– Fujitsu America
– This change is part of our effort to find ways to reduce costs while maintaining high levels of quality and service,” said BCBSNC Senior Vice President and CIO Alan Hughes. “Our employees provide these services very well – and at remarkable levels of reliability – but this new agreement will provide greater flexibility and cost-effectiveness. As we considered options for transitioning these functions, Fujitsu America‟s strong and comprehensive commitment to our people, business needs and technology set them apart.
Conclusion
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Appendix
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Capability View
Users Provider Group Member
Business Strategy
Product / Service Administration
Provider Management
Customer Management
Enrollment
Billing
Membership
Fulfillment
IT Mgmt.
HR Mgmt.
Finance Admin.
Broker Underwriting Medical Review Claims Review CSP
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Legal & Compliance
External Relations Mgmt.
Customer Service
Benefit Mgmt
Claims Mgmt
Pharmacy Mgmt
Funds Mgmt
Network Mgmt
Reimbursements
Healthcare Quality
Provider Service
Plans
Coverages
Rates
Fees
Sales Management
Strategy
Performance
Direct
Indirect
Product / Services Development
Strategy
Development
Life-cycle Mgmt
Marketing/Brand
Financial Risk Management
Actuarial Mgmt
Underwriting
Medical Reserves
Care Management
Case Mgmt
Disease Mgmt
Health & Wellness
Utilization Mgmt
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Completed Technology Facet
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