Business Value Measurements and the Solution Design Framework
78 likes38,258 views
The 2015 Blue National Summit focuses on aligning business strategic planning with solution development within the Blue Cross Blue Shield Association. Key topics include establishing architectural foundations, solution design processes, and effective communication strategies to enhance stakeholder engagement and decision-making. The document emphasizes the importance of data integrity and defines the relationship between business capabilities and value streams to maximize efficiency and support business needs.
Business Value Measurements and the Solution Design Framework
- 1. 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
- 2. 2 2
- 3. 3 Alignment Topics For Today • Foundations – Guiding Principles – Frameworks – Capabilities • Solution Design – Process – Reviews • Solution Scorecards
- 4. 4 Alignment Topics For Today • Foundations – Guiding Principles – Frameworks – Capabilities • Solution Design – Process – Reviews • Solution Scorecards
- 5. 5 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!
- 6. 6 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?"
- 8. 8 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.
- 9. 9 Alignment Topics For Today • Foundations – Guiding Principles – Frameworks – Capabilities • Solution Design – Process – Reviews • Solution Scorecards
- 10. 10 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.
- 11. 11 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.
- 12. 12 Alignment Topics For Today • Foundations – Guiding Principles – Frameworks – Capabilities • Solution Design – Process – Reviews • Solution Scorecards
- 13. 13 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.
- 14. 14 An Example – Our EA Framework Business Architecture Enterprise Strategy Value Streams Business Capabilities Core Business Processes Technology Architecture Data Technology Collaboration Systems Management Integration Technology Platforms Application Technology Network Information Architecture Data Integration Application Security
- 15. 15 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
- 16. 16 Value Streams – further defined 16 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
- 17. 17 Value Stream Map – V10
- 18. 18 Business Capabilities Map Products Member Mgmt Customer Service Claims Processing Pricing & Risk Sales Provider Network Mgmt Health Care Mgmt Finance and Regulatory Information TechMarketing 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
- 19. 19 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
- 20. 20 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 7 3-‐5 >20 0-‐2 5-‐20 1 0 1 2 1 2 0 0 1 0 7 1 1 3 1 3 1 1 6 5 0 3 3 0 0 0 0 7 0 0 1 12 6 3 5 5 1 12 4 12 0 16 13 12 2 3 22 3 51 10 0 13 13 1 5 6 1 2 1 0 15 15 13 3 4 6 28 17 522 9 5 2 0 10 47 4 29 17 0 6
- 21. 21 Value Stream + Process + Capability + Applications Capability Supporting Apps Channel Process Direct (i.e. Retail site) Public Exchange ProducerPrivate 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 FocusFacets Blue/Univera on Demand Facets Document Services Stepwise Paper App Enrollment ACS Benefit Focus Benefit Focus
- 22. 22 Alignment Topics For Today • Foundations – Guiding Principles – Frameworks – Capabilities • Solution Design – Process – Reviews • Solution Scorecards
- 23. 23 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.
- 24. 24 Solution Development Lifecycle Portfolio Mgmt SDLC Planning Business Case Analyze Design Build Test Deploy BRMs S SA App Dev RAs EA BA Bus Arch D DA BP BPE I INF A B R
- 25. 25 Solution Design Framework Business Data Application Technology StrategicEnterpriseSolutionDevelopment 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 DiagramBA200 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
- 26. 26 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
- 27. 27 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
- 28. 28 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
- 29. 29 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
- 30. 30 Alignment Topics For Today • Foundations – Guiding Principles – Frameworks – Capabilities • Solution Design – Process – Reviews • Solution Scorecards
- 31. 31 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 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
- 32. 32 Alignment Topics For Today • Foundations – Guiding Principles – Frameworks – Capabilities • Solution Design – Process – Reviews • Solution Scorecards
- 33. 33 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.
- 34. 34 Scoring – Architecture Alignment
- 38. 38 Scoring – General Visualization
- 40. 40 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 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
- 41. 41 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.
- 42. 42 Questions ?