Case Study

Health Insurer: Enterprise Architecture

Enterprise architecture positions U.S. health insurance company to harness clinical data for new line of business

Technology Shows Its Value

As one of the leading health insurance companies in the U.S., this business provides coverage to millions of residents across many states. Already, the Health Insurer has seen the positive effect technology can have for members, payers and providers.

The Health Insurer uses clinical analytics to correlate data from claims with other medical records — such as hospital admission reports, lab results and biometrics from medical devices. Members and providers are notified of health events like upcoming screenings or contraindications of newly prescribed medications. The company has closed millions of gaps in care as a result.

Members and payers have been attracted to the company in part because of its focus on developing engaging mobile applications. Through its portfolio of applications, members gain access to consumer-centric services like drug pricing tools, prescription automation and health tracking. In addition to improving member health and lowering costs, feature-rich applications have helped the company stand out in a market defined by choice and customization.

Digital Transformation Opens New Line of Business

After wins with clinical analytics and mobile application development, the Health Insurer was ready to dial up its focus on technology to create a new line of business. It believes its future lies in its ability to manage and disperse clinical data.

The proliferation of wearables in healthcare is putting more clinical data into the hands of the Health Insurer. The FDA’s approval of wearable technology as medical devices, their incorporation into employee health programs, and their adoption by hospitals as real-time monitoring tools will only expand wearable data.

The Health Insurer wants to take this influx of biometric data, correlate it with traditional medical records and organize it by medical conditions. It could then sell or lease disease-specific data sets to research institutions and hospitals. For instance, researches could use these data sets to accelerate patient stratification and gain a better understanding of associated diseases. Hospitals could use the data to further preventive care as they move toward predicative analytics as a treatment tool.

While it explores this new line of business, the Health Insurer will continue to maintain its footing as a leader in using clinical data to close care gaps and reduce costs. It also will continue to improve upon its mobile application portfolio to engage members.

The business was ready to push forward with its data management initiatives and enhanced focus on clinical analytics and mobile application development. The Health Insurer’s IT department, however, was not.

New Business Demands New IT

To manage and disperse clinical data sources, the Health Insurer needed its IT systems to communicate with one another. Organic growth from mergers, divestitures and investment opportunities stood in the way. Loosely integrated systems needed to be refreshed, and manual processes were required to scale systems to meet business requests. Automation was impossible within the company’s current architecture.

Staff was equally disconnected. With no technology adoption standards in place, and IT working teams entrenched in silos, the adoption of new technologies took too long for the company to fulfill its business vision of collecting, analyzing and dispersing clinical data.

Building from the Ground Up  

To solve these gaps and accelerate the Health Insurer’s digital transformation, we applied our complete approach to enterprise architecture.

We first conducted a 90-day assessment of the Health Insurer’s IT environment. This involved interviews with stakeholders within network, compute, storage, security, operations, automation, application development and monitoring. We also reviewed each of these group’s near- and long-term technology roadmaps.

Based on the information we collected, we created an overall IT strategy for the Health Insurer that took into account each group’s priorities. This included high-level plans for the people, processes and technology changes that would need to occur for the strategy’s successful execution.

With IT stakeholders aligned, it was time to build a technical architecture capable of supporting the intense demands that would come from managing and dispersing clinical data.

We leveraged our broad set of OEM partnerships and technical expertise to evaluate, design and implement a fully software-defined data center (SDDC) platform.

Our SDDC architecture included the following:

  • Software-defined networking (SDN) and load balancing was implemented using Arista, VMware NSX, and F5 to create a flexible application delivery fabric for infrastructure optimization and security.
  • Default deny segmentation (Enclaving) was implemented using VMware NSX distributed firewall and Palo Alto Next Generation Firewalls (NGFW) to provide user and application micro-segmentation.
  • A fully automated and integrated set of operational tools were introduced to provide all tiers of operations personnel the necessary troubleshooting and monitoring environment. Splunk was integrated for security incident event management; VMware vRealize Operations was implemented as the primary infrastructure operations tool; and VMware vRealize Log Insight was implemented for advanced troubleshooting and analytics.
  • VMware vRealize Network Insight was leveraged for application dependency mapping of an initial set of applications to provide detailed data on the impacts of migrating an existing application environment onto the SDDC platform.
  • The Health Insurer leverages Equinix co-location connectivity to access Microsoft Azure and Amazon Web Services (AWS). Multicloud development and automation (IaaS and PaaS) drove simplification and efficiency in testing, deployment and operations. VMware vRealize Automation/ Orchestration and ServiceNow serve as the primary hubs with extensions into a variety of tools and technologies, such as Microsoft Active Directory, Splunk, Infoblox, VMware vCenter, NSX, Pure, F5 and Cisco UCS.

A Best-in-Class Architecture in 90 Days

The full breadth of the WWT Advanced Technology Center (ATC) was leveraged first to evaluate the discreet technology within each area of the SDDC design and then to architect the entire solution before deployment.

By using the ATC, in 90 days we designed and delivered an always on, available anywhere, guaranteed performing, automated and secure SDDC platform. The ATC was leveraged to:

  • Build 194 Virtual Machines
  • Integrate 50 Disparate Infrastructure Components
  • Evaluate 10 OEMs
  • Develop 25 Automated Workflows
  • Conduct 14 Technology Workshops

The company will continue to use the ATC as a development sandbox for integrating and testing a multi-OEM enterprise reference architecture.

Modernization Paves the Way for Innovation

With its new SDDC architecture, the Health Insurer has a highly available, resilient and communicative platform for application development. Six-month SLAs for full-stack development environments have been reduced to 15 minutes. The Health Insurer’s application developers now have the speed and flexibility they need as they build out data management and analytics platforms core to the organization’s business strategy, as well as iterate on consumer-centric applications for members.

Network, storage, compute and security teams no longer spend valuable time provisioning infrastructure thanks to automation, and a cross-functional team has been created to oversee the adoption of new technologies into the company’s IT environment as part of defined enterprise architecture standards.

Developing its data management and dispersal capabilities will not happen overnight for the Health Insurer. It will require constantly evaluating and integrating new technology into their enterprise reference architecture to stay at the leading edge of big data and clinical analytics.

But by partnering with WWT, the Health Insurer has the advisory, testing and deployment services it needs to execute its transformative vision.