Managed care provider
            

Large managed care provider that offers health insurance policies though the U.S. government programs Medicaid and Medicare, and exchanges run by individual states. In 2019 it had 3.3 million policyholders, 11,000 employees and recorded $16.8 billion in revenue. 

As one of the United States’ largest managed care providers, this company is in a business where the stakes are high. Every day, more than three million customers count on it to cover their bills in the event of a medical crisis. In today’s times of uncertainty, the company’s mission is even more essential. Most of its policyholders are covered by Medicaid, the government program for eligible low-income individuals and families. With unemployment across the U.S. rising due to the COVID-19 pandemic, the company expects its Medicaid enrollment to spike. Now, more than ever, the company requires a high-performing IT architecture: to enroll new customers quickly, more efficiently link them with providers and get them the care they need as soon as possible.

A few years back, that architecture was in need of some revamping. The company had already invested in an enterprise architecture management (EAM) platform. The aim was to capture an accurate, real-time picture of its IT landscape and better understand how well it was supporting its goals as a business. But the tool at its disposal wasn’t cutting it: the visibility it provided was incomplete and its modeling background required constant tinkering, eating up employees’ time and resulting in too many headaches. IT staff had long known that something had to change—and eventually a new management team agreed. In early 2019, the company went off in search of a replacement. Ultimately, it went with the best EAM that money can buy: Alfabet from Software AG.

Just two clicks away from seeing any process

For the company, Alfabet was a natural fit. Members of its IT staff had used the platform in previous jobs at other companies—and they had missed it. The company’s Director of Enterprise Architecture pushed for Alfabet for several reasons. Unlike its competitors with modeling backgrounds, Alfabet allows multiple users to continually feed it information, much like an ERP. This makes it far easier to visualize the status of products and their life cycles, project the impact over time of changes to the system and ensure IT is properly supporting business initiatives and strategies. Alfabet, moreover, is the only solution out there that combines EAM with integrated IT portfolio management. This helps companies keep their IT assets better organized, understand their inter-dependencies and optimize portfolios to eliminate waste and redundancy. On top of all of this, the platform is remarkably simple.

“With Alfabet, you can choose a given capability and see all of the associated processes, applications and technologies in two clicks,” the Director of Enterprise Architecture says. “You cannot do that with any other platform on the market.”

Setting the stage for major changes

With a deal signed in May 2019, the company’s IT team finally had Alfabet at their fingertips—and they immediately began implementing it. Working closely with the Software AG partner Visual Enterprise Architecture, the company used the platform to harmonize its entire IT landscape: 1,200 applications across 187 capabilities, supported by a staff of 26. 

With that process complete, the real fun is now beginning: translating this transparent, streamlined architecture into tangible business improvements. Today, informed by its new IT visibility, the company is undertaking three major IT projects. The first is an overhaul of its enrollment management system meant to reduce the time it takes to enroll new customers. Currently, this averages 36 hours—which often means delays in getting treatment, especially for those enrolling in the midst of emergencies like an ongoing pandemic. Thanks to Alfabet, the company believes it can cut that down to just six hours. A second project aims to better combat fraud: the company loses six million dollars a month to faulty claims. Now that it finally has an accurate, real-time picture of its IT landscape, it will be able to more thoroughly audit its claims management processes and significantly scale back those losses. 

Finally, Alfabet’s out-of-the-box EA planning capabilities are helping the company build a new online portal to more effectively link patients to providers, and improve its overall policyholder experience. “This will enable people to sit down and easily find a doctor that suits their needs,” the Director of Enterprise Architecture says. “It will also improve our ability to market to providers, create a better network of medical professionals and ultimately garner more business.”

Today, all three initiatives remain works in progress. But, none could have gotten off the ground without Alfabet’s ability to align IT and business needs and analyze the impact of planned changes. “Before we lacked the tools to carry out our vision,” the Director of Enterprise Architecture says. “With Alfabet, we finally have the foundation to make the changes that our customers deserve, and bring our business to the next level.”