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

OracleEnterprise Architecture
Oracle Enterprise Architecture
<Insert Picture Here>

Iterative approach to build an Enterprise
Architecture for Health Insurance Exchange
Speaker Name: Maharshi Desai, Director, IT Strategy and Enterprise
Architecture

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

Copyright ©2011 Oracle Corporation. All rights reserved.
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 Principles
Agility and Sustainability

Business Driven

Forward Thinking

Best Practices

Time to Value

5

Oracle Architecture Development Process
Aligns with customer
and industry standard
EA frameworks

Iterative
Agile EA Approach

Reuses best practice
business models and
reference architectures

Practical Approach, Provides
Proven Methodology Governance

6

Oracle Enterprise Architecture Framework

Best Practices, • Best Practice Reference Architectures
Proven EA Artifacts • 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

Copyright ©2011 Oracle Corporation. All rights reserved. 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


HIX Vision Architecture
Individuals Workers Providers Employers

Mobile / Phone, Email, Local
Web Web
Phone, IVR Email Text ChatText Chat
Local Office
Disconnected Fax, IVR Imaging Office
Eligibility Automation Portal Layer (Customer, Worker, Provider)
Health Insurance Exchange Portal
Online Profile Eligibility Request Other Self-Service
AHBE Access SHOP Access Calculators Content
Applications Management Screening Service Tools

Dashboards, OLPA/Data mining, Ad Hoc & Scheduled Reports
Security – Identity and Access Management, SSO

Health Insurance Exchange Functions
Eligibility & Plan Customer Financial
Communications Oversight
Enrollment Management Services Management

Business Intelligence
Policy Automation Mandatory
E-Commerce/Catalog Contact Center Billing Marketing/Outreach
Reporting
Eligibility
Determination Carrier Portal Self-Service Collection Notices Dashboards & Alerts

Subsidy/Premium Carrier / Employer / Premium
Calculation Plan Certification Escalations Metrics / KPI
Broker Support Reconciliation
Enrollment Renewal Account Management Payment

SOA Enterprise Integration Services

Authoritative MMIS Issuers Master Data Management Data Management
Data Systems & Data Quality Services

Matching Address Structured &
IRS DMV Medicaid Plans / Pricing
Services Cleansing Unstructured Data

SSA HHS CHIP Enrollment De-duplication Fraud Detection Data Security &
Availability

DHS Equifax OSHASP Billing Standardization Client Index


Architecture Blueprint Plan

90-120 Day Plan

Business – Application Architecture
Business
Architecture
Establish
Roadmap
Architecture Business – Information Architecture
Planning
Vision

Apps/Data – Technology Architecture

Key Development Principles
• Rapid Iterative Design (3 Week cycles)
• Map Business to Functional Technology Design
• Collaborative Design with Stakeholders
• Leverage Oracle Reference Architectures


Approach: Level 0 and Level 1 Boundaries
Oracle Enterprise Level 0 (L0) Level 1 (L1)
Architecture
Business Capability Models
Framework Layers
Business Process Models

Business Process Support
Models
Business Define the core Business
Architecture Capabilities

Application Diagrams

Application Capability Models
Application Identify high level Application
Application tech. Support
Services required to support
Architecture Models
the Business Capabilities

Data Object Models
Data Identify high level Information
Models, Data organization, Data Integration Diagrams
Architecture and Data governance
Data Context

Identify high level
Technology Technology Platforms
Architecture required to support the
Business Capabilities Technology Capabilities

Technology Support Models


Approach: Level 1 and Level 2 Boundaries
Oracle Enterprise Level 1 (L1) Level 2 (L2)
Architecture
Framework Layers Business Capability Models

Business Process Models 1 Model for each App.
Service
Presentation Components
Business Process Support
Models Business Logic Components
Business Data Objects
Business Integration Services
Architecture Data Services

Application Diagrams Security Services

Application Capability
Models
Application Application tech. Support
Architecture Models

For each high level
Entity

Data Object Models Next level Entity Models
Data
Data Integration Diagrams For each interface
Architecture Detail Integration Diagram – High
Data Context level Canonical Models,
Technology, and Systems
At the entity level
only
Technology Data Formats
Data Standards
Architecture
Data Governance and Security
Technology Capabilities

Technology Support
Models
Technology Detail Models


Business Architecture Approach
Business Strategy & Value

Business Requirements

1 Business Area Eligibility & Enrollment (E&E)

1.1 Business Process Group E&E - Individual

1.1.1Business Process Prepare / Update Individual Eligibility
Application

1.1.1.1 Business Activity Accept and Verify Application for
Completeness and Accuracy
1.1.1.1.1 Business Tasks Manual Verification

Use Cases


Business Process to Service Mapping
• 1.1.1.1 Business Activity

Services Objects

Business Business
Service Objects

Application Application
Service Objects


Architecture Execution Plan

July 2011 August 2011 Sep 2011 Oct 2011 Nov 2011 Dec 2011

Project startup Design
activities Review
3 Week Cycle 3 Week Cycle
Plan Management Plan Management Plan Management
L1 L1-L2 L3

EE – Individual EE – Individual EE – Individual
L1 L1-L2 L3

EE - SHOP Employer EE - SHOP Employer EE - SHOP Employer
L1 L1-L2 L3

EE – SHOP Employee EE – SHOP Employee EE – SHOP Employee
L1 L1-L2 L3

Financial Management Financial Management Financial Management
L1 L1-L2 L3

Detailed Design Document


Running Workshop
Level 1 60 Minute session (3
Level 2
Business Days/Week):
Process Flow
Architecture Level 1 • Business Analysts
& • Process SME
Business • Enterprise Architecture
Requirements
• IT Team (Optional)
Application
90 Minute session to
Data review Application
Component, UI
Review Technology
Component, Data
Level 2 Component and
Business Objects:
• Business Analysts
(Optional)
Refine • Enterprise Architecture
• IT Team (Data & Apps)

90 Minute JAD session:
Level 3 & 4 • Business Analysts
• IT/Development Team


Connecting Blueprint Phase to
Development Phase
Federal State
Requirements Requirements

Requirement Architecture Models
Baseline Level 1 and Level 2

Finalize
JAD Session
Product Vision

Architecture Models
Use Cases
Level 3 and Level 4

Iterative
Product Demo and Acceptance
Development


Business Architecture
Artifacts


Highlights the key architecture capabilities and their alignment


Highlights alignment in greater detail for each business process

Highlights alignment of Business Services to Application Services


Application Architecture
Artifacts


Highlights how each business services are map to apps services


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


Data Architecture
Artifacts


Highlights application data object mapping of business data objects


Define overall ERD diagram


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


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


Technology Architecture


Highlights the required HIX Technology Capabilities


Highlights the focused technology capabilities of a specific component


Map to products required to support the specific capabilities


HIX Logical Architecture

Logical Architecture provides component view of HIX Solution


HIX Technical Architecture

Solution Architecture provides overall physical view of the architecture


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


Q&A Be Prepared For The Challenge for
EA can make it Possible Business Driven Approach
If You Believe in them

Organization need to Focused Enjoy your success
on Business Goal


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

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