intervening early to prevent unnecessary disability christine bloomfield achrf 2012
TRANSCRIPT
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Intervening Early To Prevent
Unnecessary Disability.The ACC experience
Christine Bloomfield, Rehabilitation Practice Manager
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Today
Claims flow
Streaming claims to claims managers
Predictive factors
Streaming/targeting resources
Vocational rehabilitation services
Outcomes improved rehab rates
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Auto stream some claims
for case management. Traumatic brain injury.
Multiple or serious
injuries.
Apply at risk indicators toselect claims for screening.
Create specialist triage
positions psycho-social
screening Follow-on processes based
on improved screening.
Claims segmentation: targeted triage
New claims registered daily
Highly complex
injuries direct to
case managers
Selected claims
reviewed at STCC
Client calls 0800
requesting
support
Triage manager
interview
Co-ordinator
interview
ACC claims management
New claims registered daily
Highly complex
injuries direct to
case managers
Selected claims
reviewed at STCC
Client calls 0800
requesting
support
Triage manager
interview
Co-ordinator
interview
ACC claims management
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Accurately predicts which claims will require weekly
compensation and for how long. Based on initial data and updates as we learn more about each
claim.
At the individual read code/ICD level and incorporates age, work
type, lodgement delay, past payments and individual provider
factors.
Conversion & duration models
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Conversion & duration models
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Client segmentation model
Short terms claims centres
manage approximately 80%
of claims commencing
weekly compensation.
Aim to identify and manage
those clients who return towork within 70 days.
Further segmentation
- simple
- low
None
Low
High HIGH
Case Manager manages case
including actions to reduce risk flags;
may work with a number of providersincluding SAW B
RANCH
LOW
Work with SAW provider to manageRTW obstacles
SIMPLE
CONTACTCE
NTRE/CASECO-ORD
INATOR
Manage RTW
obstacles at
current jobMonitor /
Check-in
Interven
tion
Nee
ds
Com
plexity
ProviderFace-to-face
Phone
Obst
ac
les
/barr
iers
toRTW
On Track
Yes No
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Branch case managers
manage other 20% weekly
compensation claims
Face to face contact with
client
Delegations to provide
vocational and socialrehabilitation services and
other entitlements for high
complexity cases
Client segmentation model
None
Low
High HIGH
Case Manager manages case
including actions to reduce risk flags;
may work with a number of providersincluding SAW B
RANCH
LOW
Work with SAW provider to manageRTW obstacles
SIMPLE
CONTACTCE
NTRE/CASECO-ORD
INATOR
Manage RTW
obstacles at
current jobMonitor /
Check-in
Interven
tion
Nee
ds
Com
plexity
ProviderFace-to-face
Phone
Obst
ac
les
/barr
iers
toRTW
On Track
Yes No
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File reviews expert advisor input
Rehabilitation progress checklist
Proactive contact with client, employers, providers to identify
flags obstacles to recovery
Proactive claims management including making adjustments to
plans when necessary
Review for emerging complexity
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Most time off work is not medically necessary Identify the obstacles preventing recovery at work
Identify what is needed to overcome each obstacle
Act quickly to make the necessary adjustments
Stay at work concept
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Stay at Work
ACC assesses need for service. May be triggered by GP or
employer request.
Level 1 Two weeks duration draw up RTW plan
Level 2 Single components physical or vocational
6 weeks duration
Level 3 Multiple components physical, vocational and other
components e.g. pain management skills more
intense 6 weeks duration
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Stay at Work
Level 4
Tailored service Complex Branch cases, Recover independence and Serious
Injury clients
More flexibility components and time frames
Consists of service elements currently supported by SAW,
EMP and PFWI Additional services e.g. pain management, psychologicalservices
Stand alone workplace assessment
Require detailed understanding of workplace & pre-injuryemployment
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Work ready service
Assessment informs planning (e.g. IOA, IMA)
Level 1 Consists of service elements such as employment preparation,
physical reactivation
No work trial or very simple work trial
8 weeks duration
Level 2
Consists of service elements such as employment preparation,
physical reactivation, pain management etc
Work trial or lots of service required
8 week duration
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Assessment informs planning (e.g. Independent Occupational
Assessment, Independent Medical Assessment)
Tailored service Complex Branch cases, Recover independence service and
Serious injury clients
Consists of service elements such as employment preparation,physical reactivation, work trial etc
Work readiness package at Level 1 or 2
Additional services over longer period of time e.g. pain
management, training programmes, supported employment
Work ready service
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Formal client segments based on complexity rules
Early proactive contact of these clients to establish
rehabilitation support required
Triage managers
Proactive contact with GPs, employers and providers to informrehabilitation supports required for client
Revised Vocational Rehab services - Stay at work and Work
Ready
Better targeting of referrals
Work ready service
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