Smarter Care &

and
Social
Social
Programs
Programs Care Analytics

IBM Smarter Social Programs

Integrated Eligibility: Improving Access to Health

and Social Programs

March 26th, 2015

Jeff Mann
Strategy and Market Development
IBM Cúram Social Program Management

John J. Sweeney
Sr. Product Manager
IBM Smarter Care and Social Programs

© 2014 IBM Corporation 1

© 2014 IBM Corporation
Smarter Care and Social Programs Care Analytics

Contents

• IBM Commitment

• Integrated Eligibility

• The Solution

• Summary

© 2014 IBM Corporation 2

Smarter Care and Social Programs Care Analytics

IBM has a strong, long-standing commitment to social programs,

which expanded with the acquisition of Cúram Software

• Commercial off-the-shelf, software for line of business users in

health and social programs, covering all types of organizations
• More than 700 IBM subject matter experts in social programs:
— 40 subject matter experts in social programs policy
— 300 service professionals experienced in building social program
management systems
— 320 dedicated software developers with expertise in social programs
business processes

• Social programs policy research center—the IBM Cúram

Research Institute

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Smarter Care and Social Programs Care Analytics

Social program management is the core of what we do

Family Public Disability Social Government
Employment
services pensions management assistance health

Tax credits
National Family Unemployment National Disability benefits National health
government benefits benefits pensions and pensions schemes
Social benefits

State and Child Workers’ Private insurance

provincial welfare compensation Exchanges

Homeless Employer pension

Employment Disability
Cities / child and adult
services Personal pension management
Counties care
Industry pensions services

Serving health and social programs organizations at all levels of

government, as well as non-governmental organizations

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Focus on Outcomes & Collaboration

Operational
Process Intake & On-Going Case Service
Placements
Investigations Management Delivery
Support

Outcome Service Outcome

Assessment Planning Evaluation
Management

Multi-
disciplinary
Approach

Family Shared Multi-Disciplinary

Case & Client Info Teams
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Smarter Care and Social Programs Care Analytics

IBM’s Social Program Management approach enables governments to

make necessary changes
Needs To Outcomes

Identify Assess Respond Manage Measure

• Triage & • Social Context • Integrated • Outcome Plans • Outcome
Screening & Analysis Eligibility & Evaluation
Entitlement • Personal Budgets
Applications • Evidence - Clients
Management • Intake & • Service & - Providers
• Benefit Planning Provider
Enrollment - Programs
& Selection • Strength & Needs Provisioning
Assessment • Differential - Processes
• Life Event • Collaboration and - Spend
Response
Management • Advisor Social Media
- Crisis
• Outreach • Priority, - Diversion • Multidisciplinary • Multidimensional
Management Complexity & Teams
- Prevention Analytics
Risk (PCR)
• Social Record - No Touch • Provider - Fraud
Management • Predictive & - Manage Case Management - Social
Content Analytics Innovation
- High Touch • Financial
• Personalized Management Programs
Response • Evidence-based - Assessment &
Models
• Identity & Fraud Response
Prevention Models

© 2014 IBM Corporation 6

Smarter Care and Social Programs Care Analytics

Contents

• IBM Commitment

• Integrated Eligibility

• The Solution

• Summary

© 2014 IBM Corporation 7

Smarter Care and Social Programs Care Analytics

Integrated
Eligibility

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A variety of challenges are driving the need for change in health and
social programs

Growing Pressure
High youth unemployment e.g. 58% in Spain
5% of New York high-need consume 50% of
care budget
By 2025: EU aged 50-56 will grow 20 25%...

Reform
US Affordable Care Act, Health Homes
Healthy China 2020
UK Personal Independence Payments (PIP)
Australia National Disabilities Insurance
Scheme

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How do we improve the lives of needy populations while lowering the

unsustainable growth in cost to care for them?

Slide 10, http://www.hfma.org/anihandouts/xtbce9adrpp1/A03.pdfSource: Commercial Sample – MarketScan

Commercial claims data; Medicare Sample – Medicare 5% sample.

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Super-utilizers

Face an array of complex social challenges

joblessness, homelessness, substance abuse,
etc.

50%
Of Cost

5%
Of Clients

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Governments need new approaches to address emerging social trends

and issues

Business Megatrends Requirements

Coordination
• One-size-fits-all social programs no longer • Differential response to target resources for
appropriate greatest impact
• Need to focus on prevention, early intervention • Predictive models to identify those most in need
• Societal changes need to be addressed with or at risk
holistic view of citizens, their benefits and • Outcomes - not outputs - focus, in both policy
services and service delivery

Foundation
• Program coverage expands to all populations, • Modern delivery systems to provide straight-
rural and urban through processing, accurate payments and
• Increasing reform of large-scale social increased efficiency
assistance, employment, disability and pension • Dynamic programs to implement new policies
programs rapidly
• Restructured financial models needed for • Shared and integrated service delivery models
longer-term economic vitality and new sources across government, cities and non-government
of funding sector to improve effectiveness and lower costs
• New delivery channels need to be integrated, • Universal access models to bring together
existing delivery channels need to be modified the social ecosystem to focus on people and
their families
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Person-Centered Design Principles

Enabling the
multidisciplinary team
to be more effective
and efficient across the Understanding,
Planning and Delivery adapting and
phases responding to the
Multi-
disciplinary Citizen, environment,
the context, the
situation and the team
Adaptive

Holistic
Inclusive understanding
of the client, their social
network, and their
engagement with the
care network

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Contents

• IBM Commitment

• Integrated Eligibility

• The Solution

• Next Steps

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Product
Overview

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IBM Cúram Social Program Management Platform is the foundation

Social Programs Industry Specific

• Domain specific platform, built for core needs of social programs
organizations
• Pre-defined, best-in-class business processes supporting the complete social
care lifecycle
• Role-based user experience targeted at the needs of stakeholders

Dynamic Programs
• Business user tools for program creation and modification
• Configurable, end-to-end business processes support
• Configurability built on top of a core social application, delivering the
flexibility and adaptability required by social organizations

Platform for the Future

• Flexibility to support traditional and outcome-focused delivery
• Toolsets to support differential response
• Agility to prototype and adopt new programs and delivery models (e.g.,
conditional cash transfers, social impact bonds)

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IBM Cúram Social Program Management Platform Reference Architecture

Citizens Workers Management Providers Employers CBO, NGO

Multi-channel Phone/ Paper/ Local

Web Mobile Email Chat
Access IVR Fax Office

Single
Req.
Sign-on Presentation Citizen Portals Worker Portals Partner Portals
Management
User
Architecture
Identity Identify Assess Respond Manage Measure
& Design
Triage, Screening & Strengths & Needs
Application Eligibility & Entitlement Outcome Plans Outcome Evaluation
Applications Assessment Development
Security Environment
Personalized Response Social Context Analysis Intake & Enrollment Personal Budgets Prebuilt KPIs
System Benefit Planning and Test
Outreach Management Evidence Management Provider Management Fraud Detection
Monitoring Selection
Management
Process Social Record Management PCR Collaborative Planning Financial Management
Configuration
Life Event Management Predictions Differential Response Appeals Management

Identity Management Evidence Based Models Fraud Investigations Build

Automation
Fraud Prevention

Case Management
Security Development
and Executive Embedded Predictive Content
Analytics Dashboard
KPIs
Analytics Analytics Analytics
Lifecycle
Monitoring
Social Services Content
Information Data Model
Operational Analytical
Repository
Master Client and Provider Index

Integration SOA Foundation

v1.1

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The IBM Cúram application suite

Modular for flexibility to trends and challenges

Social Family Disability Healthcare Care

Employment Pensions
assistance services management reform management

IBM Cúram Solution Modules

Configurable with best practices and industry expertise
IBM Cúram Life IBM Cúram
IBM Cúram Child Welfare IBM Cúram VerificationApplication Modules
IBM Cúram Event Management Provider Management

IBM Cúram Social IBM Cúram

IBM Cúram Income Support IBM Cúram Appeals
Enterprise Collaboration Outcome Management

IBM Cúram Income Support IBM Cúram Business

IBM Cúram Evidence Broker IBM Cúram Universal Access
for Medical Assistance Intelligence & Analytics

IBM Cúram Social Program Management platform

Administration suite and application development platform
• Funded program management • Supervisor workspace • Evidence management
• Contribution management • Common intake • Participant management
• Financial management • Eligibility and entitlement

Business and technical services

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Smarter Care and Social Programs Care Analytics

A social program data model that supports over 50 programs

out of the box

Client-centric, multi-program data model delivers a

holistic view

Prebuilt social services data structure and

relationships support over 50 social programs out
of the box

Social program–specific data model to consistently

store and report on client and provider performance
and organizational outcomes

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Smarter Care and Social Programs Care Analytics

The IBM Cúram supports a range of social programs that assist eligible
individuals and their families during economic hardship

• Supports health and social • Helps caseworkers

programs that provide: work more effectively:
– cash payment programs  Screening eligible
– tax credits program participants to
– food assistance identify optimal programs
for their needs
– housing subsidies
 Determining benefit
– utility subsidies entitlement and eligibility
– child care  Making payments
– medical care  Managing ongoing
– and other programs changes in
circumstances that may
affect entitlement.

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Smarter Care and Social Programs Care Analytics

Role-based portal workspaces

Citizen Account Case Worker Multi-Disciplinary Provider Workspace

Workspace Team Workspace

Administrative Social Business Analyst

Workspace Program Management Workspace
Platform

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Smarter Care and Social Programs Care Analytics

Person Home Page: holistic views of the individual’s information

• Ability to update as
changes in
circumstances occur
• Access to historical
person and case data
• Ability to view person’s
cases across programs
and geographies

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Smarter Care and Social Programs Care Analytics

Ongoing Case Home Page: easy access to case status and activities,
with integrated view of legal actions, outcome plans, referrals and
placements

© 2014 IBM Corporation 23

Smarter Care and Social Programs Care Analytics

Contents

• IBM Commitment

• Integrated Eligibility

• The Solution

• Summary

© 2014 IBM Corporation 24

Smarter Care and Social Programs Care Analytics

Summary

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Smarter Care and Social Programs Care Analytics

Cross-program eligibility allows you to enter complex rules once

and then use them across programs

Business user tools for rapid updates, such as

translation of legislation and policy into eligibility and
entitlement rules

One-time capture of client information for re-use

across multi-program eligibility

Assistance unit determination based on program-

specific definitions applied to household
relationships

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Smarter Care and Social Programs Care Analytics

Commercial off-the-
shelf solution

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IBM Cúram Social Program Management incorporates the best features

of packaged solution and custom development

• Cúram is built on the premise

that all social program Custom Cúram
organizations have common
core processes that can be

Flexibility
supported out of the box

• The unique requirements of

any given organization are
satisfied by extending the base Transfer Package
application via configuration
and the integrated
development environment

Cost-effectiveness

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The IBM Cúram approach to configuration and extension promotes reuse

Agency extensions
• For subset of agency requirements not met by out of the box
configuration

Agency configurations
• Agency-specific requirements can be met without coding,
using Cúram commercial off-the-shelf (COTS) solution

IBM Cúram enterprise modules

• Solutions for agency business programs
• Enhanced by IBM Cúram COTS solution

IBM Cúram Enterprise Framework

• Application foundation: a single view of client and integrated
case management capabilities
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Smarter Care and Social Programs Care Analytics

IBM Cúram Social Program Management value proposition

Enables rapid, lower-risk implementation by leveraging prebuilt

and configurable social service elements and business processes

Empowers the business to define and deploy new programs with

configuration tools in a runtime environment

Protects current investments and provides flexibility to address

new and emerging service delivery trends

Reduces overall costs and the time needed to deploy new

programs

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Thank you.
John J. Sweeney
Sr. Product Manager
IBM Smarter Care and Social Programs
[email protected]

Jeff Mann
Strategy and Market Development
IBM Cúram Social Program Management
[email protected]

http://www-03.ibm.com/software/products/en/social-assistance-solution

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Trademarks and notes

© IBM Corporation 2015

• IBM, the IBM logo, ibm.com, and Cúram are trademarks or registered trademarks of
International Business Machines Corporation in the United States, other countries, or
both. If these and other IBM trademarked terms are marked on their first occurrence in
this information with the appropriate symbol (® or ™), these symbols indicate U.S.
registered or common law trademarks owned by IBM at the time this information was
published. Such trademarks may also be registered or common law trademarks in other
countries. A current list of IBM trademarks is available on the Web at “Copyright and
trademark information” at ibm.com/legal/copytrade.shtml.
• Other company, product, and service names may be trademarks or service marks of
others.
• References in this publication to IBM products or services do not imply that IBM intends
to make them available in all countries in which IBM operates.

© 2014 IBM Corporation 32