IBM Software

Advanced Case Management

April 2010
A smarter way to
manage information in a
more complex world.
Using advanced case management solutions
from IBM
Contents
1 Acknowledging case
management as part of
your organization
2 Adopting a new approach to
meet changing business
needs
2 Closing cases faster with
better results
4 Applying advanced case
management for optimized
outcomes
Executive summary
How much would productivity increase and costs decrease if you could
automate routine claims and focus on efficiently handling exceptions?
What if you could improve customer service, cross-selling and up-
selling with a single view of all of a customers transactionsfrom
across different locations and departments?
How much time and money would you save if you were able to audit
only those parties that actually needed to be audited?
Advanced case management can make all of the above scenariosand
many morea reality. Its a new and better way of handling cases,
whether your cases are contracts, lawsuits, incidents, social cases or
applications.
In this executive brief, youll read about case management and how its
traditional approach is no longer meeting the needs of organizations
faced with todays challenges. It will also explain the concept of
advanced case management and address the IBMstrategy for using it
to optimize case outcomes.
Acknowledging case management as part of
your organization
Whether youre processing claims, loans, contracts, audits or benets
or youre managing complex projects, some form of case management
is present in processes across nearly every organization. However, dif-
ferent organizations refer to these processes in different ways: claims
management, member enrollment, contract management, customer
dispute resolution, loan origination and review, patient or customer
onboarding, social service administration, project management, fraud
investigation and more.
2
IBM Software
Advanced Case Management
April 2010
Organizations that process cases collect a tremendous amount
of information over a cases life span. All of this content needs
to be organized and made accessible, so a knowledge worker
or case handler can quickly determine the best resolution for
the case, as well as for future cases. To best use the informa-
tion, knowledge workers need appropriate tools and real-time
access to expertise, so they can make quickbut, more
importantly, rightdecisions. As a result, organizations
are increasingly looking to adopt formal case-oriented
approaches and solutions to resolve cases and solve
business problems.
Adopting a new approach to meet
changing business needs
There are many reasons why now is a good time to evolve
your case management processes.
Higher customer expectations
Organizations that want to remain competitive must deliver
quality customer service to attract and retain customers.
Great customer service increases loyalty and revenue. And
properly managing incidentssuch as customer complaints
or disputesprovides exceptional service to the customer and
protects the business should escalations occur.
Knowledge workers must manage paper-based documents
such as letters, faxes and contractsas well as e-mail, instant
messages and other electronic communications to obtain a
comprehensive, 360-degree view of a customers case. As
caseloads become increasingly information intensive, organi-
zations should consider a case management approach that
helps connect the right people at the right time to enhance
service.
Increasing number of exceptions
Automation has reduced repetitive work, so some knowledge
workers consistently handle cases that are less structured,
are more ad hoc and require more skills and interaction with
specialists and subject matter experts (SMEs). Often, the
handling process can be visualized only after it is completed,
requiring a dynamic way to handle the case while its still in
process. A exible and dynamic case management strategy
can enable organizations to handle more cases and excep-
tions, without growing headcounts, by better managing the
processes associated with case management.
Rapidly changing regulations
For some organizations, there is an increasing need to man-
age important case informationand associated processes,
decisions and other artifactsfor legal or compliance reasons.
Regulations, set forth by government or governing bodies,
may demand that both current and archived case information
be readily available to auditors or the public. Because infor-
mation is often contained in multiple formatsincluding let-
ters, faxes, contracts, e-mails and instant messagesmaking
it available can prove difficult and costly as well as expose
companies to risk. Also, this process is often inefficient, time
consuming and costly.
To better manage risk and help address compliance, organiza-
tions should leverage a case management solution or strategy
that automates regulation management processes and handles
the entire case life cycle, from opening to archival and
records management.
Closing cases faster with better results
To meet the challenges of todays case management organiza-
tions, IBMoffers a strategy that extends the concepts of case
management by adding capabilities designed to help you
close cases faster, with better results. The advanced case man-
agement strategy from IBMunies information, processes
and people to provide a 360-degree view of the case. It relies
on information, processes, advanced analytics, business rules,
collaboration and social computing to help drive more suc-
cessful, optimized case outcomes. Moreover, advanced case
management solutions help capture industry best practices in
frameworks and templates to empower business users and
accelerate return on investment.
The advanced case management strategy and solutions from
IBM are designed to help deliver key case management
improvements: insight, responsiveness, exibility, better
customer service and regulatory compliance.
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IBM Software
Advanced Case Management
April 2010
Insight
Advanced case management solutions from IBMprovide deep
insight from all sides of a case, which can provide both
micro- and macro-optimization of casework.
At a micro level, advanced case management can help case-
workers prioritize cases and make decisions based on real-
time information and key performance indicators (KPIs).
The right information is available for case progression and
resolution, which, in turn, will enable optimization of case
outcomes. For example, by developing insight from the
documents associated with a claim, a claims manager could
progress the claims that have the highest probability of meet-
ing service delivery KPIs.
At a macro level, advanced case management helps you take
advantage of the wealth of information available from multi-
ple sources to make better choices for future cases. It can
provide insight across an entire caseload and identify patterns
that could affect outcomes across departments. Content ana-
lytics may even deliver insight into specic products or serv-
ices that are frequently the subject of case exceptions. As a
result, organizations can improve case outcomes, as well as
business performance, by taking proactive measuressuch as
reallocating work, involving more SMEs, providing better
support information and improving training.
Responsiveness
Casework is collaborative and demands a dynamic work
pattern, one that requires people to systematically collaborate
on a case folder. Advanced case management solutions from
IBMsupport ad hoc collaboration, enabling knowledge work-
ers to connect in real time with SMEs and other people with
critical domain expertise. This strategy helps workers resolve
cases quickly and efficiently by leveraging enterprise knowl-
edge and experience, while helping control costs and improve
decision making.
Advanced case management supports all interactions through
a customer-oriented approach. Involving the customer
through multichannel interaction points helps ensure a suc-
cessful outcome, which is why advanced case management
from IBM supports practically all information sources, pro-
viding a 360-degree view of the case. This approach captures
all necessary information, while improving customer service
and optimizing case outcomes.
Flexibility
Advanced case management enables organizations to modify
business rules, which can be authored and abstracted to create
a powerful mechanism for implementing rule-based criteria
in a case. By extracting and managing business rules, you can
enable exible, automated content-based decision making in
systems that are subject to complex, variable and evolving
rules. As a result, you can improve process efficiency and
lower system maintenance costs.
Advanced case management helps you work smarter by
enabling business experts to manage and validate decision
logic, without help from IT, which will determine the
way cases need to be handled. As a result, companies can
respond quickly to internal and external changessuch as
those in regulations or other driving forcesand facilitate
compliance.
Advanced case management in the real world:
A success story
Juggling frequently changing regulations, as well as
terms and conditions for eligibility, a social benets
administration agency struggled with quickly and
consistently delivering benets to those who qualied.
Plus, citizen eligibility information was kept in different
offices, making it nearly impossible to properly and accu-
rately determine which individuals were truly eligible.
The benets administration agency implemented a
case management solution from IBM so that it could
change its business rules as quickly as the regulations
changed. The solution made citizen data available in a
single location, helping the agency ensure the delivery of
equal and timely services to all eligible citizens.
Please Recycle
Applying advanced case management
for optimized outcomes
IBMcreated its advanced case management strategy in
response to industries in need of a smarter, more integrated
way to handle their growing, increasingly complex caseloads
and shrinking resources. Using leading solutions and proven
best practices, IBMis equipped to assist organizations with
practically any case management scenario, in nearly any
domain.
Because software is helping make the planet smarter, organi-
zations have more opportunities to realize their potential. To
do so, they need software that is fueled by expertise, built for
change and ready for work. IBMcan help.
For more information
To learn more about advanced case management,
please contact your IBM sales representative or
IBM Business Partner, or visit the following Web site:
ibm.com/software/data/advanced-case-management
Join the conversation at: ibm.com/blogs/acm
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Produced in the United States of America
April 2010
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