MEGA International’s SOA Solution Helps Blue Cross Blue Shield Consolidate IT Systems

MEGA International today announced that Excellus Blue Cross Blue Shield, the largest nonprofit health plan in New York, is using the MEGA Modeling Suite to eliminate redundant business processes and IT systems and improve information access.

When several Blue Cross Blue Shield programs in upstate New York merged to create Excellus BCBS, each organization brought its own business processes and IT system to the new entity. Because they were so different, yet had to be consolidated, Excellus BCBS wanted to first implement a strong business analysis process to clearly identify company functions and processes.

Excellus BCBS evaluated providers against certain criteria, and found that the MEGA Modeling Suite had the most comprehensive offering. MEGA International provides enterprise architecture (EA), business process analysis (BPA), and governance, risk, and compliance (GRC) solutions that are used by corporations and government agencies. The tools help them understand assets, control operations, and govern risks.

The MEGA Modeling Suite has helped Excellus BCBS identify all company functions and processes, as it worked to reduce duplicate processes that were a normal result of the merger. With multiple platforms and environments, it was extremely challenging to create smoothly running, cohesive business processes, without a clear understanding of what processes and systems were serving each organization. Many of these legacy systems, some in place for 30+ years, didn’t have adequate documentation, so there were parts of the systems that were completely unknown.

The health plan wanted to develop single systems for claims processing, provider contracting, member registration, and more, and standardize practices so that customers and others outside the organization would feel like they were dealing with a single company, rather than multiple entities in a loose federation. In addition, Excellus BCBS recognized that a key factor to their success would be a services-oriented architecture (SOA) approach, offering the ability to devise flexible architectures that rely on smaller parts (services), rather than larger holistic solutions. Being able to implement the architecture in parts gives them more choices (buy vs. build) and allows for variation in particular components to adapt to shifting market demand for products. It was clear that going forward with big systems implementations would drive both risk and financial resource to unacceptable levels.

“With the MEGA Modeling Suite, we have gained a clear understanding of our processes and we have put the information in one place so that we can maintain consistency, starting at the architectural or planning level,” explained Eric Stephens, enterprise architect, Enterprise Architecture and Integration Team at Excellus BCBS. “Previously, we relied on individual people for their knowledge, as well as slides and Visio diagrams, but it was not nearly enough.”

Today, the Excellus MEGA/EA repository contains nearly 600 applications. The MEGA Modeling Suite is helping Excellus BCBS make better use of resources (people, money, time, equipment) and improve access to company information. It is bringing business agility to Excellus BCBS, enabling it to maintain its competitive edge, reduce time to market for new products, and respond to market changes rapidly. It allows them to identify the impact of organizational change before making actual changes through modeling, which avoids problems, and saves time and money. Additional savings are accruing because of the ability to remove redundant hardware and software, and repurposing staff for value-added activities.

Excellus BCBS is part of a $4 billion family of companies that finances and delivers health care services across upstate New York, including the major cities of Syracuse, Elmira, Rochester, Utica, and Buffalo. As New York’s largest nonprofit health plan, the organization provides health insurance to more than 2 million people, and employs more than 6,000 New Yorkers.

MEGA International ( ) is a privately-held company providing enterprise architecture, business process analysis, and governance, risk, and compliance solutions, with 45,000 software licenses worldwide. The company is consistently ranked as an industry leader by Gartner and Forrester. Clients include AT&T, DirecTV, Enterprise Rent-a-Car, Morgan Stanley, NASA, Nissan, Wyeth, and the US Departments of Homeland Security and Transportation.