Health Plans Converge with Differing Systems

Excellus Blue Cross Blue Shield 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 state’s largest nonprofit health plan, the organization provides health insurance to more than 2 million people, and employs more than 6,000 New Yorkers.

It is the result of a merger of several health organizations serving upstate New York. Following the merger, Excellus found that there were few enterprise architecture (EA) standards embraced by all of the previously independent entities. The company formed a group within the IT department to focus on EA as it consolidated business and IT systems and reduced the amount of technical diversity within the organization. With multiple platforms and environments, it was extremely challenging to create smoothly running, cohesive business procedures, 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.

“Before making sweeping policy or platform decisions, we recognized the importance of identifying all company functions and the processes used to implement them,” explained Eric Stephens, enterprise architect, Enterprise Architecture and Integration Team at Excellus. “This was the first step in our effort to reduce duplicate processes that were a normal result of the merger. We had to develop single systems for claims processing, provider contracting, member registration, and more, but could not do that until we fully understood and mapped the existing processes".

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