Smarter Care and Social Programs
IBM Smarter Care & Social Programs
Monthly Partner Webcast
September 4, 2014
Michael Hortatsos
Worldwide Channel Leader
Phone: +1-312-342-4848
E-mail: michael.hortatsos@us.ibm.com
© 2014 IBM Corporation
Smarter Care and Social Programs Care Analytics
Agenda
1. Marketing
2. Enablement
3. Smarter Care Sales Play Update
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IBM Health & Social Programs Summit Update
Registration – only $375!: https://www-950.ibm.com/events/wwe/curam/curam14.nsf/Registration.xsp
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Getting To Know You Videos
Goals
Enable
Deliver a compelling, concise internal
communication to our field and management
teams, includes video interview
Enable IBMers to connect and collaborate
with you!
© 2014 IBM Corporation
Next recording session @
IBM Health & Social
Programs Summit
Reserve your spot today!
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Webcast: “Smarter Care for Mental Health” September 16 – 1:00pm EDT
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Registration:
http://event.on24.com/eventRegistration/EventLobbyServlet?target=lobby.jsp&eventid=807051
&sessionid=1&key=ADC9B14F231AA6FD9FDE3684BDAF64C7&eventuserid=102908349
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© 2014 IBM Corporation
Registration: http://www.aphsa.org/content/ism/en/events/ISM_47th_Annual_Conference.html
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It’s burning a hole in my pocket…
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IBM Cúram Enablement Overview
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Smarter Care and Social Programs Care Analytics
Enablement: IBM Cúram Training Paths
Sales
Business Analysts
Developers / Technical
Cúram Sales mastery
Test Preparation
3.5 hours
Fundamentals of the IBM Cúram
SPM Platform for Business Analysis
6.0.5
Start
Or
Web-based
Fundamentals of the IBM Cúram
SPM Platform for Developers(ADE)
6.0.5
9D319
Self-paced Virtual Class
Fundamentals of the IBM Cúram
SPM Platform for Developers 6.0.5
You may be ready
for:
Test 00M-652
You may be ready for:
Test CUR-011
Cúram Sales Mastery
Test v1
IBM Certified Associate Business
Process Analyst – Cúram v6.0.5
9D32D
Classroom (10 days)
$7500
Optional
Fundamentals of IBM
Cúram Express Rules
v6.0.5
Classroom (4 days)
$3000
Fundamentals of the IBM Cúram
SPM Platform for Developers
(Customization) 6.0.5
9D419
Self-paced Virtual Class
Functional Overview of IBM
Cúram Universal Access
Entry Edition v6.0.5
Classroom (1 day)
9D409
Self-paced Virtual Class
Optional
$750
You may be ready for:
Test CUR-010
Don’t forget to take
9
advantage
of “You Pass, We Pay”!
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IBM Cúram v6.0.5
Application Development
Fundamentals of IBM
Cúram Express Rules for
Developers v6.0.5
Classroom (5 days)
$3750
Fundamentals of IBM
Cúram Workflow for
Developers v6.0.5
Classroom (4 days)
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$3000
Smarter Care and Social Programs Care Analytics
IBM Cúram Enablement Overview
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Smarter Care and Social Programs Care Analytics
Getting Started with IBM Cúram – Sales Training & Certifications
1
Sign-up for Monthly Business Partner Enablement Call
2
Visit and bookmark the Smarter Cities Page in
PartnerWorld (access sales kits, enablement roadmap & webinar replays)
3
Study for Sales and Technical Sales Mastery Exams
4
Take required Cúram Sales Mastery and Technical
Sales Mastery
5
Review On-demand Smarter Care & Social Program
Management Modules
© 2014 IBM Corporation
Click Here for Cúram (1st Thursday of every month – 10 AM Eastern)
Cúram Sales Mastery
Technical Sales Mastery
Authorized resellers need 1 sales, 2 tech sales masteries in Smarter Cities
Authorized Product Group
2014 SWG Sales Academy (scroll to Industry Solutions\Smart Care & Social Programs)
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Smarter Care Sales Play Update
Abha Keshava
© 2014 IBM Corporation
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Smarter Care and Social Programs Care Analytics
Addressing the social determinants of health has a
demonstrated impact on health conditions and costs
Genetics: 5%
Behavioral
factors:
20%
Medical
care:
The 30-year increase in life expectancy in
the 20th century can be attributed to
improved social conditions (water, safety,
20%
transportation, access to healthcare).
Environmental
and social factors:
55%
Medical care accounts for approximately
20 percent of population health status.
Example: Baltimore citizens
living six miles apart, in
different social conditions,
can have a 20-year
difference in life expectancy.
SOURCE: Lloyd B. Minor, M.D., Johns Hopkins
Environmental and social factors
account for approximately 55 percent.
SOURCE: Barbara J. Sowada, A Call to Be Whole: The Fundamentals
of Health Care Reform, July 30, 2003, Praeger.
© 2014 IBM Corporation
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Smarter Care and Social Programs Care Analytics
Government policy is clearly signaling a desire to
improve coordination within Healthcare
£3.8B fund for health and social care integration, June 2013
‘…the announcement of £3.8 billion worth of funding to ensure closer integration between health
and social care was a real positive. The funding is described as “A single pooled budget for
health and social care services to work more closely together in local areas, based on a plan
agreed between the NHS and local authorities”. We are calling this money the health and social
care Integration Transformation Fund (ITF).’
- Bill McCarthy, NHS England Director of Policy, and
Carolyn Downs, Chief Executive, Local Government Association
£240M Technology Fund second round, £1B total investment in IT, September 2013
‘Health secretary Jeremy Hunt has announced another £240m for the technology fund, in a move
that will see the government and NHS organisations invest £1 billion in IT over the next three
years. Beverly Bryant, NHS England director of strategic systems and technology said “…we’re
also keen to push on integration between health and social care and across health economies”’.
- Jeremy Hunt, Health Secretary, and Beverly Bryant NHS England Director of
Strategic Systems and Technology (via eHealth Insider)
£1B CCG top-slice to fund integration, May 2013
‘Part of clinical commissioning groups’ budgets – potentially worth more than £1bn – should be
used to fund integration with council-run social care services’
- Norman Lamb, Minister of State for Care and Support, Department of Health
© 2014 IBM Corporation
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Smarter Care and Social Programs Care Analytics
Multiple Funding Sources Available in US
• CMS Waivers
–
–
Medicaid – State Specific Innovation Initiatives, eg NYS $9B, all states
Elderly, Disabled, Seriously Mentally Ill, Homeless, Adult & Juvenile Offenders, Foster Kids, Chronically Ill, Hi Risk
Kids, Addiction, Pregnant Teen Moms, etc
• Health Homes & Coordinated Care Organizations
–
–
Medicaid - High Cost, 2+ Chronic Conditions, 30+ state, eg WA, MO, IA
Elderly, Disabled, Mentally Ill, Elderly, Disabled, Seriously Mentally Ill, Homeless, Adult & Juvenile Offenders, Foster
Kids, Chronically Ill
• Dual Eligibles –Elderly and Disabled
–
–
Medicaid & Medicare - High Cost, 30-40% of spend in each program, – 28 states
Elderly, Disabled, Mentally Ill – 28+ states
• State Innovation Grants – New Models of Care
–
–
Medicaid & Medicare & Commercial Payers – all populations, 24 states in planning, pilot, implementation phases
Implementation: AK ($42M), MN ($45M), VT ($45M) OR ($45M), MA $44M), ME ($33M)
• Balanced Incentive Program (LTC)
–
–
Medicaid – NWD, Univ Assess, Integrated Case Mgmt & focus on community-based care, 19 states
Elderly, Disabled, Mentally Ill
• Money Follows the Person (LTC)
–
–
Medicaid – Keep clients in their home, 45 states
Elderly, Disabled, Mentally Ill
• DSH - NFP Hospitals
–
Uninsured, e.g. SC HOP program, all states
• Accountable Care Organizations, All Payers, Transitions in Care
© 2014 IBM Corporation
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Smarter Care and Social Programs Care Analytics
Catalan Institute of Health reduces cost while improving
patient health and satisfaction
Holistic assessments
for clinical and social needs of
patients
Referral management
to support incoming requests
and care team collaboration
Individualized
care plans based on
assessments for motor and
cognitive skills, social and
palliative needs
© 2014 IBM Corporation
Business problem: With the rise in chronic disease in an ageing population consuming
more and more of healthcare resources, Catalan Institute of Health (ICS), a major health
provider in Catalonia, Spain is developing a new target program for Complex Chronic
Disease Management with the objectives to improve adherence in care programs,
improve patient quality of life and to improve satisfaction with the healthcare system and
reduce costs. They needed a system that can provide a holistic view of the patient,
creating an individualized care plan to support care delivery in home settings,
reassessments, referrals and collaboration across key resources.
Solution: Deploy a program for coordinated care planning and delivery using the IBM
Cúram solution to provide a complete view of the patient for care delivery and
collaboration across clinicians and social workers. A “Software as a Service” model was
enabled by IBM business partner Iteria. Iteria purchased the licenses from IBM and
offered the solution on a cloud that allows the customer to pay for it on a subscription
basis.
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Smarter Care and Social Programs Care Analytics
South Florida Behavioral Health Network replaces information
scattered over twenty databases with a holistic view of the patient
Risk Management
reduces probability of re-arrest for
mental health patients in crisis by
30%-50%
Visibility
in near-real-time into analysis
of service provider activity
improves use of public funding
Individualized
Business problem: South Florida Behavioral Health Network, Inc., a mental health
services provider network in Florida needed a coordinated care and healthcare analytics
solution, thereby gaining the ability to offer consistent, patient-centric mental
healthcare services and predict preventable mental health crises to help reduce
hospitalizations and incarcerations.
Solution: IBM and business partner Otsuka Pharmaceutical Co., Ltd. provided a solution
that supports coordinated care management and healthcare analytics to help deliver
more consistent, harmonized patient care throughout its provider network
insight into patient risk factors
through use of analytics
© 2014 IBM Corporation
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Smarter Care and Social Programs Care Analytics
Otsuka Pharmaceutical Co., Ltd. invests in the holistic
care of mental health patients – for better outcomes
Collaboration
between patients and providers for
earlier intervention and personal
accountability
Coordination
of services, resources and
professionals for the right skills
applied at the right time
OutcomeBased
of services, resources and
professionals for the right skills
applied at the right time
© 2014 IBM Corporation
Business problem: Pharmaceutical companies must demonstrate the efficacy of
their medications to improve the well-being of end-consumers. Otsuka
Pharmaceutical Co., Ltd. recognized that mental health patients need more
support than they typically get if they are to lead productive lives. Proper
medication management is critical, but for sustainable results, treatment may
require broader support from physicians, educators, occupational therapists, home
care agencies or other service providers.
Solution: an outcomes-based care management system designed by health and
social programs professionals. It embeds a wealth of industry-specific expertise
that ensures holistic assessment of patient needs. Personalized care plans are
made easy to design, manage and monitor. Providers and the individuals they
treat can now more closely manage medication and other treatment activities
collaboratively – real time and online, for better results.
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Smarter Care and Social Programs Care Analytics
Some of Our Key Learnings
We Are Successful When
We Get Dinged When
Buyer:
Intersect Healthcare and Government
Requirements:
“Vulnerable populations” that need to be
identified and managed
Need a platform for coordinating care
across a large/varied group of
stakeholders
Look to embed social elements of the care
management i.e. it is not just a clinical
plan
“OK” with an on-premise or hosted
solution
Offering:
Combination of Cúram platform to manage
care and leverage of analytics for
differentiation
Buyer:
X Pure Healthcare provider or payer with
focus on JUST clinical plans
X Care plans are relatively simple, carried
out by a small group of stakeholders
Requirements:
X Looking for a disease management
solution
X Clinical content and care plan is focused
strictly on clinical content
X Want prescriptive IP/ care pathways to
manage the clinical care
X Multi-tenancy is a key
© 2014 IBM Corporation
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Smarter Care and Social Programs Care Analytics
Three key aspects of IBM Smarter Care solution
Provide
holistic,
individualized
care
Collaborate
for better
outcomes
Orchestrate
and integrate
across care
settings
© 2014 IBM Corporation
• Use predictive analytics and assessments across social, clinical and behavioral
indicators to identify ‘at risk’ individuals
• Inform care plans through analytics and assessment results allowing for the use
of evidence based approaches and differentiated care processes
• Leverage cohort analysis to allow for treatment comparisons, physician matching
and utilization analysis
• Collaborate across diverse stakeholders efficiently coordinating care, locating and
referring care providers and optimizing resources
• Parse unstructured data uncovering hidden insights in care
• Empower and engage patients and family caregivers in the care process
• Automate and orchestrate processes across organizations to better align care
delivery with organizational goals and governance models
• Integrate source systems bi-directionally using best practices and industry
standards, including HL7 and IHE
• Unify and synchronize fragmented information from social, clinical and behavioral
systems to create a single patient view and plan
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Smarter Care and Social Programs Care Analytics
Target Market Segment Plays in focus for 2014
Head of Research
Directors of
Government
Healthcare (e.g.
Medicaid and
Medicare)
IBM Led Plays
Target Market Segment & Buyer
Lead Customer
Government Healthcare
Transformation (US)
US States approved for ACA Funding for Health
Home initiative & Balanced Incentive Programs
Target Directors of Medicaid/Medicare
Ref: Cúram incumbencies in 14 US States
New York State Health
Homes
Vulnerable Populations
facing multiple Chronic
conditions (WW)
Government Healthcare Programs - UKI, SPIGI,
Nordics, DACH, SSA, China, Canada
Target Chief Medical Officers (CMO)
Catalonia
Evidence Based Insights &
Medication Adherence with
GBS (WW)
Life Sciences & Pharmaceutical
Target Head of Pharma/CEO
Otsuka
Chief Medical
Officer (CMO),
Hospital
Executives
© 2014 IBM Corporation
IBM Confidential
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Smarter Care and Social Programs Care Analytics
Opportunity Identification Checklist for GHT Play
GHT play is focused on states that are using one or more CMS funding streams to drive
health care transformation in their state (funding examples can be seen on the following
slide)
Target Medicaid Directors of states with pending or active SPAs (20 approved so far) for
Health Homes that have no technology solution in place
– New states are being added monthly and submitted SPAs can be found at:
http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-TechnicalAssistance/Approved-Health-Home-State-Plan-Amendments.html
Target states with approved BIP applications, prioritizing those who have structural
change work plans in place (list in backup slide 8). Buyers are Medicaid agencies
supported by Ageing agencies, Mental Health agencies and Disability agencies. BIP is a
key funding source for LTSS – there are other funding sources too. In general states
focused on reforming LTSS should be the target
Target states that are availing State Innovation Grants which are like an umbrella grant
potentially including Health Homes, PCMH, long term support services and broader care
coordination. States can use waivers to combine various funding streams
© 2014 IBM Corporation
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Smarter Care and Social Programs Care Analytics
Funding Model Overview
Funding Model Target Population
Program
Buyer
Health Homes
Persons with
Two chronic conditions
One chronic condition and risk for second
Serious and persistent mental health
condition
Medicaid
• State, Local
Government
• Commercial Payers
• Providers
Elderly and Individuals with
•Mental illness
•Developmental disability
•Physical disability (such as traumatic brain
injury)
•Other conditions that warrant LTSS like
Alzheimer’s
Medicaid, Dual
Eligibles
• State Government
• MCO (maybe)
Broad based with focus on people enrolled in
•Medicare
•Medicaid
•Children’s Health Insurance Program (CHIP).
Mental illness
Medicare,
Medicaid, CHIP
• States, Local
Governments
90/10 match
29 States so far
BIP (Balancing
Incentive Program)
$3 billion
16 States so far
CMMI State
Innovation Grants
25 States so far
$300 million
© 2014 IBM Corporation
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Smarter Care and Social Programs Care Analytics
How do I know if the States in my territory have funding
• There are multiple funding streams  to understand funding status – go the below
link:
http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/ApprovedHealth-Home-State-Plan-Amendments.html
• And answer the following questions:
– Has the state submitted a State Plan Amendment (SPA) for Health Home grant?
– If the state does have one or more SPA(s) for Health Homes, what type of populations are
they serving?
– What stage is the SPA in?
– Is IT transformation part of the plan?
– What is the state’s plan for coordinating care across medical and behavioral?
• Additionally has the state submitted a BIP application? Has it been approved? Are
they working on a “structural change work plan”? Is IT transformation part of the plan?
• Has the state applied or planning to apply for State Innovation Grant? What stage are
they in? Is IT transformation part of the plan?
© 2014 IBM Corporation
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Smarter Care and Social Programs Care Analytics
How do I know if there is good fit?
• Ideal targets are:
– Medicaid Directors of states with pending or active SPAs for Health Homes that have no
technology solution in place
– Also target states with approved BIP applications, prioritizing those who have structural change
work plans in place. Buyers are Medicaid agencies supported by Ageing agencies, Mental Health
agencies and Disability agencies.
– And target states that are availing State Innovation Grants which are like an umbrella grant
potentially including Health Homes, PCMH, long term support services and broader care
coordination
• Does the state out source the care to one or more Managed Care Organizations
(MCO)?
– Which Medicaid populations are covered by MCOs (e.g. PCP care, LTSS, Dual Eligibles,
Behavioral Health)?
– How many MCOs are there in the state? Who will be getting the CMS funds?
– Does the contract with the MCO follow a “capitated model” or FFS model?
– Is the Managed Care Program required to have a care coordination model?
– Is the Managed Care Program required to include coordination of behavioral health services?
© 2014 IBM Corporation
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Smarter Care and Social Programs Care Analytics
Other Helpful Links
Where to find information for Long Term Services and Supports
• For CMS info on LTSS including BIP:
– CMS info on all LTSS can be found here
– BIP Applications and Structural Change Workplans are found here
– CMS info for all Balancing programs are found here. Balancing efforts seek to
increase the percentage of Home and Community Based Services (HCBS) as
compared to institutional care. BIP applications often will state all of the states
balancing efforts as well as the agencies involved in those efforts.
• Other sources of info for state efforts regarding LTSS & HCBS:
– Kaiser Family Foundation – search on LTSS and HCBS for stats by state and white
papers
– Center for Healthcare Strategies - A nonprofit health policy resource center dedicated
to advancing access, quality, and cost effectiveness in publicly financed health care
– Long Term Care.gov (US Dept. HHS)
© 2014 IBM Corporation
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Smarter Care and Social Programs Care Analytics
Other Helpful Links
Where to find information on Health Home initiatives
•For CMS info on Health Homes
– Home page
– Health Home Information Resource Center page
– Approved Health Home State Plan Amendments are found here
– Health Home Design guides
•Other sources of info for state efforts regarding Health Homes
– Center for Healthcare Strategies
– SAMHSA – Health Homes for Behavioral Care
© 2014 IBM Corporation
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Smarter Care and Social Programs Care Analytics
Buyer
Elder Care Chronic Disease Management
• Primary: Government Health & Human Services Commissioners
• Secondary: MCO’s implementing solutions on behalf of large governments & Large Payors capable of
implementing a program to support the complex needs of high cost, high need chronic disease clients
Pain Points
Client Identification
•How do I make sense of my claims data to identify
high cost clients?
•How can I predict future at risk candidates?
•How do I reveal opportunities to reduce cost and
improve care?
•How do I create required reports on the efficacy of
interventions and report on those results for
reimbursement?
Solution
•
•
•
Prediction of at-risk candidates
Recommended interventions derived from
analysis of similar case situations
Pre-built reports for measuring program efficacy
© 2014 IBM Corporation
Care Planning & Delivery
•
•
•
•
How do I augment my clinical understanding
with Social and Behavioral context in a single
plan?
How do I know what activities are suitable for an
individual’s care plan?
How do I enhance the communication across
care team members out in the field?
How do I quickly understand and respond to a
patients changing needs?
• Assessment and planning framework supporting
clinical, social, behavioral dimensions of health in
partnership with leading assessment providers
• Rules driven care pathways based on industry
standards
• Mobile Care Delivery leveraging open data to
enhance the experience of care providers
• Patient and care giver mobile support and
scheduling based on planned and unforeseen
invents
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Smarter Care and Social Programs Care Analytics
Opportunity Identification Checklist – Elder Care
Target should be at the intersection of social and health. Ideal target organization is
looking to provide care for the elderly/ageing population by addressing their needs across
all determinants of health (clinical, social and behavioral)
Complex coordination is a necessity
– complex needs that require care by providers
across disciplines, acting as a team
Population over 60 > 20% (or trending fast towards it) and they consume about 70% of
resources. (Eg. by 2020, Americas will have 200 million older adults, almost twice the
number in 2006, and more than half of them will be living in Latin America & Caribbean)
Chronic diseases that now account for 75 percent of global health care spend are also
responsible for 7 out of 10 deaths among people aged 70 and older
Elder Care is a top down initiative – a
mandate, legal requirement or policy restructuring
that clearly makes outcome-focused care of elderly/ageing population an imperative
Serious budget issues are forcing transformation. Changing demographics of increasing
elderly proportion of population are putting unsustainable pressure on budgets
We should prioritize targets where we have existing client relationships through GBS or
S&D, as well as via business partners. A key factor for our win in Catalonia was the GBS
relationship
© 2014 IBM Corporation
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Smarter Care and Social Programs Care Analytics
Opportunity Identification Checklist – Chronic Disease Management
Target should be at the intersection of social and health. Ideal target organization is
looking to provide care for citizens with chronic disease(s) by addressing their needs
across all determinants of health (clinical, social and behavioral)
Complex coordination is a necessity – complex needs that require care by providers
across disciplines, acting as a team.
Chronic disease rates and associated costs are rising and they consume about 75%
of health care resources
Preventable hospitalization is a focus area: >15% of hospitalization is due to chronic
diseases and is preventable
Chronic illnesses are a leading causes of death and illness accounting for > 65 percent of
deaths and 60 percent of disability-adjusted life years
Lost economic production is a concern - a study of 23 low and middle income countries
estimates that US$85 billion of economic production will be lost from heart disease, stroke
and diabetes between 2006 and 2015 (IADB report)
Serious budget issues are forcing transformation. Changing demographics of rising
rates of chronic disease are putting unsustainable pressure on budgets. Eg, chronic care
cost in Brazil is estimated to rise from 20 billion rial in 2008 to 45 billion rial in 2050
Chronic Care is a top down initiative – a
mandate, legal requirement or policy
restructuring that clearly makes outcome-focused care of people with multiple chronic
diseases an imperative
© 2014 IBM Corporation
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Cúram Info on PartnerWorld
• Cúram Sales Kits (on main Smarter Cities page - scroll down to Sales Kits
section): https://www304.ibm.com/partnerworld/wps/servlet/ContentHandler/swg_com_sfw_bp_ibm_
smarter_cities/lc=en_ALL_ZZ
• Monthly Cúram Partner Webcasts: https://www304.ibm.com/partnerworld/wps/servlet/ContentHandler/swg_com_sfw_smartercities-business-partner-enablement-curam
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Thank you
© 2014 IBM Corporation
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