Blue Cross

When several Blue Cross Blue Shield programs in upstate New York merged, each organization brought its own business processes and IT systems to the new entity. Because they were so different, yet had to be consolidated, the new entity, Excellus Blue Cross Blue Shield, wanted to first implement a strong business analysis process to clearly identify company functions and processes. They wanted to be able to inventory and visualize their current state architecture in support of system modernization and SOA efforts.

Problem Excellus Blue Cross Blue Shield is part of a $4 billion family of companies that finances and delivers health care services across upstate New York, including the major cities of Syracuse, Elmira, Rochester, Utica, and Buffalo. As New York State’s largest nonprofit health plan, the organization provides health insurance to more than 2 million people, and employs more than 6,000 New Yorkers. It is the result of a merger of several health organizations serving upstate New York.

Following the merger, Excellus found that there were few enterprise architecture (EA) standards embraced by all of the previously independent entities. The company formed a group within the IT department to focus on EA as it consolidated business and IT systems and reduced the amount of technical diversity within the organization. With multiple platforms and environments, it was extremely challenging to create smoothly running, cohesive business procedures, without a clear understanding of what processes and systems were serving each organization.

Many of these legacy systems, some in place for 30+ years, didn’t have adequate documentation, so there were parts of the systems that were completely unknown. “Before making sweeping policy or platform decisions, we recognized the importance of identifying all company functions and the processes used to implement them,” explained Eric Stephens, enterprise architect, Enterprise Architecture and Integration Team at Excellus. “This was the first step in our effort to reduce duplicate processes that were a normal result of the merger.

We had to develop single systems for claims processing, provider contracting, member registration, and more, but could not do that until we fully understood and mapped the existing processes. ” Excellus recognized that a key success factor would be a service-oriented architecture (SOA) approach, offering the ability to devise flexible architectures that rely on smaller parts (services), rather than larger monolithic solutions. Being able to implement the architecture in parts gives the company more choices (buy vs. uild) and allows for variation in particular components to adapt to a shifting market demand for products.

It was clear that going forward with big systems implementations would drive both risks and financial resources to unacceptable levels. In addition, the organization established a goal of standardizing practices so that customers and others outside the organization would feel like they were dealing with a single company, rather than multiple entities in a loose federation.