open group presentation final

From Build to Run at the Colorado Health Insurance Marketplace July 21, 2014

Proteus Duxbury, CTO

Connect for Health Colorado

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…unknown

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Helping to make Coloradans smile

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What is Connect for Health Colorado?

An open, competitive marketplace for individuals and small employers to: • Shop health plan features • Compare information regarding

cost and quality • Determine eligibility for and

access financial assistance • Support network access,

including service center, health coverage guides and brokers

• Enroll in a health plan

Shop for Plans

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Choice – Individual Marketplace

150 Health Plans

22 Dental Plans

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Choice – Small Business Marketplace

92 Health Plans

45 Dental Plans

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We have enrolled 139,000 consumers

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We have a varied and mixed pool of enrollees

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Our marketplace users are very active

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Systems are performing well under load

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500,000

1,000,000

1,500,000

2,000,000

2,500,000

3,000,000

3,500,000

4,000,000

1-Oct 16-Oct 31-Oct 15-Nov 30-Nov 15-Dec 30-Dec 14-Jan 29-Jan 13-Feb 28-Feb 15-Mar 30-Mar 14-Apr

Volume

Median M-F

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Strong leadership has been critical to our

success

• Leadership & team

o Shared vision

o Empowered to make decisions

o Start-up culture

o Skilled and highly dedicated team

• Flexible vendor

o Agile with rapidly changing regulatory

requirements

o Committed to achieving success

o Strong contract and definition of requirements

• COTS solution

o Minimal customization and custom development

o Scope control

o Leading HIX suite

o Best of breed around the edges

o Highly resilient and available architecture

o Secure

Vendor Solution

Team

LEADERSHIP

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We have a 3 year roadmap to move from build

to run

2015 – THEN “STABALIZE” Implement the ‘run’ strategy. Stabilize the

technology in production and reduce overall

technology spend in line with sustainability

targets. Moving to a variable IT cost where

possible.

2016 – FINALLY “REACH THE

SUMMIT” Business as usual technology operations.

Predictable ‘run’ environment with ability to

deliver on new project requests efficiently.

2014 – FIRST “BUILD” Complete the implementation of the

marketplace and eligibility system builds as

planned. Develop ‘run’ strategy.

Base

Camp

Start

• All ITIL processes fully deployed

• Continuous improvement program in place

• Metric driven IT organization

• Predictable IT cost base

• Innovation

• Full sourcing strategy benefits realization

• Ongoing innovation and enhancement

• ITIL implemented

• Architecture enhancements deployed

• Key contracts renegotiated, sourcing re-

balanced

• Operational cost base established with

variability where possible

• API implemented

• Consulting support significantly reduced

• 1.x marketplace functionality deployed

• Release 2.0 marketplace functionality deployed

• Shared Eligibility System deployed

• IT strategy developed

• Sourcing strategy / new SLAs documented

• C4 IT Team fully resourced

• Architecture review and roadmap

• Capacity planning

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Why architecture is important!

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Why are we building an architecture roadmap?

• Reduce M&O expense

• Consolidate architecture and gain efficiencies

• Continue to meet key SLAs

• Operationalize IT

• Stabilize foundations as a platform for future

growth

• Align technology investments with business

goals

• Motivate new team

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A quick poll – setting and documenting goals

• Group 1 was asked to simply think about the business-related

goals they hoped to accomplish

• Group 2 were asked to write their goals

• Group 3 was also asked to write action commitments

• Group 4 had to both write goals and action commitments and

also share these commitments with a friend.

• Group 5 did all that and sent a weekly progress report to a

friend.

43%

64%

76%

Psychology professor Dr. Gail Matthews

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Do you ever feel like this?

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Challenges in building out the roadmap

• Budget is a constraint

• There are many federal requirements we must meet

• Multiple partner engagement

• Multi-vendor environment

• ‘Startup in a fishbowl’

• Delivering while planning

NAME OF

PRESENTATION

|

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High level roadmap approach

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• Loosely coupled Technology Agnostic Design (TAD)

• Enterprise COTS solutions over custom developed solutions

• Best of breed where strategic

• Pay for compute

• Data entered once and shared across systems (single source of truth)

• Use State data sources for verification

• Low M&O impact architecture

• ROI driven architecture

Key C4 Architectural Principles

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We started by mapping our business capabilities

Business capabilities map L2 Key: L1 Business Capability Map

7. Conduct Core Operations

Enrollme

nt

7.2

Manage Billin

g

Syste

m

Sharin

g

7.7

Manage Government

Program Encounte

rs

7.0 Business Management and Shared Services

7.3 Manage IT Services

7.4 Manage Financial

Operations 7.5 Manage Procurement

7.7 Manage Compliance,

Legal, Regulatory

7.9 Manage

7.2 Manage Enterprise

1. Develop

Product

1.1

Implement Product Strategy

1.2

Design Products

1.3 Manage

Ancillary

Services

Actuari

al Servic

es

Member

2. Plan Management

2.1 Establish Issuer and

Plan Details

2.2 Monitor Plans

2.3 Manage Plan

Management Rules

5. Communications

5.1 Manage Outreach

5.3 Manage Notifications

5.2 Manage

Communication Rules

4. Customer Service and

Account Management

4.1 Manage Customer

Support

4.2 Manage Enrollee Survey

4.4 Manage Rules

4.3 Manage Broker /

Navigator Relationship

1. Enrollment and

Eligibility

1.1 Manage Individual

Eligibility & Enrollment

1.2 Manage Individual

Responsibility

Exemption

1.3 Manage SHOP

Employer Eligibility and

Enrollment

1.4 Manage SHOP

Employee Eligibility&

Enrollment

3. Financial Management

3.1 Transaction Processing

3.2 Risk Management

3.4 Rules Management

3.3 Payment Monitoring

3.5 Reporting

6. Oversight

6.1 Governance and

Management Support

6.2 Human Resource

Management

6.3 Assets Management

6.4 Knowledge and

Information Management

7.6 Manage Vendors

1.5 Manage Appeals

7.1 Manage Channel

Interfaces

7.8 Manage Internal Audit 7.9 Manage Public Relations 7.10 Manage Continuous

Quality

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… and aligned our application portfolio against them

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Our roadmap has a series of transitional

states

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Our roadmap has a series of transitional

states …

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Key elements of the roadmap

• Release 2

• Cloud

• Mobile

• APIs

• Decision support

• Integration

• Architecture enhancements

• Data quality / governance

• New products

Need

Help?

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Some lessons learned along the way

• Without a burning platform the chance of

failure is high

• Speak a language the business can

understand … Don’t use the ‘A’ word

• Continually demonstrate ROI

• Business design is critical

• Be tactical and strategic

• Don’t be afraid to make tough decisions

… and stick to them

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Thank you!

Any questions?

Proteus Duxbury

CTO

Connect for Health Colorado

E-mail:

pduxbury@connectforhealthco.com