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As physicians, hospitals and healthcare providers seek ways to revamp their operations to improve outcomes and rein in costs, technologies such as advanced analytics and cloud computing are offering new ways to reshape the healthcare industry. Through IBM Research Services, experts from Global Business Services (GBS) are teaming with researchers from IBM’s nine worldwide research laboratories to develop innovative solutions to simplified healthcare delivery, personalized treatment plans for patients, and outcome-based rewards incentives for physicians.

Boosting service quality

Healthcare benefit plans are regularly subject to changes in regulations, policies and patient coverage, which require changes to the business rules for each health plan in the claim processing systems. The changes are so complex that one small update can cascade a series of unintended consequences, causing valid healthcare claims to be denied or paid inaccurately. To assist healthcare payers in better managing this process, IBM Research Services is helping the National Account Service Company (NASCO) improve claim processing accuracy through traceability—the ability to link benefit plan documentation back to contractual and regulatory requirements, and forward to the system code that drives accurate automated claim processing. To assist with the process, IBM Research has developed an innovative tool that examines the code associated with complex benefit rules and translates the benefit code into English. This process allows business analysts who may not have technical knowledge to quickly understand the relationship between sequences of code and the tasks they perform, with the goal of improving claim accuracy, business agility and customer service for NASCO’s large healthcare payer customers.

Improving patient outcomes

In an effort to improve patient outcomes by coordinating and optimizing treatment regimens, hospitals and physicians are seeking new ways to connect, analyze and share health information. IBM Research Services is helping healthcare professionals access the information they need to design individualized care for patients through a private cloud-based service called Collaborative Care Solution. In one of the first implementations, California’s Sharp Community Medical Group (SCMG) is using the system to help provide deep insight into improving patient care by culling through vast amounts of patient data and identify trends and patterns to help manage chronic diseases such as hypertension or diabetes. Using sophisticated algorithms, the system analyzes a predetermined set of patient health variables and assigns patients to groups based on similar health histories and medical issues. New patient similarity analytics provide better understanding of which treatments are most effective and help predict treatment outcomes based on patients' clinical characteristics.

Managing patient care

Meanwhile, in China, IBM researchers are working with Peking University People’s Hospital on a pilot project to deliver evidence-based patient-centric clinical (ePC3) care. The project initially focuses on chronic disease management and will integrate a comprehensive view of a patient’s health information and history, best practices derived from previous diagnoses, treatment, research and more to provide doctors with clinical decision support at the point of care. At the same time, the solution incorporates a mobile platform that will enable doctors and nurses to provide remote care and monitoring service and more proactive intervention.

Building powerful tools

To help determine optimal treatment plans for rare skeletal diseases, scientists at IBM Research-Haifa have teamed with Italy’s Rizzoli Orthopedic Institute in a joint research effort involving data mining and advanced analytics. Working together, the team has developed a pedigree analytics platform to help improve treatment of and research into rare genetic diseases using genomic data, medical images and family history. The insights generated through the data analytics could provide guidance to physicians on optimal treatment options for rare skeletal diseases.

Connecting the dots

To help individuals, governments and businesses better understand ways to improve human health, scientists at IBM Research have begun a multi-year research effort to connect and analyze enormous collections of data from a wide variety of sources. Through advanced modeling and simulation, they will investigate and simulate the cause-and-effect relationships between agriculture, transportation, city planning, eating and exercise habits, socio-economic status, family life, and more to better pinpoint what types of incentives or investments might be needed and how to prioritize them as we shift to a healthcare system that is focused on disease prevention and wellness.

Meeting competitive challenges with smarter healthcare

Rapid advances in healthcare technology and delivery systems are paving the way for more efficient patient care and improved outcomes. As hospitals, physicians and healthcare providers implement new systems that leverage these capabilities, IBM is making major investments in innovative healthcare applications and services.

For more information on engaging IBM expertise in advanced technologies to help deliver smarter healthcare, contact IBM Research Services today.