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© 2014 IBM Corporation

Smarter Care and Social Programs

IBM Smarter Care & Social ProgramsMonthly Partner Webcast

September 4, 2014

Michael HortatsosWorldwide Channel Leader Phone: +1-312-342-4848E-mail: [email protected]

mailto:[email protected]

© 2014 IBM Corporation 2

Smarter Care and Social Programs Care Analytics

Agenda

1. Marketing

2. Enablement

3. Smarter Care Sales Play Update



IBM Health & Social Programs Summit Update

Registration – only $375!: https://www-950.ibm.com/events/wwe/curam/curam14.nsf/Registration.xsp

https://www-950.ibm.com/events/wwe/curam/curam14.nsf/Registration.xsp



Getting To Know You Videos

GoalsDeliver a compelling, concise internal

communication to our field and management teams, includes video interview

Enable IBMers to connect and collaborate with you!

Enable

Next recording session @IBM Health & Social

Programs Summit

Reserve your spot today!



Webcast: “Smarter Care for Mental Health” September 16 – 1:00pm EDT

Registration: http://event.on24.com/eventRegistration/EventLobbyServlet?target=lobby.jsp&eventid=807051&sessionid=1&key=ADC9B14F231AA6FD9FDE3684BDAF64C7&eventuserid=102908349

http://event.on24.com/eventRegistration/EventLobbyServlet?target=lobby.jsp&eventid=807051&sessionid=1&key=ADC9B14F231AA6FD9FDE3684BDAF64C7&eventuserid=102908349

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Registration: http://www.aphsa.org/content/ism/en/events/ISM_47th_Annual_Conference.html

http://www.aphsa.org/content/ism/en/events/ISM_47th_Annual_Conference.html



It’s burning a hole in my pocket…



IBM Cúram Enablement Overview



9

Fundamentals of the IBM Cúram SPM Platform for Business Analysis

6.0.5

9D319Self-paced Virtual Class

You may be ready for:Test CUR-011

IBM Certified Associate Business Process Analyst – Cúram v6.0.5

Functional Overview of IBM Cúram Universal Access

Entry Edition v6.0.5

Classroom (1 day) $750

Optional

Business Analysts

Fundamentals of the IBM Cúram SPM Platform for Developers 6.0.5

9D32DClassroom (10 days) $7500

You may be ready for:Test CUR-010

IBM Cúram v6.0.5Application Development

Developers / Technical

Optional

Sales

Cúram Sales mastery Test Preparation

3.5 hours

Web-based

You may be ready for:

Test 00M-652

Cúram Sales Mastery Test v1

Fundamentals of the IBM Cúram SPM Platform for Developers(ADE)

6.0.5


Fundamentals of the IBM Cúram SPM Platform for Developers

(Customization) 6.0.5


Or

Start

Fundamentals of IBM Cúram Express Rules

v6.0.5

Classroom (4 days) $3000

Enablement: IBM Cúram Training Paths

Fundamentals of IBM Cúram Express Rules for

Developers v6.0.5


Fundamentals of IBM Cúram Workflow for Developers v6.0.5


Don’t forget to take advantage of “You Pass, We Pay”!



IBM Cúram Enablement Overview



Study for Sales and Technical Sales Mastery Exams Cúram Sales Mastery Technical Sales MasteryAuthorized resellers need 1 sales, 2 tech sales masteries in Smarter Cities Authorized Product Group

Sign-up for Monthly Business Partner Enablement Call Click Here for Cúram (1st Thursday of every month – 10 AM Eastern)

Review On-demand Smarter Care & Social ProgramManagement Modules 2014 SWG Sales Academy (scroll to Industry Solutions\Smart Care & Social Programs)

Take required Cúram Sales Mastery and Technical Sales Mastery

Visit and bookmark the Smarter Cities Page in PartnerWorld (access sales kits, enablement roadmap & webinar replays)

Getting Started with IBM Cúram – Sales Training & Certifications

1

2

3

4

5

http://www-03.ibm.com/certify/mastery_tests/eduM2170-652.shtml


http://www-03.ibm.com/certify/certs/58000202.shtml

https://www-950.ibm.com/events/swgeer/swgeer06.nsf/signin?openform&seminar=kwocslr9g7kh7&lang=en

https://www-304.ibm.com/partnerworld/wps/servlet/ContentHandler/pw_com_swg-sales-academy-sessions-2014


http://www-03.ibm.com/certify/certs/58000202.shtml

https://www-304.ibm.com/partnerworld/wps/servlet/ContentHandler/swg_com_sfw_bp_ibm_smarter_cities/lc=en_ALL_ZZ



Smarter Care Sales Play Update

Abha Keshava



Medical care accounts for approximately 20 percent of population health status.

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.

Example: Baltimore citizens living six miles apart, in different social conditions, can have a 20-year difference in life expectancy.

Addressing the social determinants of health has a demonstrated impact on health conditions and costs

The 30-year increase in life expectancy in the 20th century can be attributed to improved social conditions (water, safety, transportation, access to healthcare).

Genetics: 5%

Medical care:

20%

Environmental and social factors:

55%

Behavioral factors:

20%

SOURCE: Lloyd B. Minor, M.D., Johns Hopkins


Smarter Care and Social Programs Care AnalyticsSmarter Care and Social Programs

Government policy is clearly signaling a desire to improve coordination within Healthcare

‘…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

£3.8B fund for health and social care integration, June 2013

‘Part of clinical commissioning groups’ budgets – potentially worth more than £1bn – should be used to fund integration with council-run social care services’

£1B CCG top-slice to fund integration, May 2013

- Norman Lamb, Minister of State for Care and Support, Department of Health

‘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”’.

£240M Technology Fund second round, £1B total investment in IT, September 2013

- Jeremy Hunt, Health Secretary, and Beverly Bryant NHS England Director of Strategic Systems and Technology (via eHealth Insider)



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



Catalan Institute of Health reduces cost while improving patient health and satisfaction

Holistic assessmentsfor clinical and social needs of patients

Referral managementto support incoming requests and care team collaboration

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.

Individualizedcare plans based on assessments for motor and cognitive skills, social and palliative needs



South Florida Behavioral Health Network replaces information scattered over twenty databases with a holistic view of the patient

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

Risk Managementreduces probability of re-arrest for mental health patients in crisis by 30%-50%

Visibilityin near-real-time into analysis of service provider activity improves use of public funding

Individualizedinsight into patient risk factors through use of analytics



Otsuka Pharmaceutical Co., Ltd. invests in the holistic care of mental health patients – for better outcomes

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.

Collaborationbetween patients and providers for earlier intervention and personal accountability

Coordinationof services, resources and professionals for the right skills applied at the right time

Outcome-Basedof services, resources and professionals for the right skills applied at the right time



We Are Successful WhenBuyer:Intersect Healthcare and Government

Requirements: “Vulnerable populations” that need to be

identified and managedNeed 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

We Get Dinged WhenBuyer:X Pure Healthcare provider or payer with

focus on JUST clinical plansX Care plans are relatively simple, carried

out by a small group of stakeholdersRequirements:X Looking for a disease management

solutionX Clinical content and care plan is focused

strictly on clinical contentX Want prescriptive IP/ care pathways to

manage the clinical careX Multi-tenancy is a key

Some of Our Key Learnings



Three key aspects of IBM Smarter Care solution

Provide holistic,

individualized care

Collaborate for better

outcomes

Orchestrate and integrate

across care settings

• 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



Target Market Segment Plays in focus for 2014

IBM Led Plays Target Market Segment & Buyer Lead CustomerGovernment Healthcare Transformation (US)

US States approved for ACA Funding for Health Home initiative & Balanced Incentive ProgramsTarget Directors of Medicaid/MedicareRef: 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, CanadaTarget Chief Medical Officers (CMO)

Catalonia

Evidence Based Insights & Medication Adherence with GBS (WW)

Life Sciences & PharmaceuticalTarget Head of Pharma/CEO

Otsuka

Directors of Government Healthcare (e.g. Medicaid and Medicare)

Head of Research

Chief Medical Officer (CMO), Hospital Executives

IBM Confidential



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-Technical-Assistance/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

http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Approved-Health-Home-State-Plan-Amendments.html




Funding Model Target Population Program Buyer

Health Homes

90/10 match29 States so far

Persons with Two chronic conditionsOne chronic condition and risk for secondSerious and persistent mental health condition

Medicaid • State, Local Government

• Commercial Payers• Providers

BIP (Balancing Incentive Program)

$3 billion16 States so far

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)

CMMI State Innovation Grants

25 States so far$300 million

Broad based with focus on people enrolled in •Medicare•Medicaid •Children’s Health Insurance Program (CHIP). Mental illness

Medicare, Medicaid, CHIP

• States, Local Governments

Funding Model Overview



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/Approved-Health-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?






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?



Other Helpful LinksWhere 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)

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Long-Term-Services-and-Supports.html

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Balancing/Balancing-Incentive-Program.html

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Balancing/Balancing-Long-Term-Services-and-Supports.html

http://kff.org/medicaid/

http://www.chcs.org/focus_area/integrated-care-for-people-with-complex-needs-medicaid-medicare-enrollees/

http://longtermcare.gov/medicare-medicaid-more/medicaid/



Other Helpful LinksWhere 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

http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Long-Term-Services-and-Supports/Integrating-Care/Health-Homes/Health-Homes.html

http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Health-Home-Information-Resource-Center.html


http://www.medicaid.gov/State-Resource-Center/Medicaid-State-Technical-Assistance/Health-Homes-Technical-Assistance/Guide-to-Health-Homes-Design-and-Implementation.html

http://www.chcs.org/?s=health+homes

http://www.integration.samhsa.gov/integrated-care-models/health-homes



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

Client Identification Care Planning & Delivery

Buy

erP

ain

Poi

nts

Sol

utio

n

• 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?

• 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

• Prediction of at-risk candidates • Recommended interventions derived from

analysis of similar case situations• Pre-built reports for measuring program

efficacy



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



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



Cúram Info on PartnerWorld

• Cúram Sales Kits (on main Smarter Cities page - scroll down to Sales Kits section): https://www-304.ibm.com/partnerworld/wps/servlet/ContentHandler/swg_com_sfw_bp_ibm_smarter_cities/lc=en_ALL_ZZ

• Monthly Cúram Partner Webcasts: https://www-304.ibm.com/partnerworld/wps/servlet/ContentHandler/swg_com_sfw_smarter-cities-business-partner-enablement-curam



https://www-304.ibm.com/partnerworld/wps/servlet/ContentHandler/swg_com_sfw_smarter-cities-business-partner-enablement-curam

https://www-304.ibm.com/partnerworld/wps/servlet/ContentHandler/swg_com_sfw_smarter-cities-business-partner-enablement-curam



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