Health Insurance Industry Reference Architecture

• Health Insurers require a unified and validated view of their capabilities that aligns product development, distribution and underwriting, policy management and servicing, and claims management to provide value to patients and stakeholders.
• Health insurance organizations are a central component of the healthcare system and interact with providers and other points of care across the healthcare continuum.
• Health insurers are focused on developing products and services that facilitate the payment of health costs related to illness or injury.
• Depending on where you live, health insurance may be provided as single payer, private, public-government payers, or through a combination of private insurance and public-government payers.

• The business and IT often focus on a project, ignoring the holistic impact and value of an overarching value stream and business capability view.

Our Advice

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 and Result

• Demonstrate the value of IT’s role in supporting your hospital 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 hospital 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.