Business Scenario Document
Business Scenario: Health Insurance Enrollment Engine
Version <1.0>
Revision History
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11 February 2002 |
0.5 |
Initial Submission |
Ryan Gaylor |
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Table of Contents
1. Enrollment Engine 1
1.1 Description 1
2. Participants 1
2.1 HealthNow 1
2.1.1 Role 1
2.1.2 Relationships 1
2.1.3 Business Objectives 1
2.1.4 Solution Requirements 1
2.2 divine Inc 2
2.2.1 Role 2
2.2.2 Relationships 2
2.3 Corporate Website 2
2.3.1 Role 2
2.3.2 Relationships 3
2.3.3 Business Objectives 3
2.4 Employer Group 3
2.4.1 Role 3
2.4.2 Relationships 3
2.4.3 Business Objectives 3
2.5 End-User 4
2.5.1 Role 4
HealthNow is a large regional Health Management Organization (HMO), with millions of lives covered under its policies. The majority of policies covered by HealthNow are provided as employee benefits, with the majority of policies paid by the employer. Within any given year HealthNow will process approximately 1.5 million enrollment or change in policy requests per year. This is accomplished through a predominantly paper based process where employer group’s Human Resource staff administrate the delivery, collection, and forwarding of policy enrollment forms to HealthNow, which then has to enter the information into their internal enrollment system.
To eliminate the cumbersome burden and inefficient process associated with enrolling individuals into policies, HealthNow is leveraging its existing enrollment system to create a Web Service to help automate this task, by using the divine Composite Application Platform (CAP). By creating a Web Service Enrollment Engine HealthNow can extend internal systems to their employer groups based on their specific needs.
As a regional HMO, HealthNow provides a variety of health insurance policies to its members. With a legacy enrollment system in place, HealthNow has identified that with the help of divine they can expose the necessary elements of the Enrollment Engine through the Web and use the divine platform to facilitate consumption at various endpoints by employing Web Service technology.
In this scenario HealthNow is the originator or Producer (with the assistance of divine as the vendor) P0.
Note: HealthNow is a fictional organization.
HealthNow currently offers the policies that will be supported by the Web Service Enrollment Engine to employer groups. The purpose of the service is to facilitate that relationship by eliminating the manual process that is currently in place.
To reduce cost, increase switching costs and increase revenues by offering a differentiating service that leverages the existing systems in place at HealthNow and extend them to employer groups through Web Services.
§ Leverage Existing Infrastructure: Minimize the impact to existing systems in place at HealthNow and avoid duplication of effort.
§ Brand Control: Ensure that HealthNow’s brand is controlled irregardless of where the service is consumed.
§ Flexible Distribution: Utilize the divine CAP display engine to display the service through HealthNows corporate website, a stand alone portal, or as a component within another portal.
§ Loosely Coupled: Link directly with the infrastructure in place and design Web Services to securely extend functionality through the Web.
§ Authentication/ Security: Ensure that enrollment process meets industry standards and government regulations such as the Health Insurance Portability and Accountability Act (HIPAA), while also leveraging existing authentication methods already in place.
§ Adaptability: Increase the flexibility of consuming the Enrollment Engine, independent of the device it is consumed by.
§ Context Sharing: Allow employer groups to direct the Web Service to retrieve standard information from existing resources to create a cleaner process (ie populating standard information like employee name, DOB, SSN, address…to eliminate the need of having employees to key that information in).
§ Control: Ensure that standard elements required in the enrollment process are constructed to eliminate error at consumption.
§ Low Maintenance: HealthNow does not want to be responsible for the UI design of employer groups or other parties that may consume the Enrollment Engine, nor coordinate standard upgrades or changes made to the service (ie dynamic delivery).
Responsibility of usability resides at the producer of the UI for the service.
Authentication will depend on the UI used and final responsibility of verifying eligibility will be a cooperative process between HealthNow and its employer groups.
Technology vendor that enables delivery of Enrollment Engine through a combination of software and services. The services organization will be responsible for assessing the legacy enrollment system of HealthNow an developing the Web Service wrapper. Software will then be installed and configured to HealthNow’s needs via services. Depending on HealthNow’s IT department, they may work with employer groups to produce UI for the service or contract divine services to manage the product.
In this scenario divine facilitates HealthNow as a Producer P0.
Divine is a products and services vendor employed to meet HealthNow’s demand for extending their enrollment system.
Managers of the corporate website will consume the Enrollment Engine Web Service and produce a User Interface that is built into the existing corporate website for enrollment of individuals and small employer groups.
In this scenario the Corporate Website is both a Consumer C0 (of the Enrollment Engine) and a Producer P1 (presenting the Enrollment Engine in the existing website).
This is an internal IT department of HealthNow that manages the content and functionality used to serve customers/employer groups through their corporate website.
Provide a simple means for small employer groups and individuals to enroll in health insurance policies, using the existing touchpoint of the corporate website.
Usability will be controlled by the IT department and based on the elements and restrictions developed into the Web Service to ensure consumption and presentation quality.
Small employer groups and individuals will have to be issued a login and password and once enrolled a process will be established to verify eligibility by the employer group.
For large employer groups that have an Intranet or Enterprise Portal in place, the Enrollment Engine service can be consumed in their existing environment and presented to their employees.
In this scenario the Intranet Portal is both a Consumer C1 (of the Enrollment Engine) and a Producer P2 (presenting the Enrollment Engine in the existing portal).
As an employer group that acquires healthcare policies from HealthNow for their employees, these organizations may choose to incorporate the Enrollment Engine into their internal administration tools to ease administration of benefits.
The employer group is not required to have any relationship or interaction with divine.
Create a more efficient process for administrating employee healthcare benefits by incorporating the Enrollment Engine service as seamless part of their existing portal.
Usability will be controlled by the employer group’s IT department and based on the elements and restrictions developed into the Web Service to ensure consumption and presentation quality.
Authentication of users can leverage existing directories in place at the employer group, but will require trust between the systems and verification by the employer group’s HR staff.
End users are the individuals insured under policies provided by HealthNow (either through direct purchase or as a benefit provided by their employer). The Enrollment Engine is used in place of standard enrollment documents usually issued by HealthNow to enroll in benefits.
From a WSIA perspective the end-user is neither a Consumer nor a Producer. They are simple any one of n-possible users. (U1-n..).