Post on 14-Sep-2014
description
Transport Accident CommissionReturning to Work after a Transport Accident
Presenter: Damian Poel
■ Sole provider of personal injury insurance for transport accidents in state of Victoria
■ Victoria’s population 5.57 million
■ No-fault scheme
■ TAC funds: □ treatment □ income □rehabilitation □ lifetime care
Overview of the TAC
■ 4.3 million vehicles registered
■ Compulsory premiums paid with annual vehicle registration
■ TAC invests in: □ Road safety □ Safer road infrastructure
$1.1B claim payments 2013/14
$10.9B liabilities as at June 2013
CLAIMS DIVISION
2013
19,000+ new claims 2013/14
45,000+ people received funded support in 2013/14
Alex
2015 strategy
Goals
Core Functions
Recovery – Mild to moderately injured clients
ServiceStreamlining our processes to make it easier
for clients
IndependenceMaximising our
clients’ independence
RecoveryHelping our clients back to work and
health sooner
EnablersAlign to deliver on the TAC 2015 agenda
Road traumaMaximise potential of Arrive Alive and
explore step-out opportunities
Capital ManagementOptimise the balance sheet
for clients
Vision and Mission for Recovery
“Our vision is that by working together we enable
and empower those affected by road trauma to get their lives back on track sooner”
“Our mission in the Recovery branch is to support our “Our mission in the Recovery branch is to support our clients to return to work and health as quickly, sustainably and efficiently as possible. We do this by working with our clients in an innovative and person-centred way to achieve outcomes together”
What changed?
Benefit Delivery Portfolios based on injury type
Claim movements all manual based on pre-defined time-lines and events
Multiple file handovers (5+) during life of claim
Portfolio sizes and staff not aligned to client needs
Recovery Algorithm to automatically segment
claims by risk factors as claim accepted
Portfolio sizes clearly differentiated to client needs
Risk screening tool for return to work, mental health and pain risk factors
Strong focus on early intervention, expectation setting and client aligned to client needs
Long tail claims scattered across teams
Missed opportunities for early intervention & common law
expectation setting and client outcomes
Larger Client Assist stream to absorb low needs clients
Fewer file handovers
Targets review of long tail clams and outlier providers
Earlier identification of Common Law
Recovery Phase 2
Phase 2 focussed on changes to the systems, processes and people required to better support our client’s recovery
• Roll-out of Motivational Interviewing skills training
• Introduction of Recovery Action Plan focussed on • Introduction of Recovery Action Plan focussed on barriers and interventions
• Focus on effective interventions and pathways –particular focus on mental health, persistent pain, and return to work barriers
GoalsCore Functions
Service – Impacts all clients
ServiceStreamlining our processes to make it easier
for clients
IndependenceMaximising our
clients’ independence
RecoveryHelping our clients back to work and
health sooner
EnablersAlign to deliver on the TAC 2015 agenda
Road traumaMaximise potential of Arrive Alive and
explore step-out opportunities
Capital ManagementOptimise the balance sheet
for clients
Major streamlining of core Claims processes
Significant investment in building staff capability and empathy for clients
Service
and empathy for clients
New service options for clients to support their Recovery or Independence goals
80% claims accepted in five days
Services expanded to e-therapy and psycho social support service
Client required to fill out 14-page hard copy claim form
Claim acceptance takes up to 70 days
40% of incoming calls are from providers following up outstanding
accounts
90% provider / client accounts paid in 14 days
Clients no longer required to fill out a hard copy claim form
ServiceBEFORE NOW
Services pre-approved for new clients for increased chance of early RTW
acupuncture, chiropractic, physiotherapy, psychology, exercise physiology, osteopathy
Psychologist / psychiatrist only option for clients with mental health issues
No recording of calls / no coaching for employees in customer service skills
Clients must seek prior approval for most services
Consistent customer service culture
Recovery Today
Structure
Recovery TodayTeams
Recovery Then 9 different kinds of teams
11 teams in total
Early Support – managing both return to work and return to health claims
Return to Work – 2 complex teams and 2 less-complex teams.
Recovery Now 5 different kinds of teams
10 teams in total
Early Support – managing return to work claims only
Return to Work – 5 teams managing similar mix of claims and more even and 2 less-complex teams.
Complexity linked to risk of high cost, driven by common law
Return to Health – Complex and less-complex
Client Assist – one large team
Client Review – 8 staff, both reviewing claims and assisting with other tasks
similar mix of claims and more even workload
Return to Health – one team only
Client Assist – two equivalent teams
Client Focus – 3 staff, renewed focus on reviewing claims
Recovery TodayTools & Processes
Recovery Then Client conversational tool –
- questions to identify ‘high needs’ clients
Recovery Now Mental Health and Persistent Pain
Screening tool –
- 4 screening questions: cognition, resilience, social support, pre-existing mental health
- Service catalogue to assist with identifying services / approach for
Managing common law risk
Automatic identification at intake
Flag on claims management system
Shared KPIs between Recovery & Lump Sum (who manage common law benefits)
identifying services / approach for clients “at risk”
Managing common law risk
- Automated identification shifted to 3 month mark to increase accuracy
- Shared KPIs removed, but KPIs for Recovery in 2013/14 call out their impact on common law
Recovery TodayTools & Processes
Recovery Then Proactive data analytics –
- Claims analytically selected for review using triggers based on cost, age of claim, recent activity
- Triggers able to be adjusted to address current areas of concern
Recovery Now Proactive data analytics –
- Active management focusing on proactive management, reducing need for review
- Streamlined up front approvals introduced, creating space for more reviews with new to criteria
Segmentation Algorithm
- Flexible enough to cope with structure changes
Segmentation Algorithm
Automatic allocation of claims to appropriate teams at acceptance
Logistic regression
Combined no fault and common law models
Processed SAS and claims management system
structure changes
- More accurate for no fault model
- Recent change to only using no fault model at acceptance
- Now fully integrated in claims management system
- Use of statistical models to support decision making extended to claim eligibility decision and initial income payment
Mental Health and Persistent Pain• Secondary mental health and persistent pain are considerable
issues for our clients and for scheme outcomes
• We have introduced a new approach to screening clients to identify risk
• This is not diagnostic but is focussed on risk
• The approach is based on internal and external research
Research on Return to WorkBackground (TAC):
Recovery Client – Average Lifetime Cost
$25K 31%
$94K$81K
RTWNo RTW / No Pain/ No Mental Health
$11K54%
* Chart is a product of Business IntelligenceProduced in 2013
17
$45K3%
$32K2%
$84K1%
$94K4%
$81K2%
$161K2%
Persistent Pain
Mental Health
Average Cost per Claim
% of claims
Impacts of Recovery Model on Scheme Objectives
Client Experience
• Client Satisfaction has improved with a record score of achieved in June 2013 and maintained results in 2013/14
• All attributes – keep me up to date, resolve my issues, treat me as an • All attributes – keep me up to date, resolve my issues, treat me as an individual, and empathy, have shown statistically significant improvements since the introduction of the Recovery model
• This score is the result of long term change and improvement
Impact on Scheme Objectives Record client satisfaction score
Overall Satisfaction with the TAC
7.12 7.27
7.44 7.40 7.52 7.627.35
7.06 7.167.31 7.43
7.25 7.24
7.34 7.33 7.40 7.507.63
7.5
8
8.5
9
9.5
10
Overal l
6.56
6.79 6.95 6.937.12 7.27
7.06 7.16 7.25 7.24
5
5.5
6
6.5
7
Feb Jun Jun Jun Jun Jun Jun Jun Jun Jun Jun Feb Apr Jun Aug Oct Feb Apr Jun Oct Feb Jun
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2011 2011 2011 2011 2012 2012 2012 2012 2013 2013
Overal lsatisfaction
Impact on Scheme ObjectivesOverall satisfaction by life of claim
8
8.5
9
9.5
10
0-12 mths
13-36 mths
Overall Satisfaction by Life of Claim
5
5.5
6
6.5
7
7.5
Feb 2011 Apr 2011 Jun 2011 Aug 2011 Oct 2011 Feb 2012 Apr-12 Jun 2012 Oct 2012 Feb 2013 Jun 2013
13-36 mths
37-72 mths
73+ mths
Overall Satisfaction with the TAC- RTW
7.38 7.307.21
7.62
7.50
8.00
8.50
9.00
9.50
10.00
Impact on Scheme ObjectivesOverall client satisfaction: Return to work
6.67
6.98 7.05 7.05
6.56
7.387.10 7.21 7.09
5.00
5.50
6.00
6.50
7.00
7.50
Feb Apr Jun Aug Oct Feb Apr Jun Oct Feb Jun
2011 2011 2011 2011 2011 2012 2012 2012 2012 2013 2013
Satisfaction
Impact on Scheme Objectives
Scheme Viability
Returning clients to work is a major focus for Recovery and is key to achieving future savings in common law payments, reductions in income and paramedical payments, and great experience and outcomes for our clientsexperience and outcomes for our clients
• The main indicator of return to work success is a low percentage of clients who require income support at 6 months post accident. The result for the full year was below target at 36.7% (against a target of 39%)
Impact on Scheme Objectives
Client Outcomes
A client outcomes index has been developed and incorporating outcomes survey results, income durations and scheme participation for Recovery. Used for the first time during 2012/13 we have achieved the weighted target in 2013/14
The outcome measures used include self assessed mental health, physical health and return to work outcomes.
The branch has seen improvement in both 12 month income durations and Scheme Participation results The branch has seen improvement in both 12 month income durations and Scheme Participation results over the last three months. Both scheme participation and 12 month Income Duration results are below target for 2013/14
The branch has specifically focussed on ensuring that return to work outcomes are sustainable and that the services we fund drive both return to work and return to work outcomes
The successful launch of First Service, Streamlined Decisions and Right Payments is having a significant impact on the time it takes for clients to access the services they need to help them recover. This early intervention is a key strategy for client outcomes.
Conclusion
• Renewed focus on core purpose of returning people to work and health as quickly, efficiently, and sustainably as possible
• Realignment of the branch and every role and work purpose
• New processes introduced to more effectively identify claims at risk of becoming high cost and focussed on providing the best chance of achieving outcomes with our clients
• Focus on tools, processes, systems and people • Focus on tools, processes, systems and people
• Development of other complimentary programs to increase effectiveness
• The TAC has undergone a large cultural shift towards putting client outcomes at the centre of everything we do
• The successful implementation of the Recovery model has been an instrumental part of this shift and there remains considerable upside for both our clients and the organisation’s objectives
BEYOND 2015
A future where the majority of clients self navigate the system
Fundamental shift away from scrutinizing each individual claim
Focus on influencing whole ecosystem
Marcus
Focus on influencing whole ecosystem
Sophisticated analytics to manage risk
A model that aligns to the future of disability care in Australia where clients have choice and empowerment
Damian PoelTransport Accident Commission
Thank you