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From Oracle’s website:

http://www.oracle.com/us/corporate/profit/features/092412-oregon-1852010.html

EXCERPT:

When the healthcare reform legislation was signed, IT staff at Oregon DHS was already modernizing several agency delivery programs, such as Temporary Assistance for Needy Families (which supplies cash assistance to indigent American families with dependent children) and the Supplemental Nutrition Assistance Program (which provides financial assistance for food to low-income families). Lawson had identified a short list of potential technology suppliers, including Oracle, and asked if they could create the new insurance exchange as well.

In conjunction with the exchange, Oregon DHS leadership wanted to modernize fundamental business processes for determining Medicaid eligibility and receiving payments—which were, at the time, being handled by cumbersome legacy systems. They also needed systems to accommodate new types of healthcare providers. For example, the healthcare reform legislation requires providers to change from managed care organizations (MCOs) to coordinated care organizations (CCOs)—networks of doctors, dentists, mental health specialists, and other providers who have agreed to work together to support patients who will receive insurance benefits through the health insurance exchange.

“In a project of this magnitude, with these kinds of expressed timelines, we knew that if we didn’t take an enterprise approach, not only would there be collisions, but we’d tie ourselves in knots,” Lawson admits. “Neither the insurance exchange nor the CCOs had ever existed before. Without the right enterprise approach, we might end up with the same technology silos we were moving away from.”

Further complicating the process was the 2011 transition of DHS and other Oregon health and human service programs into two distinct agencies—DHS and OHA. While the modernization efforts remained with DHS, responsibility for the health insurance exchange project fell under the new OHA. However, the agencies determined that the projects should work jointly to develop the automated Medicaid eligibility and enrollment foundation they both require.

To keep both initiatives in sync and arrive at a cohesive future-state architecture, Lawson and her team decided to engage Oracle’s enterprise architects and apply their enterprise architecture (EA) process.

“The Oracle team helped us see the issues philosophically before we approached the practical aspects of the project,” she recalls. “Then they supplied the structure and personnel we needed to execute the required tasks. Oracle gave us a new perspective on the challenges at hand. Their support has been invaluable.”

By the time the project is complete, the State of Oregon will have spent as much as US$200 million on the exchange and related information systems. However, Lawson believes that if Oregon staff had hired a systems integrator to install a packaged exchange application and integrate it with its legacy DHS systems, as many other states are doing, they would have had to spend even more money than that, and engage more people overall. “We’re taking the money that many states are spending on just the insurance exchange and rebuilding our entire enterprise,” she notes.

Public servants, from Oregon Governor John Kitzhaber on down, have been thrilled with the team’s progress, as well as with the example that Oregon is setting for other states. Lawson credits the Oracle EA methodologies and frameworks for keeping the project on track.

“Without our dedication to enterprise architecture, we wouldn’t have been able to pull off a project of this magnitude,” Lawson emphasizes. “EA provided a structure for moving forward, from designing the business architecture to mapping the various functions to the technologies that we needed. The State of Oregon has not received any more funding, magic pixie dust, or anything that makes us different from any other state,” she adds. “We walked in with the same needs, the same challenges, the same funding.