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Health Insurance Industry Reference Architecture

Capability maps, value streams, and strategy maps for hospital organizations.

  • 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.

Health Insurance Industry Reference Architecture Research & Tools

1. Accelerate the strategy design process

Leverage a validated view of the hospital’s business capabilities to realize measurable top-line business outcomes and unlock direct value.

About Info-Tech

Info-Tech Research Group is the world’s fastest-growing information technology research and advisory company, proudly serving over 30,000 IT professionals.

We produce unbiased and highly relevant research to help CIOs and IT leaders make strategic, timely, and well-informed decisions. We partner closely with IT teams to provide everything they need, from actionable tools to analyst guidance, ensuring they deliver measurable results for their organizations.

What Is a Blueprint?

A blueprint is designed to be a roadmap, containing a methodology and the tools and templates you need to solve your IT problems.

Each blueprint can be accompanied by a Guided Implementation that provides you access to our world-class analysts to help you get through the project.

Capability maps, value streams, and strategy maps for hospital organizations.

Need Extra Help?
Speak With An Analyst

Get the help you need in this 4-phase advisory process. You'll receive 9 touchpoints with our researchers, all included in your membership.

Guided Implementation #1 - Build your organization’s capability map
  • Call #1 - Introduce Info-Tech’s industry reference architecture methodology.

Guided Implementation #2 - Use business capabilities to define strategic focus
  • Call #1 - Define and create value streams.
  • Call #2 - Model level 1 business capability maps.
  • Call #3 - Map value streams to business capabilities.
  • Call #4 - Model level 2 business capability maps.

Guided Implementation #3 - Assess key capabilities for planning priorities
  • Call #1 - Create a strategy map.
  • Call #2 - Introduce Info-Tech's capability assessment framework.

Guided Implementation #4 - Adopt capability-based strategy planning
  • Call #1 - Review capability assessment map(s).
  • Call #2 - Discuss and review prioritization of key capability gaps and plan next steps.


Jennifer Jones

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