Leveraging IT to deliver better social outcomes

Martin Duggan – Director, IBM Cúram Research Institute

Intake &

Enrollment

Referral

Inte

grat

ed

Serv

ice

Del

iver

y

OutcomePlan

Universal Access

Social Program Case Management

Outcome Management

SOCIAL and ECONOMIC POTENTIAL

CARE andPROTECTION

Benefit Planning & selection

Screening & Application

Life Event Management

Needs-Based Triage

Financial Management

Provider Management

Participant Management

Evidence Management

Eligibility & Entitlement

Finance

Shelter

Safety

Education

Food

Health

Disability & Workers’ Comp.

Public HealthInsurance

Family Services

Social Assistance

Pensions

Employment

Outcome Identification

Service Provisioning

Outcome Planning

Outcome Evaluation

Non-GovernmentOrganizations (NGO)

Government Agencies

Providers

Client

Life Events

Needs

Non-Government Organizations CBOs & Service Providers

Government AgenciesNeeds to Outcomes™Maximizing the social & economic return on investment

Intake &

Enrollment

Universal Access

Social Program Case Management

Outcome Management

Screening & Application

Life Event Management

Financial Management

Provider Management

Participant Management

Evidence Management

Eligibility & Entitlement

Finance

Employment

Non-GovernmentOrganizations (NGO)

Government Agencies

Providers

Client

Life Events

Needs

Government Agencies

Single Agency Model

Payment

Social Program Management Systems follow a common process to deliver benefits and services to meet needs and outcomes

Identify

Assess

RespondManage

Measure

Identify target client(s) through stated needs or predictive analysis. Verify client identity and provide secure access to information about benefits and services and targeted recommendations. Assess priority, complexity and risk

through evidence-based models and a clear understanding of social context and client strength and needs. Identify optimal client outcomes and key performance indicators for measuring client success.

Determine eligibility and entitlement. Determine appropriate response and identify qualified, effective providers who can deliver benefits and services.

Create and manage the client’s outcome plan, provision services and deliver appropriate response. Configure, calculate and manage delivery of financial payments.

Measure client, agency, provider and program success based on key performance indicators. Use statistical analysis to predict future needs and to prevent fraud.

IBM Social Program Universal Service Delivery Model

IBM Social Programs Reference Architecture

IBM Social Programs Reference Architecture Software Components

Cúram has invested heavily in an updatable data model

Personalization and Outreach

Case Worker Workspace

Cúram enables automation from triage to delivery, including automatic change-in-circumstance processing

12

Accurate

Eliminates manual change tracking and impact

Eligibility and Entitlement Processing–Automatically detect and process ongoing benefits in response to changes in circumstances, life events, rates and rules

Eligibility and Entitlement

Evidence Rules Rates

$5 $5 $20 $15 $25

Prebuilt integration with evidence, rates, and rules

Prebuilt Financial Processing to issue payment schedule changes

Automatic calculation of change timelines

Processes multiple evidence rules and rate changes

Key Features

Business Value

Timely detection of changes

Full traceability

Accurate calculations over multiple pay periods with multiple changes

Retroactive Change Handling–Out of the box calculation of under and overpayments in response to retroactive changes

$50 $80 $80

Today

$65 $70 $70

Income Expense

$15 $10

$5

Financial Processing

$5

Automatically detects retroactive changes and initiates reassessment

Consolidates changes over the reassessment period

Issues advice for underpaid amount

Key Features

Business Value

Outcome Management Key Features

Configurable Framework to Define Assessments Graphical Assessment Results

Graphical Workspace to Develop Client Plan

On-Going Graphical tracking of client progress

Examples of Cúram Clients and projects

• New Zealand Ministry of Social Development – implementing benefits for work, students and seniors

• UK Department of Work and Pensions – implementing the disability system to focus on ability not disability

• US States of Indiana, Louisiana, North Carolina, Utah – integrated eligibility for welfare, food stamps and medical care

• US State of California – Workers’ Compensation Appeals• Catalonia Department of Health in Spain – integrating health and social care to reduce costs for

chronic illness patients• New York City in New York State – universal access and benefits & services for children,

immigrants and low income residents• Province of Ontario in Canada – social assistance benefits, disability services, children at risk and

work supports• Province of Alberta in Canada – social assistance benefits, children and risk• Province of British Columbia – Workers’ Compensation benefits• Various US States – Affordable Care act