IBM World of Watson: Applying IBM Predictive Analytics to IBM Case Manager

Applying IBM Predictive Analytics to IBM Case Manager to Create Cognitive Solutions ECM-1794Brian Benoit, Manager, Solution ConsultantsMichael Song, Senior Systems EngineerKevin Knill, Director Product Development10/24/2016

• Traditional Case Solutions

• Cognitive Case Solution

• Using Watson with Case

• APS: an Example2 11/2/16World of Watson 2016

3

Capability Maturity Model

11/2/16World of Watson 2016

Same Organized Processes

No OrganizedProcesses

Most Processes Organized

Processes Are Managed

Processes Continuously

Improved

Software Engineering Institute (SEI) @ Carnegie Mellon University. Initiated by US Dept. of Defense

Processes are Improved at the Work Group or Departmental Level

Processes are Organized and Redesigned at the Enterprise Level

Processes are Measured and Managed Systematically

Processes Teams Continuously Improve Processes

The Capability Maturity Model Guidelines for Improving the Software Process by Mark Paulk, Charles Weber, Bill Curtis, Mary Beth Chrisses, et al. 1995 Cultures of HeroesLevel 1

Level 5

Level 4

Level 3

Level 2

11/2/164

IBM Case Manager

World of Watson 2016

Information Work

OutcomesAgility

Make Better Decisions

Support the Way People

Work

Take ControlOptimize

Case Outcomes

5

A Case Structure


The Case, Documents & Associated Cases

Automatic & ManuallyInitiated Tasks

Application

Setup/Registration

Agent Request

Processing

OFAC ReviewAgent Review

Issue PolicyBind Policy

Licensing Task

Underwriter Request

Setup Request Processing Request

Named Request

Manager Request

Policy Underwriting

Application Review Pre-Processing Underwriting Policy Issuing

Underwriting

Additional Review

Manager Approval

MedicalRelease

Interviews

APS

Credit Report

EFT Form

PredictWhat if you could tell which tasks, data and documents would lead a case to a more successful completion?

ExtendUsing predictive analytics and exposing that information to the knowledge worker makes a standard case solution smarter. Users make decisions with guidance by the application of cognitive components.

ImproveTool becomes more knowledgeable and accurate.6

Solution Goals


7

Results


Same Organized Processes

No OrganizedProcesses

Most Processes Organized

Processes Are Managed

Processes Continuously

Improved

Processes are Improved at the Work Group or Departmental Level

Processes are Organized and Redesigned at the Enterprise Level

Processes are Measured and Managed Systematically

Processes Teams Continuously Improve Processes

Cultures of HeroesLevel 1

Level 5

Level 4

Level 3

Level 2

• Predictable

• Accurate

• Measure Trends

• Improve Process

• Learning

8

Cognitive


Business RulesVS• Must be defined/developed

by business• Requires manual analysis

of results• Changes have to be

implemented/deployed• Only as good as the

person who defines them

• Model based rather than dictated

• Results automatically applied to future decisions

• Success is repeated and enforced

• Accuracy based on results and not isolated to the process

11/2/16World of Watson 2016 9

Cognitive Case Structure (A)

Application

Application Review Pre-Processing Underwriting Issuing

Underwriting

Additional Review

MedicalRelease

Interviews

APS

Credit Report

EFT Form

Policy Underwriting


Cognitive Case Structure (B)

Application

Pre-Processing Underwriting Issuing

Underwriting

Additional Review

Manager Approval

MedicalRelease

Interviews

APS

Credit Report

EFT Form

Agent Updates

Processing Request

Application Review

Policy Underwriting

Cognitive Tools using IBM Watson and IBM Bluemix

Why IBMBluemix?

Fully on Cloud• Subscription or usage based

payment model• Free tiers for development use

Easy to use• REST APIs• Public test benches• Instant setup

Platform Agnostic• IBM Case Manager• IBM Content Navigator


What’s Available?

Language• Alchemy• Translation• Conversation

Speech• Speech to text• Text to speech

Vision• Visual Recognition

Data Insights


Making Sense of Data


Making Sense of Data


What is IBM SPSS?


Statistical Analysis and

Reporting

Big Data Analytics

Decision Management

and Deployment

Predictive Modeling and Data Mining

Attending Physicians Statement (APS): An Example

Attending Physician Statements

A Necessary Evil in Life Underwriting• Best source of history for applicants health.• Generally required for 30% of applications.• Adds 10 - 60 days to the total approval time.• Adds $50 - $150 to the application UW process.

Applicant

Physicians

Policy Underwriting

DocumentIngestion

APS Collection

APS Summary

Applicant Assessment

Agent

Paramed

Copy Service


Loma Survey Results

Organizations: 15

Total: 607,000 APS /year

Volume: 1000 –160,000 APS/y

Key Issues Weighting

Special Authorizations 62

APS Collection Time 50

Additional APS Req’d 25

APS Cost 17

APS Quality and Length 12

Physicians

Policy Underwriting

DocumentIngestion

APS Collection

APS Summary


Agent

Paramed

Copy Service

Cognitive Pre-diagnosis

Cognitive Extraction

AnalyticTools

Cognitive Pre-Diagnosis

Underwriting

ApplicationAge

Face AmountAilments

Rules

RulesBasedAPS Request


NO APS

TrainDiagnostic Assessment- Supported- Unsupported- Unrelated

UnderwritingAgeFace Amount

Diagnoses RX History

Social

SPSS Predictive

Model

Watson

TrainingCognitivePre-diagnosis

NO APS

TrainDiagnostic Assessment- Supported- Unsupported- Unrelated

UnderwritingAgeFace Amount

Diagnoses RX History

Social

SPSS Predictive

Model

Watson

AutomatedCognitivePre-diagnosis

Train

NO APSDiagnostic Assessment

Predictive Model

APS Cognitive Extraction

DiagnosesPulmonary embolism

Pg, Date, I26.xPg, Date, EKGPg, Date, PrescriptionPg, Date, Follow-up

visitList of Physicians

Pg, Date, PageUnreadable Pages

UnderwritingAPS

Train Review Add

Correct

Watson Cognitive Engine

AgeFace Amount

Declared Ailments

Rx History Pattern of Care

MIB Report

Teleview Notes ParamedResults

ClaimsTrain

CognitiveExtraction

APS Analytic Assessment

APS Assessment Tool

View large documents• 200-300 pages common, 1000’s pages possible

Help quickly and effectively rate diagnoses• Preserve a record of the investigation

Support other underwriting operations• MIB declarations• Creating a decision document• Help determine the value of the APS Document


BookmarksPulmonary embolism

Pg, Date, I26.xPg, Date, EKGPg, Date, PrescriptionPg, Date, Follow-up

visitList of Physicians

Pg, Date, Page

Review, Add and Rate

APS

Underwriting

Let’s look at Jane Doe


Summary

Cognitive Pre-diagnosisWatson diagnostics + SPSS forecasting based on UW experience

Analytic ToolsAPS Assessment ToolCapture UW actions, corrections and decisions

Cognitive ExtractionWatson EMR assessment + UW experience based training

Physicians

Policy Underwriting

DocumentIngestion

APS Collection

APS Summary


Agent

Paramed

Copy Service

Cognitive Pre-diagnosis

Cognitive Extraction

AnalyticTools

Thank You

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