This document describes how IBM's predictive analytics and cognitive computing capabilities can be applied to IBM Case Manager to create smarter case management solutions. Specifically, it discusses using IBM Watson to analyze medical records like Attending Physician Statements to provide diagnostic assessments and extract key information that can help underwriters make better decisions. An example is provided of how Watson could be used to analyze an APS for a life insurance applicant to identify relevant medical conditions and optimize the underwriting process. The goal is to make case management tools more knowledgeable and accurate over time by incorporating cognitive insights.

1. Applying IBM Predictive Analytics
to IBM Case Manager to Create
Cognitive Solutions
ECM-1794
Brian Benoit, Manager, Solution Consultants
Michael Song, Senior Systems Engineer
Kevin Knill, Director Product Development
10/24/2016

2. • Traditional Case
Solutions
• Cognitive Case
Solution
• Using Watson with
Case
• APS: an Example2 11/2/16World of Watson 2016

3. 3
Capability
Maturity
Model
11/2/16World of Watson 2016
Same Organized
Processes
No Organized
Processes
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

4. 11/2/164
IBM Case Manager
World of Watson 2016
Information Work
OutcomesAgility
Make Better
Decisions
Support the
Way People
Work
Take Control
Optimize
Case
Outcomes

5. A Case Structure
The Case, Documents & Associated Cases
Automatic & Manually
Initiated 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
Medical
Release
Interviews
APS
Credit Report
EFT Form

6. Predict
What if you could tell which tasks, data and
documents would lead a case to a more
successful completion?
Extend
Using 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.
Improve
Tool becomes more knowledgeable and
accurate.6
Solution
Goals
11/2/16World of Watson 2016

7. 7
Results
11/2/16World of Watson 2016
Same Organized
Processes
No Organized
Processes
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. 8
Cognitive
11/2/16World of Watson 2016
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

9. 11/2/16World of Watson 20169
Cognitive Case Structure (A)
Application
Application Review Pre-Processing Underwriting Issuing
Underwriting
Additional
Review
Medical
Release
Interviews
APS
Credit Report
EFT Form
Policy
Underwriting

10. 11/2/16World of Watson 201610
Cognitive Case Structure (B)
Application
Pre-Processing Underwriting Issuing
Underwriting
Additional
Review
Manager
Approval
Medical
Release
Interviews
APS
Credit Report
EFT Form
Agent
Updates
Processing
Request
Application Review
Policy
Underwriting

11. Cognitive Tools
using IBM
Watson and
IBM Bluemix

12. Why IBM
Bluemix?
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
11/2/16World of Watson 201612

13. What’s
Available?
Language
• Alchemy
• Translation
• Conversation
Speech
• Speech to text
• Text to speech
Vision
• Visual Recognition
Data Insights
11/2/16World of Watson 201613

14. Making
Sense of
Data
11/2/16World of Watson 201614

15. Making
Sense of
Data
11/2/16World of Watson 201615

16. What is IBM
SPSS?
11/2/16World of Watson 201616
Statistical
Analysis and
Reporting
Big Data
Analytics
Decision
Management
and Deployment
Predictive
Modeling and
Data Mining

17. Attending Physicians
Statement (APS): An
Example

18. 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
Document
Ingestion
APS
Collection
APS
Summary
Applicant
Assessment
Agent
Paramed
Copy
Service
11/2/16World of Watson 201618

19. 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
Document
Ingestion
APS
Collection
APS
Summary
Applicant
Assessment
Agent
Paramed
Copy
Service
Cognitive
Pre-diagnosis
Cognitive
Extraction
Analytic
Tools

20. Cognitive
Pre-Diagnosis

21. Underwriting
Application
Age
Face Amount
Ailments
Rules
Rules
Based
APS
Request
11/2/16World of Watson 201621

22. NO APS
TrainDiagnostic Assessment
- Supported
- Unsupported
- Unrelated
UnderwritingAge
Face Amount
Diagnoses
RX History
Social
SPSS
Predictive
Model
Watson
Training
Cognitive
Pre-diagnosis

23. NO APS
TrainDiagnostic Assessment
- Supported
- Unsupported
- Unrelated
UnderwritingAge
Face Amount
Diagnoses
RX History
Social
SPSS
Predictive
Model
Watson
Automated
Cognitive
Pre-diagnosis
Train
NO APSDiagnostic
Assessment
Predictive Model

24. APS Cognitive
Extraction

25. Diagnoses
Pulmonary embolism
Pg, Date, I26.x
Pg, Date, EKG
Pg, Date, Prescription
Pg, Date, Follow-up
visit
List of Physicians
Pg, Date, Page
Unreadable Pages
Underwriting
APS
Train Review
Add
Correct
Watson
Cognitive
Engine
Age
Face Amount
Declared
Ailments
Rx History
Pattern of Care
MIB Report
Teleview Notes
Paramed
Results
ClaimsTrain
Cognitive
Extraction

26. APS Analytic
Assessment

27. 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
11/2/16World of Watson 201627
Bookmarks
Pulmonary embolism
Pg, Date, I26.x
Pg, Date, EKG
Pg, Date, Prescription
Pg, Date, Follow-up
visit
List of Physicians
Pg, Date, Page
Review, Add
and Rate
APS
Underwriting

28. Let’s look
at Jane
Doe
11/2/16World of Watson 201628

29. Summary
Cognitive Pre-diagnosis
Watson diagnostics + SPSS
forecasting based on UW
experience
Analytic Tools
APS Assessment Tool
Capture UW actions, corrections
and decisions
Cognitive Extraction
Watson EMR assessment +
UW experience based training
Physicians
Policy
Underwriting
Document
Ingestion
APS
Collection
APS
Summary
Applicant
Assessment
Agent
Paramed
Copy
Service
Cognitive
Pre-diagnosis
Cognitive
Extraction
Analytic
Tools

30. Thank You
www.PyramidSolutions.com