no need to “rip and replace” existing investments to ensure

2014 Softheon, Inc. and/or its affiliates. All rights reserved. Softheon is a registered trademark of Softheon, Inc. or its affiliates. This publication may not be reproduced or distributed in any form without Softheon’s prior written permission. The information contained in this publication has been obtained from sources believed to be reliable. Softheon disclaims all warranties as to the accuracy, completeness or adequacy of such information and shall have no liability for errors omissions, or inadequacies in such information. This publication consist of the opinions of Softheon’s research organization and should not be constructed as statements of fact. The opinions expressed herein are subject to change without notice. Although Softheon may include a discussion of related legal issues. Softheon does not provide legal advice or services and its research should not be constructed or used as such.

No Need to “Rip and Replace”Existing Investments to EnsureSuccess in ACA Marketplaces.Softheon Marketplace Connector Cloud; A Service OrientedArchitecture compliant enterprise messaging & businessprocess management platform for Marketplace integration.

Softheon Marketplace Connector Cloud (MC2) is designed with Service- Oriented Architecture (SOA) in mind. MC2 facilitates integration with insurer’s existing IT assets based on X12 standards (834, 820) and opens up internal systems.

Serving the healthcare payer industry, Softheon has introduced a SOA compliant cloud based enterprise service bus and business process management framework for application development and delivery processes since 2008

Enterprise Messaging & Business Process Management

With the advent of the Internet, enterprise information has been growing with tremendous velocity. Recent studies have suggested that approximately 80 percent of this information, which takes the form of documents, images, reports, digital media, Web content and e-mail, is unstructured in nature.

Over the last decade, organizations have learned to appreciate the value of unstructured content and its importance to business operations. As a result, many companies have invested in enterprise content management (ECM) systems to capture, manage, classify and control this content. But while these systems have enabled companies to solve departmental business problems, they’ve also created isolated islands of content that cannot be readily accessible, shared, or leveraged by other facets of the organization. In fact, many medium - and large - sized organizations have dozens of isolated repositories where critical content is stored, managed — and trapped.

This isolation can undermine key business initiatives, such as customer service, corporate compliance and regulatory compliance, while also creating tremendous duplications of effort and missed

Copyright 2014. Confidential and proprietary information. of 12

Service-oriented architecture (SOA) is recognized for accelerating deployment of new applications and capabilities, streamlining business-critical processes, reducing costs, and enabling organizations to increase their return on investment. This is accomplished by utilizing an accumulation of diverse systems and communication technologies.

Health payers are challenged to work with multiple content systems and business process management systems resulting from departmental investments or inherited through mergers and acquisitions. SOA based enterprise messaging and business process integration frameworks have emerged as the preferred solution in order to break through these silos and unlock the value of content across the enterprise.

This paper will examine the basic premises underlying SOA andwill describe how frameworks and service adapters, like Softheon’s can assist organizations in recognizing the benefits of SOA.

Softheon offers a large library of pre-built connectors to many commercial systems, such as Trizetto FACET, QNXT, Amisys DST, HealthEdge, ikaSystems, MC400, EPIC and provide real-time, bidirectional access to the native member and claims data stored in these systems.

Softheon MC2 for IT

Why Softheon?


through a single suthentication process. This capability can alsointegrate with existing Lightweight Directory Access Protocol(LDAP) infrastructures.Subscription event services let companies create custom eventhandlers and other rules-based behaviors that span multiplecontent and workflow systems.Automatic subscriptions allow content and workflow queues to bemonitored and to automatically trigger e-mail notificationsand/or other events when changes occur.Cross-repository capabilities enable a range of event-basedfunctions, such as content and/or metadata replication betweendisparate repositories; declaring a document as a record; ortriggering a workflow or event that must occur.View services can render Windows-based document, including allstandard business formats and specialized formats such as TIFF.

Softheon offers a large library of pre-built connectors to many commercial systems, such as Trizetto FACET, QNXT, Amisys DST, HealthEdge, ikaSystems, MC400 and EPIC. Softheon provides real-time, bi-directional access to the native member and claims data stored in those commercial systems. Integration services expose all of the basic library services and the specialized functionality of underlying repositories, as well as provide repository-profiling capabilities that make differences in functionality between repositories completely seamless to the end user.

The Softheon MC2 development platform provides all the necessary tools needed to build and deploy distributed content and process-centric solutions with complete user interfaces and client applications. The development platform includes .NET and J2EE components that snap into any Web-based application, portals, and Web Services API that provides a common object model and full programmatic access to underlying content and workflow systems. The .NET and J2EE components deliver the core library services required within a content-oriented application.

For business operations:Makes relevant content accessible from one production workflow application.Enables companies to achieve higher levels of automationand business process continuity.Create custom workflows with subscription event services.

Organizations are seeking access to a single, comprehensive view of their content, plus the ability to distribute content to their business applications

Point-to-point integration of priority applications Some

Service Oriented Architectures – A Definition

According to Gartner, SOA is “an application topology in which the business logic of the application is organized in modules (services) with clear identity, purpose, and programmatic access interfaces.” Services behave as "black boxes” with an internal design, independent of the nature and purpose of the requestor.

A primary goal of deploying SOA is simplify ing the development and implementation of new applications and capabilities byaggregating many low-level tasks into higher-level services. Electronic business processes are implemented at the lowest level for specialized functions designed to perform specific tasks. Low-level

been implemented with one system are often difficult oreven impossible to duplicate in another system withdifferent functionality. Also, for companies expectingmerger and acquisition activity, the very concept of a singlestandard platform is not an option, as the next merger oracquisition can be counted upon to bring another set of incompatible systems.

companies will attempt to create custom point-to-pointintegrations between customer-service applications andunderlying repositories. There are many risks and problemsassociated with custom integrations, which include not onlythe initial cost and time to market, but also the extraordinarilyhigh cost of maintaining these often brittle integrations;particularly when a company upgrades to new back-endrepositories and front-end applications.

In fact, an upgrade to a new application or repository oftenmeans that the initial integration becomes little more thanthrowaway code and the integrations must be rewritten fromthe ground up. Therefore, as a company’s IT infrastructureevolves, the cost of these integrations become a recurringexpense and can fall burden to ongoing maintenance.

With SOA, data and business logic are encapsulated in modularbusiness components with documented interfaces. This clarifiesdesign and facilitates incremental development and futureextensions. An SOA application can also be utilized to enhanceintegration with heterogeneous, external legacy and purchasedapplications much better than a monolithic, non-SOA application.


Avoiding

SOA ensures that all content that is subject to discovery can be readily located and retrieved.

Production Workflow Applications

Many production workflow applications are heavily dependent on content. This is true for horizontally applicable processes such as contract management, and more vertically oriented applications such as claims processing or loan origination. However, the dispersion of content usually cause these applications to become inefficient. For example, the workflow for a claims case must include documents and images, such as the claims form, photographs, estimates and appraisals, e-mail and traditional correspondence. This content is often stored in disparate and incompatible systems, however with SOA, such content can become accessible within a single workflow application.

Today’s workflow applications have eliminated much of the paperwork and human intervention associated with traditional work processes. But because they’re often deployed to address a narrow departmental process, workflows have often failed to achieve business continuity or visibility across processes. It’s the spaces between these departmental workflows where much of the inefficiency remains trapped. SOA enables companies to integrate multiple, disparate workflow processes to achieve higher levels of automation and business process continuity. SOA takes advantage of these event-based business rules, to trigger workflows or other

behaviors to eliminate the need for manual steps that


SOA provides a way to quickly integrate multiple content sources and workflow systems for centralized auditing and for extending records management applications across distributed content sources. This can ensure that organizations:

Minimize risk of noncompliance SOA ensures physicallydistributed content sources are subject to and governed byappropriate recordkeeping plocies.Reduce litigation costs and protect goodwillnoncompliance has important implications for both anorganization’s overall litigation costs, as well as protecting theenterprise’s valuable reputation, goodwill and brand equity.Reduce discovery costs

customtypically occer between processes.

Streamline work processes Connecting isolated workflowsto maximize efficiency and business velocity.

bypasses the complexity created by multiple disparate data repositories and provides a means for consolidating content in a single repository over time. Through SOA, content is free for use by enterprise applications and to support initiatives to comply with records management regulations.

Without overhauling your information infrastructure, implementing new repositories and/or migrating content and metadata, SOA can provide:

SOA integrates

Organizations

Aside from

Enriched portals and key business applicationskey content scattered across multiple repositories into your portal, workflow processes and line-of-business (LOB) applications, including Enrollment, Claims, Member Services, Provider Services and ERP applications.

Extended reach of records management initiativesare under extreme pressure to comply with mandates and policies around how they store and manage their records-class content assets. But the reality is that much of this content is often distributed across multiple systems. SOA allows organizations to extend their electronic records management applications to reach content stored in multiple disparate systems.

A migration path toward a common infrastructure providing unified access to distributed content, SOA also provides the means to physically migrate content away from various legacy repositories over time - allowing organizations to reduce the cost and complexity of their content infrastructure, as part of a phased migration strategy.

Key benefits of consolidation SOA enables companies and publicsector agencies to achieve the unification benefits of consolidation without the time, cost and process disruption of a “rip and replace” initiative.


What Does SOA Mean For the Organization?

SOA frees content for use by enterprise applications and helps to support compliance management initiatives

In both

Risk Management & Compliance

Corporate accounting scandals throughout the last decade have led to new legislation and reform around corporate compliance and governance. For example, the Sarbanes-Oxley Act of 2002 resulted in making corporate officers personally accountable for fraudulent, falsified, or erroneous financial disclosures. Similarly, Healthcare providers are under pressure to conform to patient privacy regulations, defined by HIPAA.


When the critical business content can’t be readily accessed and subjected to corporate processes, it can have negative implications for operational efficiency, revenue and growth opportunities, as well as the ability to manage corporate risk. A SOA solution, can not only simplify the information infrastructure, in which content is stored, but it can help to extend the value of existing applications and content.

SOA, therefore, can improve results in vital areas of the company, including Claims, Member & Provider Services, Sarbanes- Oxley and HIPAA compliance management, enterprise applications and portal initiatives, production workflow applications, as well as research and intelligence operations.

Additionally, SOA provides a unified way to access to all forms of customer-related content, ranging from call center to web self-service applications. Implications include:

Better customer satisfaction and improved retention ratesself-service and call center applications, SOA provides access to customer-related content, lowering customer service costs and ensuring a better experience.

Reduced customer service costs Traditional inbound call centerservice can cost $30 per incident. SOA enables inbound calls to be deflected to a low-cost Web-based self-service application.

More effective cross-and up-selling SOA provides unified accessto this scattered content to ensure customer service reps have the full customer context and texture they need to make effective cross-and up-sell offers.

Organizations are seeking access to a single, comprehensive view of their content, plus the ability to distribute content to their business applications

services are designed to behave like text messaging – short, to- the-point interactions. These low-level services are created and maintained by people who have the expertise required to weave them together and produce a desired business result. A service doesn’t necessarily know about other services or how they operate. For example, when a financial reporting application needs data, it simply asks for it from a software service without needing to know where or how the data is supplied. And at higher levels of aggregation, neither does a web application, portal, or application system require knowing what other applications do.

Service-oriented architecture is based on existing computing assets and aggregating lower levels of functionality to effectively enable diverse assets to collaborate for improved business processes and enhanced application capabilities.

SOA and Enterprise Content Management

The SOA based enterprise content management framework distributes content that is isolated in separate repositories as a single source that provides a powerful solution that integrates content across multiple distributed systems. As a result, content is made accessible and actionable by key business applications.

The SOA framework enables disparate content repositories and workflow systems to act as a single unified platform, eliminating the issue of scattered and isolated content.

Unified access to content is particularly important in specific application areas. For example, to be fully effective, a call center application needs to access scanned application forms, contracts, invoices, e-mail and any other customer-related content stored in multiple locations across the enterprise.

Within a healthcare payer company, claims adjudication system users must access member enrollment applications, claims, EOBs, appeals, and other scattered content related to adjudication processes. And an electronic records management application must apply critical recordkeeping policies on distributed content to ensure proper compliance.

SOA solves the problems created by disconnected information silos, by helping to integrate the information’s infrastructure. SOA both


Softheon Marketplace Connector Cloud – the Leading SOA Platform for HealthCare Payers

Improve visibility and coordination Creating a single view intomultiple workflow tasks for better visibility, coordination and controlof business-critical processes that span multiple workflow systems.

Mitigate Risk Automating monitoring, auditing and controllingmanual work processes to reduce errors and improve compliancewith corporate policies and regulatory mandates.

The Softheon Marketplace Connector Clous (MC2) is a SOAcompliant business process management and enterprise messagingintegration platform that is fully WSE 3.0 compliant, and is based onthree layers of service: integration, federation a nd developer. TheSoftheon MC2 offers many benefits to the healthcare insurers.

It enables organizations to consolidate multiple, content repositories and workflow systems by unifying isolated silos to improve access, reuse and control distributed content assets. It provides bi-directional access to underlying content, workflows and functionality that delivers a rich set of additive functions that span multiple repositories.

By aggregating content into 360-degree content views, it allows organizations to create a single logical view of content related to a specific process or topic — regardless of where the content is stored and managed. These content views remove barriers imposed by disparate content sources and make content appear as if it were organized in a virtual repository.

Metadata mapping services normalize index values across multiple systems. This intuitive mapping tool makes it easy to define a common data model for working with content stored in multiple disparate repositories.

Federated search capabilities enable property-based and full-text queries against multiple repositories, returning an aggregated result set. This feature also allows users to create saved searches for enhanced productivity.

Single sign-on encrypts and stores repository credentialsand allows users to log on to multiple underlying systems


Softheon Marketplace Three reasons for technology fragmentation of content:

Departmental IT

spending Best-of-breed

purchasing Mergers and

acquisitions

There are three key reasons this fragmentation has occurred:

Departmental IT spending Until recently, discretionary spending authority was largely delegated to internal departments and lines of business - enabling each to invest in content management systems to solve their own narrowly defined business problems. While many corporate IT functions have begun to reclaim control, this period of autonomy has left a vast array of content silos in its wake.

Best-of-breed purchasing Content can take many forms,

ranging from traditional files and documents, to rich multimedia formats, images, web content and archived records. Many companies have discovered that there is no single solution for managing every type of content, and have invested in specific repositories to accommodate each type.

Mergers and acquisitions Even when a company attempts

to create a single enterprise standard for managing content, the next merger or acquisition can break that standard. Having dozens of content repositories, such as those mentioned earlier, have the potential to double with a merger - magnifying the problem of siloed content.

Before SOA

Traditional approaches for dealing with isolated systems, such as enterprise content and process management systems have been inherently limited. Before SOA, integration solutions included:

Migrating to a single platform The idea of a single-standard

platform is attractive in its simplicity. However, for many organizations, this is not a feasible approach. First, the time, expense and complexity of replacing numerous content- related systems already in place are too difficult to justify. Second, applications and customizations that have


opportunities for leveraging and reusing content. Additionally, vitalenterprise applications such as enterprise resource planning (ERP),customer relationship management (CRM), collaborative applicationsand portals can become degraded as result of the lack of valuableenterprise content. This content can include documents, images, e-mails, reports, web content, in addition to unstructured forms.


Service- oriented architecture (SOA) becomes an essential part of long term IT strategy.SOAP WSE 3.0 compliant web interfaces for Microsoft.NET and J2EE.

Provides the ability to access and work with isolated content,utilizing the unique functionality of various underlying repositories.

Delivers superset functionality that can be utilized acrossmultiple disparate content sources to create a unified experience.

Quickly content-enables business applications with component-based interfaces and a complete API. Leverages out-of-the-boxadapters to underlying content sources and pre-built interfaces to key business applications.

For developers:

Spanning all distributed information domains helps companiesaccelerate time to market, improve business intelligence andreuse IT investments.Seamless, real-time, bidirectional access to the native content andmetadata stored in many vendors’ systems.Turn disparate content repositories into a single, virtual,searchable system.Single sign-on enables you to sign on once to multipleunderlying systems.

About Softheon Empowering the nation's first state health benefit exchange since 2008, Softheon's vision and strategic direction address healthcare payer, provider, and government agencies’ goal of meeting Affordable Care Act (ACA) milestones. Softheon provides solutions for interacting with Federal and State Health Insurance Exchange (HIM) Marketplaces, while measurably reducing administrative costs, improving member and provider satisfaction, as well as addressing regulatory compliance challenges in all managed care administrative processes.

Softheon's Marketplace Connector Cloud (MC2) has been trusted by over 40 health plans as an accelerated federal, state, and private exchange integration platform. Softheon MC2 is a Software-as- a-Service (SaaS) solution where insurers pay a one-time activation and ongoing PMPM fees for exchange members only, while eliminating most, if not all, risks associated with ACA compliance of 2014 enrollment and other mandates.

For more information please contact your Softheon representative or call us at 1.800.236.7941

Visit our Web site at: www.softheon.com

© Copyright Softheon, Inc. 2014

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