Rip and Replace

No Need to “Rip and Replace”
Existing Investments to Ensure
Success in ACA Marketplaces.
Softheon Marketplace Connector Cloud; A Service Oriented
Architecture compliant enterprise messaging & business
process management platform for Marketplace integration.
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.
Softheon Marketplace
Connector Cloud (MC2)
is designed with ServiceOriented Architecture
(SOA) in mind. MC2
facilitates integration
with insurer’s existing IT
assets based on X12
standards (834, 820) and
opens up internal
systems.
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 and
will describe how frameworks and service adapters, like Softheon’s
can assist organizations in recognizing the benefits of SOA.
Enterprise Messaging & Business
Process Management
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
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.
Page 2 of 12
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.
through a single suthentication process. This capability can also
integrate with existing Lightweight Directory Access Protocol
(LDAP) infrastructures.
Subscription event services let companies create custom event
handlers and other rules-based behaviors that span multiple
content and workflow systems.
Automatic subscriptions allow content and workflow queues to be
monitored and to automatically trigger e-mail notifications
and/or other events when changes occur.
Cross-repository capabilities enable a range of event-based
functions, such as content and/or metadata replication between
disparate repositories; declaring a document as a record; or
triggering a workflow or event that must occur.
View services can render Windows-based document, including all
standard 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.
Softheon MC2 for IT
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.
Why Softheon?
For business operations:
Makes relevant content accessible from one production
workflow application.
Enables companies to achieve higher levels of automation
and business process continuity.
Create custom workflows with subscription event services.
Copyright 2014. Confidential and proprietary information.
Page 3 of 12
been implemented with one system are often difficult or
even impossible to duplicate in another system with
different functionality. Also, for companies expecting
merger and acquisition activity, the very concept of a single
standard platform is not an option, as the next merger or
acquisition can be counted upon to bring another set of
incompatible systems.
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
companies will attempt to create custom point-to-point
integrations between customer-service applications and
underlying repositories. There are many risks and problems
associated with custom integrations, which include not only
the initial cost and time to market, but also the extraordinarily
high cost of maintaining these often brittle integrations;
particularly when a company upgrades to new back-end
repositories and front-end applications.
In fact, an upgrade to a new application or repository often
means that the initial integration becomes little more than
throwaway code and the integrations must be rewritten from
the ground up. Therefore, as a company’s IT infrastructure
evolves, the cost of these integrations become a recurring
expense and can fall burden to ongoing maintenance.
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.
With SOA, data and business logic are encapsulated in modular
business components with documented interfaces. This clarifies
design and facilitates incremental development and future
extensions. An SOA application can also be utilized to enhance
integration with heterogeneous, external legacy and purchased
applications much better than a monolithic, non-SOA application.
A primary goal of deploying SOA is simplify ing the development
and implementation of new applications and capabilities by
aggregating 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
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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 physically
distributed content sources are subject to and governed by
appropriate recordkeeping plocies.
Reduce litigation costs and protect goodwill Avoiding
noncompliance has important implications for both an
organization’s overall litigation costs, as well as protecting the
enterprise’s valuable reputation, goodwill and brand equity.
Reduce discovery costs 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
custom behaviors to eliminate the need for manual steps that
typically occer between processes.
Streamline work processes Connecting isolated workflows
to maximize efficiency and business velocity.
Copyright 2014. Confidential and proprietary information.
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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:
Enriched portals and key business applications SOA integrates
key 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 initiatives Organizations
are 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 Aside from
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 public
sector agencies to achieve the unification benefits of
consolidation without the time, cost and process disruption of a
“rip and replace” initiative.
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What Does SOA Mean For the
Organization?
SOA frees content for
use by enterprise
applications and helps
to support compliance
management initiatives
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 rates In both
self-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 center
service 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 access
to 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.
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.
Copyright 2014. Confidential and proprietary information.
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services are designed to behave like text messaging – short, tothe-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
Organizations are
seeking access to a
single, comprehensive
view of their content,
plus the ability to
distribute content to
their business
applications
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
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Improve visibility and coordination Creating a single view into
multiple workflow tasks for better visibility, coordination and control
of business-critical processes that span multiple workflow systems.
Mitigate Risk Automating monitoring, auditing and controlling
manual work processes to reduce errors and improve compliance
with corporate policies and regulatory mandates.
Softheon Marketplace Connector
Cloud – the Leading SOA Platform
for HealthCare Payers
The Softheon Marketplace Connector Clous (MC2) is a SOA
compliant business process management and enterprise messaging
integration platform that is fully WSE 3.0 compliant, and is based on
three layers of service: integration, federation a nd developer. The
Softheon 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 credentials
and allows users to log on to multiple underlying systems
Copyright 2014. Confidential and proprietary information.
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Softheon Marketplace
Three reasons for
technology
fragmentation of
content:
Departmental IT
spending
Best-of-breed
purchasing
Mergers and
acquisitions
opportunities for leveraging and reusing content. Additionally, vital
enterprise applications such as enterprise resource planning (ERP),
customer relationship management (CRM), collaborative applications
and portals can become degraded as result of the lack of valuable
enterprise content. This content can include documents, images,
e-mails, reports, web content, in addition to unstructured forms.
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 contentrelated systems already in place are too difficult to justify.
Second, applications and customizations that have
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Spanning all distributed information domains helps companies
accelerate time to market, improve business intelligence and
reuse IT investments.
Seamless, real-time, bidirectional access to the native content and
metadata 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 multiple
underlying systems.
For developers:
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 across
multiple disparate content sources to create a unified experience.
Quickly content-enables business applications with componentbased interfaces and a complete API. Leverages out-of-the-box
adapters to underlying content sources and pre-built interfaces to
key business applications.
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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-asa-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
Softheon, Inc. 1500 Stony Brook Rd, Stony Brook NY 11794
Copyright 2014. Confidential and proprietary information.
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