Part 2: Thriving in a regulated era — the business capabilities model

With several provisions of the Affordable Care Act already implemented, health plans are poised for new growth opportunities.

Last week, we kicked off our blog series on considerations for thriving in a regulated era with a review of the business vision and business plan. Here in part two, we take a closer look at the next process which that can help you grow, adapt and succeed in this new marketplace — the business capabilities model.

Designing the business capabilities model
Your business capabilities model determines the capacity your organization has to perform essential business activities. It should be established at a high level first before it’s drilled down to the additional levels that will initiate the model’s core design. The first level should define functional elements, while the second level should provide the prioritization for achieving your strategy.

Beyond the two levels, your capabilities model should align with the functions and processes necessary for business execution, as well as the resources to enable them. Keep your model flexible — it needs to be scalable enough to meet future market needs.

Throughout the design process, think about what is critical to your business strategy. That includes addressing these two questions:

Can every function be processed without technology? Technology doesn’t drive the design of your capabilities model, but it will help you gain efficiencies, reduce costs and create scale. Determine what it is you need before you commit to spend. Defining your business requirements in advance will make it easier to determine what you’re looking to obtain from vendors.
How much documentation is required to support your business? Documenting the end-to-end process with defined roles, responsibilities and accountabilities will ensure consistency in decision-making.

Enterprise architecture
The build phase of your capabilities model will overlap with the design phase so you’ll understand the impact your capabilities have on your enterprise architecture.

Preparing a high-level cost estimate to implement business functions will need to be prioritized based on value to the business. Some business functions may require significant spend, but that doesn’t necessarily mean they are critical to achieving your business strategy.

Download the white paper
Our blog series continues next week with establishing the technology road map, sourcing strategies and a go-to-market approach.

An in-depth review of recommended considerations is available in our white paper, “Thriving in a regulated era: Key considerations to guide new value creation.”

About the Author:

Jim MahJim Maher headshoter

Vice President, Optum, Optum Consulting Group
As part of the operations and administration consulting practice at Optum, Jim Maher is responsible for client advisory services. With 25 years of consulting experience, Jim’s core competencies include legacy transformation, business process reengineering, IT solution development and implementation, migration planning and complex program management.

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