Traditionally, as states seek federal funding for health services, they respond to each program with a proposal designed to win the money. Only when the dollars have been won is delivery of care designed.
Oregon's approach is different. Oregon is putting business architecture up front by viewing every new health-care program as part of a system--a system that must be seamless.
"The traditional approach is to design program architecture artifacts to meet federal requirements, not for the purposes of actively managing the program," explains Matt Betts, a business architect for the Oregon Health Authority (OHA). Betts and several colleagues from OHA and Oregon's Department of Human Services (DHS) attended the Medicaid Enterprise Systems Conference in Boston last month, and they used the occasion to contrast Oregon's approach to their peers'.
In the real world of health-care delivery, clients come into a state's system at multiple points of entry, but their needs often reach across multiple programs. Navigating across the system can be a nightmare--incredibly inefficient for both those in need of care and those who administer and deliver it. Too often, each program has its own intake process and information-technology system to support it.
Trina Lee, modernization director for DHS, says the use of a common management system to design its business architecture is the key to eliminating silos and creating an efficient and effective delivery system. DHS, OHA and many other Oregon agencies are working to build a common language and use a common logic to design programs. "Our management system pushes us to be agile and flexible," says Lee.
Lee and her colleagues are taking the concepts of business architecture and bringing them to life. "This is about delivering services to clients in an integrated way," explains Michelle Johnson, project manager and business architect at DHS. Johnson sees good service as quality service that is efficient and timely, a primary goal of the federal Affordable Care Act.
What Betts, Lee and Johnson realized as they spoke with colleagues from across the nation is that Oregon's approach appears to be unique. The agencies are building management-system maps as a part of Oregon's legislatively mandated commitment to outcome-based budgets that connect mission, vision, values, key goals and processes to fact-based outcome and process scorecards.
Oregon starts with business architecture and sees IT architecture as a response to the business, not designed in the absence of business architecture. The whole logic focuses on clients' outcomes through understanding work flows, clarifying who owns what, defining how success is measured and what happens when things don't go as the targets would indicate they should. When you think about it, isn't that the way things should be in the delivery of all government services?