1. New England States Collaborative for Insurance Exchange Systems
September 14, 2011
Presented by:
• Jay Himmelstein, UMass Medical School (UMMS), Principal Investigator
• Manu Tandon, Chief Information Officer, MA EOHHS, Principal Technical Lead
• Bob Nevins, Chief Operating Officer, MA Health Connector, Principal Functional Lead
• Scott Devonshire, Chief Information Officer, MA Health Connector
•Michael Tutty, Project Manager (UMMS), Administrative Lead
1

2. Agenda
Reusability Approach
Reusability of HIX Components Within MA
Reusability of HIX Components With Other States
Confidential Information – Restricted Use Only 2

3. What to Reuse?
• Documents
Artifacts • Code
• Packaged Components / Libraries
• Techniques
Process • Methodologies
• Heuristics
• Experience in Management
Knowledge • Experience in Execution
• Business Knowledge
Confidential Information – Restricted Use Only 3

4. Cloud Computing - Features
Characteristics
Economic
Elements Cost Sharing
Scalability and
Reliability
Elasticity
Architectural Service Model
Elements
SaaS PaaS IaaS
Strategic Deployment
Elements
On-Premises Hybrid Off-Premise
Confidential Information – Restricted Use Only 4

5. A NIST Notional Definition of Cloud Computing Services
Software as a Service (SaaS)
• The capability provided to the consumer is to use the provider’s applications running on a
cloud infrastructure. The applications are accessible from various client devices through a
thin client interface such as a web browser (e.g., web-based email). The consumer does not
manage or control the underlying cloud infrastructure including
network, servers, operating systems, storage, or even individual application
capabilities, with the possible exception of limited user-specific application configuration
settings
Platform as a Service (PaaS)
• The capability provided to the consumer is the ability to deploy onto the cloud
infrastructure consumer-created or acquired applications created using programming
languages and tools supported by the provider. The consumer does not manage or control
the underlying cloud infrastructure including network, servers, operating systems, or
storage, but has control over the deployed applications and possibly application hosting
environment configurations.
Infrastructure as a Service (IaaS)
• The capability provided to the consumer is to provision processing, storage, networks, and
other fundamental computing resources where the consumer is able to deploy and run
arbitrary software, which can include operating systems and applications. The consumer
does not manage or control the underlying cloud infrastructure but has control over
operating systems, storage, deployed applications, and possibly limited control of select
networking components (e.g., host firewalls).
Source: http://www.info.apps.gov/content/what-are-services
Confidential Information – Restricted Use Only 5

6. Cloud Computing –Sharing & Reuse
Cloud Computing allows many services to be reused. Only
business agnostic and stateless services are sharable with
multiple clients.
SaaS
Business Agnostic
Stateless Services
Shared
IaaS PaaS
Confidential Information – Restricted Use Only 6

7. Reuse Framework
Based on Service Oriented Design
Patterns
Architecture (SOA)
Develop using Federal and industry Infrastructure
Application
best practices as a Service
Frameworks
(IaaS)
“Cloud First” approach
Reuse
Follow Federal and CMS security &
privacy guidelines
Service
Platform as a
Oriented
Based on Exchange Reference Service (PaaS)
Systems
Architecture
Follow ACA Section 1561 Software as a
Service (SaaS)
recommendations
Confidential Information – Restricted Use Only 7

8. Reusability Approach
Within MA With Other States
Tier 1
 Portal Share
 Eligibility Domain Documents, Pro
cesses and
 Shared Services Knowledge
 Middleware and
Infrastructure Tier 2
Share & Reuse Code,
Library and Packages
Tier 3
Jointly procure
hardware/software and manage
deployments
Confidential Information – Restricted Use Only 8

9. Agenda
Reusability Approach
Reusability of HIX Components Within MA
Reusability of HIX Components With Other States
Confidential Information – Restricted Use Only 9

10. Reusability of HIX Components Within MA
• Portal
 HIX Portal will be extended for Integrated Eligibility
• Eligibility Domain
 Rules Engine, Business Process Management (BPM),
Enterprise Service Bus (ESB) and Master Data
Management (MDM) will be shared and reused.
 Eligibility Domain will be extended for all Health and
Human Services Programs.
• Shared Services
 Identity Management (AIMS)
 Enterprise Document Management (EDM)
 HIPAA X12 Translator
• Middleware and Infrastructure 10
Confidential Information – Restricted Use Only

11. IntegratedInsurance Exchange
Health Eligibility & HIX
Current Systems
MA Health Connector MA Virtual Gateway IE&R My Account Page
(Current Health Insurance Exchange) (EOHHS wide Program Screening) (Limited Self Service Medicaid & SNAP)
Portal
Health *Business Process
Insurance Management Medicaid / CHIP /
Exchange Basic Health/ HSN
SNAP/TANF
Portal*
*Eligibility Hub
State Eligibility Systems
Real Time Eligibility & Enrollment
*Rules Engine
Portal
Medicaid/
Private / Subsidized
Portal For *MDM Eligibility
MMIS
Other
EOHHS Integrated Eligibility Domain Medicaid/CHIP System
Programs
BEACON
Federal Hub
SNAP/TANF System
State Claims /Enrollment
EOHHS Carrier Hub Case Management Systems
wide Portal
* Reusable components developed by HIX
External Data Hub 11

12. Integrated Eligibility Systems
Public Facing Portal (Integrated)
Virtual Gateway
Health Insurance Exchange
for Other EOHHS Programs
Internal Applications
HIX Admin Business Activity Monitor Case Management Claims Processing
Integrated Eligibility Domain
Health Insurance Exchange Domain
Public Benefits Domain
Business Business SNAP/
HIX Medicaid
Process Rules TANF/
Middleware /CHIP
Management Engine Other
Enterprise Service Bus
DB MDM DB
Enterprise Shared Services
Identity Document
Management Management

13. Agenda
Reusability Approach
Reusability of HIX Components Within MA
Reusability of HIX Components With Other States
Confidential Information – Restricted Use Only 13

14. Sharing with Other States
Tier 1
First Level Share
Documents,
Process and Knowledge
Tier 2
Share & Reuse Code, Library and
Packages
Tier 3
Jointly procure hardware/software and manage
deployments
Confidential Information – Restricted Use Only 14

15. Tier 1: Sharing
Exchange Life Cycle Artifacts
Exchange Life Cycle Experiences
Project Management Methodology
Business Knowledge
Operation Knowledge
Procurement Approach
Best Practices
Confidential Information – Restricted Use Only 15

16. Tier 1: Collaboration Tools
Collaborative Application Lifecycle Tool (CALT)
NESCIES (http://nescies.org/index.htm) (https://calt.hhs.gov)
For Preliminary Artifacts provided by Federal HHS
For Artifacts
Confidential Information – Restricted Use Only

17. Sharing with Other States
Tier 1
Share
Documents,
Process and
Knowledge
Tier 2
Second Level
Share & Reuse Code, Library and
Packages
Tier 3
Jointly procure hardware/software and manage
deployments
Confidential Information – Restricted Use Only 17

18. Tier 2: Share & Reuse
Tier 1 Components
HIX Portal
Business Rules
Web Services Interfaces
Source Code (Java)
Database Scripts
Metadata, Configurations
Confidential Information – Restricted Use Only 18

19. Tier 2: Share & Reuse
How to reuse • As is with configuration changes
• With modification for various platforms
components? • With enhancement to meet state business requirements
• Follow vendor neutral approach for interfaces
How code definition, and schema
could be • Follow NIEM and other industry standards for
information exchange
reusable? • Follow industry naming conventions for reuse
What is • MA specific shared services, such as:
difficult to • Access and Identity Management System (AIMS)
• Electronic Document Management (EDM)
share?
• Code is shared in common repository (CALT)
How is code • Common code will be maintained by MA and provide
shared and releases
• State specific code will be maintained by State or a
maintained? common vendor
Confidential Information – Restricted Use Only 19

20. HIX Deployment – Tier 2 Example
Sharable HIX components such as portal, middleware and database could be deployed by
each state in their own datacenter.
MA State X State Y
HIX UI Layer
Rules Engine, Rules Engine, Rules Engine,
BPMS, BPMS, BPMS,
Application Application Application
Server Server HIX Middleware Server
Database Database Database
HIX Database
MDM MDM
MDM
Medicaid/CHIP Medicaid/CHIP
Medicaid/CHIP
State Systems
Shared Services Shared Services
Shared Services
Confidential Information – Restricted Use Only 20

21. Sharing with Other States
Tier 1
Share
Documents,
Process and
Knowledge
Tier 2
Share Code, Library and Packages
Tier 3
Third Level
Jointly procure hardware/software and manage
deployments
Confidential Information – Restricted Use Only 21

22. Tier 3: Share & Reuse
Tier 1 & Tier 2 Components
Software Licenses
Infrastructure / Platforms / Datacenter
Third Party Services (e.g. Electronic Payment)
Cloud Ready Deployment Model
Operations & Maintenance of Infrastructure
Confidential Information – Restricted Use Only 22

23. Tier 3: Share & Reuse
• Software Licenses
What needs to • Hosting Services
be procured? • Third Party Application Services
• Vendor for Operation and Maintenance
• TBD - Consortium for participating states ?
How do we do • Governance Structure
this? • Cost sharing model based on usage
• Own the platform and secure it for state specific
What is each requirements
state’s • Maintain code and customization
• Manage the deployments
responsibility? • Ongoing operation and maintenance of applications
Confidential Information – Restricted Use Only 23

24. Tier 3: Reuse – Cloud Model - Example
Software as a • Example of services available as SaaS:
Service • Stateless, Business Agnostic Web Services such as
Address Validations and HIPAA Translator.
(SaaS)
• Example of components that will leverage PaaS:
Platform as a
• Portal
Service • Middleware (Rules Engine, BPMS etc.)
(PaaS) • Database
Infrastructure
• Shared Datacenter
as a Service • Virtual Machines
(IaaS)
Confidential Information – Restricted Use Only 24

25. HIX Deployment – Tier 3: Example 1
HIX portal is available in shared cloud, while middleware and database are running in state’s
private cloud .
HIX Cloud
Rules Engine, Rules Engine, Rules Engine,
BPMS, BPMS, BPMS,
Application Application Application
Server Server Server
Database Database Database
MDM MDM State X Cloud MDM State Y Cloud
Medicaid/CHIP Medicaid/CHIP Medicaid/CHIP
Shared Services Shared Services Shared Services
Federal
MassCloud Cloud
25

26. HIX Deployment – Tier 3: Example 2
HIX portal and middleware are available in shared cloud while database is running in state’s
private cloud .
HIX Cloud
Rules Engine, Rules Engine, Rules Engine,
BPMS, BPMS, BPMS,
Application Application Application
Server Server Server
Federal
Cloud
Database Database Database
MDM MDM MDM
Medicaid/CHIP Medicaid/CHIP Medicaid/CHIP
MassCloud MassCloud MassCloud
Shared Services Shared Services Shared Services
MassCloud State X Cloud State Y Cloud 26

27. HIX Deployment – Tier 3: Example 3 - Recommended
HIX portal, middleware and database are available in shared cloud.
Rules Engine, Rules Engine, Rules Engine,
BPMS, BPMS, BPMS,
Application Application Application
Server Server Server
Database Database Database
Federal
Cloud
MDM MDM MDM
Medicaid/CHIP Medicaid/CHIP Medicaid/CHIP
Shared Services Shared Services Shared Services
MassCloud State X Cloud State Y Cloud
27

28. HIX Deployment – Tier 3: Example 4 - Future
Example showing Multiple Tenant, Multiple Instance, Some Shared Instance
Business Rules Business Rules Business Rules
Business Process Business Process Business Process
Business Services
Database Database Database
Infrastructure
Shared Services
Shared Services
Infrastructure
Infrastructure Federal
Cloud State Y Cloud
MA Cloud
Tenant (State) owns the code and deploys on the platform available via PaaS model.
Service provider owns the code and makes it available via SaaS model
Service provider owns the hardware and makes it available via IaaS model 28

29. Key Points and Conclusion
 Advantages of reuse are lower costs, faster software
development.
 HIX components will be designed for reuse using well
known design patterns, application framework and
cloud computing.
 Tiered approach gives us flexibility to accommodate
each state’s requirements and platform.
Confidential Information – Restricted Use Only 29