Leveraging Business Architecture

for Business TransformationBusiness Architecture Innovation Summit

3-26-2014

Tim Hurley

Director, Business Architecture, Planning, Solution Design, and Analysis

Agenda

+ Historical Context: Business Architecture 2009

+ Recent Progress: Business Architecture 2010 – 2013

� Initial Business Transformation Planning Sprints

+ Current Business Architecture Focus Areas 2014

� Business Solution Design

2

� Business Solution Design

� Portfolio Business Impact and Analysis

� Project Business Analysis and Requirements

Management

+ Future Business Architecture Opportunities

In 2009, the Business Architecture practice did not exist,

but we had a mature IT oriented Enterprise Architecture

practice

+ Robust set of technology architectures, patterns,

solutions and standards

+ Technology-centric planning service

+ Extensive IS engagement but minimal business

3

+ Extensive IS engagement but minimal business

engagement

� Projects funded and launched before Enterprise

Architecture (EA) engagement

� EA had a road-blocker reputation in the business

community

In 2010, my company needed to accelerate change to

successfully compete in a fluid and fast-changing

environment

+ Unprecedented amount of disruption in the health

care industry

▪ Patient Protection and Affordable Care Act ▪ Health Care and Education Reconciliation Act of 2010

4

▪ Health Care and Education Reconciliation Act of 2010

+ Significant corporate changes

▪ New CIO and CEO▪ New business strategies

I will use this enterprise planning cycle to describe how our

Business Architecture Practice evolved over the past several

years

Strategy

Management

Business

Planning

Change

Delivery

Business

Operations

External

Assessment

Strategy

Creation

Business

Planning

Portfolio

Management

Project

Execution

Value

Realization

Business

Modeling

Performance

Management

Business

Roadmapping

Business

Modeling

Enterprise Business Planning Cycle

5

Division

Enterprise

Program\Project

2010-20132014+ Refreshes

2014 Future

Legend

The EA Team responded to this urgent need for change by

developing a capability-based business transformation planning

serviceStrategy

Management

Business

Planning

Change

Delivery

Business

Operations

External

Assessment

Strategy

Creation

Business

Planning

Portfolio

Management

Project

Execution

Value

Realization

Business

Modeling

Performance

Management

Business

Roadmapping

Business

Modeling

Division

Enterprise

The initial sprint focused on IT, and the methodology was adopted by the Divisions

across the company from 2010 through 2013 6

Current

State

Long Term

Roadmap

Near Term

Portfolio

Future

State

Project

Summaries

Capability-Based, Divisional

Strategy to Execution Planning

The business transformation methodology was implemented in a

series of workshops that created specific planning deliverables

Phase Deliverables Example

Fu

ture

Sta

te D

efi

nit

ion

Customer

Focused

Strategy Map

Mission, Vision,

Goals, and

Objectives

Phase Deliverables Example

Cu

rre

nt

Sta

te

De

fin

itio

n

Capability

Performance

and Root Cause

Financial

Baseline

Analysis

Trusted

Business

Partner

Time to

Value

Enterprise IT Divisional IT IT Builder IT Broker Effective and

Predictable

Costs

Easy to Work

With

Information

Mgt and

Analytics

IT C

usto

mer

Em

phasis

BCBSNC IT Value Map

IT Focus

ShiftIT Delivery

Approach

Shift

Past

FutureHigh

Low

Attributes

Capability Name

Effe

ctive

ne

ss

Efficie

ncy

Capability Value Index Heat

Care Management Market Offer

Development2.0 2.0 Strategic Support 5

Medical Guidelines Management 3.5 3.0 Essential 2

Payment Guidelines Management 2.5 2.0 Essential 3

Evidence Based Guidelines

Management3.5 3.0 Business Necessity 4

Pharmacy Plan Design 4.0 3.0 Essential 2

Formulary Management 3.5 3.0 Essential 2

Pharmacy Policy Management 4.0 2.0 Essential 3

Pharmacy Reimbursement

Management

3.5 3.0 Strategic Support 1

Pharmacy Claims Configuration 3.0 2.5 Business Necessity 4

7

We adapted an Accelare Consulting

methodology

Fu

ture

Sta

te D

efi

nit

ion

Future State

Declarations

Fu

ture

Sta

te

Ca

pa

bil

ity

Va

lue Capability

Model

Capability Value

Classifications

Str

ate

gic

an

d T

acti

cal

Pla

ns

Strategic

Roadmap

Tactical Project

Portfolio

1.2 New Market Offer Development6.1 Provider Relationship Management

6.2 Network Strategy Management

6.3 Contracting and Reimbursement

7.6 Stakeholder Service

6.4 Pricing Configuration and Maintenance

6.5 Network Operations and Support

6.5.1 Provider Onboarding

6.5.2 Claims-System Provider Data Maintenance

6.6 Provider Based Analysis

6.1.1 Provider Outreach

6.1.2 Provider Interaction Management

6.1.3 Provider-Related Intelligence/ Comm unication Gathering

6.1.4 Provider Relationship Analysis

6.2.1 Market Research and Intelligence Gathering

6.2.2 Network Strategy Definition

and Refinem ent

6.2.3 Network Strategy Development

6.2.4 Network Strategy Implementation

1.2.2 New Market Network Planning

7.6.2 Provider Service

6.6.2 Provider , Network and MEDEX

Per formance Analysis

6.6.1 Provider , Network and MEDEX

Information Management

6.3.1 Contract Management

6.3.3 Contract Negotiation

6.3.4 Provider Contract Compliance

6.3.2 Contract Development

6.4.1 Pr icing and Reimbursement Configuration

(Claims-based)

6.4.3 Pr icing and Reimbursement Maintenance

(Claims-based)

6.4.2 Pr icing and Reimbursement Configuration (non Claims-based)

6.4.4 Pr icing and Reimbursement Maintenance (non Claims-based)

Readiness

Objectives

Focus

Areas

Objectives Objectives

EvolutionEfficiency &

Optimization

Sourcing

Other

Organization

Staff

Development

Governance

Transition State

Objective

Transition State

Objective

Transition State

Objective

Transition State

Objective

Transition State

Objective

Transition State

Objective

Transition State

Objective

Transition State

Objective

Transition State

Objective

Transition State

Objective

Readiness Phase

Objectives

Focus

Areas

Readiness - Projects

Sourcing

Other

Organization

Staff

Development

Governance

ProjectTransition State

Objective

Transition State

Objective

Transition State

Objective

Project

Project

Project Project Project

Strategic

Support

Business

Necessity

Advantage

Essential

Financial Impact

Strategic and Value Prop.

People Process Architecture

Cu

rre

nt

Sta

te

Fu

ture

Sta

te

1.Roles

2.Skills

3. Internal Staff

Demand

4.Sourcing

Adoption

5.Organization

1.Process Quantity

2.Manual

Interventions

3.Complexity

4.Governance

1.Application

Quantity

2.Customized

Percentage

3.Complexity

4.Control

1.Roles

2.Skills

3. Internal Staff

Demand

4.Sourcing

Adoption

5.Organization

1.Process Quantity

2.Manual

Interventions

3.Complexity

4.Governance

1.Application

Quantity

2.Customized

Percentage

3.Complexity

4.Control

Customer

1.Market

2.Customer

3.Product

4.Channels

5.Service

Delivery

1.Market

2.Customer

3.Product

4.Channels

5.Service

Delivery

Our transformation approach was extremely successful

and was implemented in divisions across the company

+ Accelerated strategic realization: Topaz, FAI and NTT

Partnerships, Care Management at the Point of Delivery

PoC, etc…

+ Improved strategic comprehension across the leadership

team and down to the individual contributor

+ Drove business-stakeholder ownership, clarity, focus,

8

+

priorities, and plans

+ Enabled cross-division, enterprise-level perspectives and

collaboration

+ Improved the planning competency across the leadership

community

+ Led to the creation of a new internal team: Business

Architecture, Planning, Design and Analysis

* Featured in the Corporate Executive Board 2013 EA leadership development curriculum

+ Historical Context: Business Architecture 2009

+ Recent Progress: Business Architecture 2010 – 2013

� Initial Business Transformation Planning Sprint

+ Current Business Architecture Focus Areas 2014

� Business Solution Design

Agenda

� Business Solution Design

� Portfolio Business Impact and Analysis

� Project Business Analysis and Requirements

Management

+ Future Business Architecture Opportunities

9

Strategy

Management

Business

Planning

Change

Delivery

Business

Operations

External

Assessment

Strategy

Creation

Business

Planning

Portfolio

Management

Project

Execution

Value

Realization

Business

Modeling

Performance

Management

Business

Roadmapping

Business

Modeling

We are currently expanding on our initial success by improving the

enterprise portfolio management and investment planning processes

Division

Enterprise

Business Scope and

Outcomes

Solution Options,

Estimates, Risks,

Recommendation

Solution Design

Traceability:

Verify & Validate

Business Strategy

Alignment

Investment Decision

Support

Business Models and

Visualizations

Portfolio/Program/Project

Business Solution Design and Analysis

10

Strategy

Management

Business

Planning

Change

Delivery

Business

Operations

External

Assessment

Strategy

Creation

Business

Planning

Portfolio

Management

Project

Execution

Value

Realization

Business

Modeling

Performance

Management

Business

Roadmapping

Business

Modeling

We are also leveraging our extensive set of models and planning

materials to accelerate project execution and outcome realization

Program\Project

Project Scope

and Objective

Refinement

Project

Requirement

Management

Plan

Domain Solution

Design Support

Business

Traceability:

Verify & Validate

Business

Requirements

Definition

Functional

Specification

Definition

Acceptance

Testing

Business Analysis and Requirements Management

11

Agenda

+ Historical Context: Business Architecture 2009

+ Recent Progress: Business Architecture 2010 – 2013

� Initial Business Transformation Planning Sprints

+ Current Business Architecture Focus Areas 2014

� Business Solution Design

12

� Business Solution Design

� Portfolio Business Impact and Analysis

� Project Business Analysis and Requirements

Management

+ Future Business Architecture Opportunities

Strategy

Management

Business

Planning

Change

Delivery

Business

Operations

External

Assessment

Strategy

Creation

Business

Planning

Portfolio

Management

Project

Execution

Value

Realization

Business

Modeling

Performance

Management

Business

Roadmapping

Business

Modeling

Division

Enterprise

Our future focus includes the integration or creation of external

models and enriching the existing business models

• Develop Value Network and Value

Stream Model

• Integrate the Market Offer Model

• Integrate the LOB Model

• Support Diversification Efforts

13

• Corporate Planner’s Calendar

• Enterprise Business Model

• Deepen Domain Capability

Modeling

• Create a Training Program

Strategy

Management

Business

Planning

Change

Delivery

Business

Operations

External

Assessment

Strategy

Creation

Business

Planning

Portfolio

Management

Project

Execution

Value

Realization

Business

Modeling

Performance

Management

Business

Roadmapping

Business

Modeling

Enterprise

To summarize, we initially focused on divisional transformation

to meet urgent business demand and we are building on the

initial success to improve adjacent enterprise planning

processes

Division

Enterprise

Program/Project

142010-20132014+ Refreshes

2014 Future

Legend

Recommended Resources

+ Corporate Executive Board customers can download

the BCBSNC business planning case study at:

https://www.eaec.executiveboard.com/Members/Rese

archAndTools/Abstract.aspx?cid=101221332&fs=1&q

=bcbsnc&program=&ds=1

+ Accelare Consulting: www.accelare.com

15

+ Accelare Consulting: www.accelare.com

+ Business Architecture Guild:

www.businessarchitectureguild.org

+ Lynch, Diezemann, Dowling (2003). The Capable

Company