BPJS Kesehatan Enterprise Architecture (BEA): Strategy for Integrating Business Processes and Information Technology in the Sustainability of the Social Health Insurance Program

Social Health Insurance Administration Body (BPJS Kesehatan), as the administrator of the Social Health Insurance Program (SHI), is required to run the organization effectively and efficiently in order to meet the expectations of participants and the needs of stakeholders through accelerated digital transformation. To achieve this, since 2021 BPJS Kesehatan has initiated the BPJS Kesehatan Enterprise Architecture (BEA) based on the TOGAF Architecture Development Method (ADM) using ArchiMate and the application of Business Process Model and Notation (BPMN). This study aims to describe the BEA development process, analyze the implementation results, and evaluate its contribution to organizational performance using a qualitative case study approach through internal documentation, interviews, and participatory observation.

The results show that BEA resulted in the simplification of 354 processes, the re-arrangement of 229 processes, the digitization of 636 activities, and the strengthening of functions in 54 processes. These findings confirm that the business-driven EA approach is relevant for large-scale public organizations. Theoretically, this research enriches the EA literature in the health sector; practically, BEA can be used as a best practice for digital transformation and governance in highly complex public institutions.