damian poel - transport accident commission - returning to work after a transport accident

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Transport Accident Commission Returning to Work after a Transport Accident Presenter: Damian Poel

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Damian Poel delivered the presentation at the 2014 Return to Work Forum. The 2014 Return to Work Forum brought together speakers from multiple sectors to share best practice in return to work, injury management and rehabilitation. For more information about the event, please visit: http://bit.ly/returntowork14

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Page 1: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

Transport Accident CommissionReturning to Work after a Transport Accident

Presenter: Damian Poel

Page 2: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

■ 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

Page 3: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

$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

Page 4: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

2015 strategy

Page 5: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 6: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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”

Page 7: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 8: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 9: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 10: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 11: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 12: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

Recovery Today

Structure

Page 13: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 14: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 15: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 16: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 17: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

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Page 23: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 24: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 25: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 26: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 27: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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%)

Page 28: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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.

Page 29: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 30: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

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

Page 31: Damian Poel - Transport Accident Commission -  Returning to work after a transport accident

Damian PoelTransport Accident Commission

Thank you