IBM Cúram Solution for Disability Management

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Presentation transcript:

IBM Cúram Solution for Disability Management April 14, 2015 Dr. Hector Upegui, MD

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

Disability is a significant issue worldwide that needs to be addressed 190 m. 13 m. > 1 billion The world’s population which is estimated to live with some form of disability Number of people who have very significant difficulties in functioning Number of people with severe disabilities who are children between 0-14 7% >15% 2-4% Percentage of the world’s population based on 2010 global population figures Percentage of people with disabilities and have very significant difficulties in functioning Percentage of all people with severe disabilities who are children between 0-14 years 3

Strategies Trends Addressing the challenges New focus on prevention Shift from assessing disability to focus on ability More and better qualification of human resources More information & communication Improved social protection and program management Return-to-work programs Pooling efforts across social programs - more coordination Segmenting Predicting Automating Armed conflicts and violence Demographic changes Chronic diseases Behavioral changes Shift of traditional to non-traditional risks (for example from asbestos to psychological risks) Technological changes Demands for economic and social equality 4 4

Structure of Disability Management Programs The impact of risk factors on disabilities: Support approaches: 10% road traffic risks 17% occupational risks 73% daily life 17% born 56% acquired Support for people with disabilities Disability Insurance Workers Compensation Insurance Source: IBM Cúram Research Institute based on GBD data-2004 –Years lost to disability (YLD)

Types of services and objectives of Disability Management Programs Prevention Health Care Support Cash Vocational rehabilitation Professional rehabilititation Support for people with disabilities Social Inclusion Return-to- Work Disability Insurance Workers Compensation Insurance Economic sustainability (efficiency and efficacy)

Social Programs Industry Specific IBM Cúram Social Program Management Platform is the foundation for the IBM Cúram Disability Management Solution 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 Social Industry Specific Domain Specific Platform, built to address the core needs of Social Organizations Pre-defined, best-in-class business processes supporting the complete social 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) 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) 7

Common Features for Disability Management Universal Access and Life Events – Direct Online Access for Client to file disability claim or apply for disability benefits and manage updates Social Program Management Platform – Platform for Case Management – Allows for management of disability case Benefits/Claims –SPMP plus Verification and Evidence – File for Worker’s Compensation Insurance or Disability Benefits/Insurance Appeals – Appeal Decisions, Hearings Outcome Management/Social Enterprise Collaboration/Provider Management – Outcome Planning/MDT’s – Return to Work, Rehabilitation, Social Inclusion Analytics –Opportunity to utilize various options for analytics and predictive 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 Low risk: Pre-built and configurable Empowers business: Define new programs thru configuration tools Protect investment: Platform for the future—address new and emerging delivery trends Reduces overall costs and the time needed to deploy new programs 9

A government agency in Asia-Pacific implements Cúram software to improve information and reporting systems and deliver higher quality services for individuals with disabilities Accessible provides a single point of access to programs and services Automated expedites eligibility determination, the issuance of benefits and the subsequent closing of cases Business Challenge:. A state government agency in Asia Pacific provides services and supports for nearly 18,500 disabled people and their families. The department launched a transformation project aimed at improving service levels and ensuring more effective funding. The existing information system could not automatically share information across the department’s 130 sites, which made it difficult for staff members to serve clients. Clients were required to fill out multiple applications and undergo multiple assessments to determine eligibility across programs. Matching individual needs with available services was difficult without real-time information and automated rules-based processes. The Solution: The organization implemented IBM Cúram software to establish a more transparent, easier-to-access business-information system that will help facilitate higher quality services for people with disabilities. For individuals, the solution provides a single point of contact for personalized and simplified intake. The Cúram rule sets help to apply standardized eligibility and decisions for individuals across the state. For suppliers, the solution offers a comprehensive, easy-to-use server catalog and more efficient payment administration. It provides the department with more equitable use of its available funding, improved information and reporting systems and a better overall capacity to plan and prioritize. Integrated multiple sources of information are used to match individuals to the right services and programs based on their actual needs Solution components IBM Cúram Social Program Management Platform IBM Cúram Financial Management IBM Cúram Provider Management  10

A Canadian government agency responsible for administering social services and disability support programs implements IBM Cúram to create a more fair, accessible, and sustainable system of care Needs Focused Fiscal management and controls allow fund allocation based on needs and priorities Accuracy Improved the accuracy of eligibility determinations Low Risk Flexible modularity and simple integration with existing systems reduces risk, cost, and time associated with large technology investments Business Challenge: A complex and fragmented system of government and independent agencies provided access to services in this Canadian province. Over time, the complex nature of the system resulted in inequitable and inefficient service delivery. Many different paper-based processes and dozens of disparate IT applications were used to evaluate each citizen’s needs, identify available services, request funding and recommend placement. The ministry also experienced difficulty measuring the demand for services, resulting in ineffective planning for funding requirements. The Solution: By implementing a suite of IBM Cúram software, the ministry streamlined its business processes including a standard application and assessment process that ensures people’s needs are assessed consistently. Clear eligibility criteria for accessing services allow the ministry to make more consistent eligibility decisions, helping to reduce errors and possible fraud. In addition, individual support plans, service profiles and active case management through system automation enable better outcomes for citizens while stronger fiscal management and control allows funds to be allocated based on assessed needs and priorities. Solution components IBM Cúram Appeals IBM Cúram Evidence Broker IBM Cúram Provider Management IBM Cúram Social Program Management Platform IBM Cúram Verification Engine IBM Cúram Business Intelligence and Analytics IBM Cúram Social Enterprise Collaboration 11

For additional information: Thank you. For additional information: www-03.ibm.com/software/products/en/disability-management hector.upegui@de.ibm.com Linkedin: http://www.linkedin.com/pub/dr-hector-upegui-md Twitter: @upegui_hector

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