Health Insurance Industry Reference Architecture Guide

Author(s): Jennifer Jones

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Client Challenge:

  • Health Insurance operate as a part of an interconnected web of service providers that create opportunities for people to have a healthy life.
  • Health insurance organizations are a central component of the healthcare system and interact with providers and other points of care across the healthcare continuum.
  • Healthcare payers such as insurance companies and government institutions pay for a portion of or all products and services. Health insurers are focused on developing products and services that facilitate the payment of health costs related to illness or injury.
  • The business and IT often focus on a project, ignoring the holistic impact and value of an overarching value stream and business capability view. Critical Insight:
  • Using an industry-specific reference architecture is central, and has many benefits, to organizational priorities. It’s critical to understanding, modeling, and communicating the operating environment and the direction of the organization, but more significantly, to enabling measurable top-line organizational outcomes and the unlocking of direct value. Impact:
  • Demonstrate the value of IT’s role in supporting your organization’s capabilities while highlighting the importance of proper alignment between organizational and IT strategies.
  • Apply reference architecture techniques such as strategy maps, value streams, and capability maps to design usable and accurate blueprints of your healthcare operations.
  • Assess your initiatives and priorities to determine if you are investing in the right capabilities. Conduct capability assessments to identify opportunities and to prioritize projects.

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