A perfect partnership: improving the financials and delivering - - PowerPoint PPT Presentation
A perfect partnership: improving the financials and delivering better client outcomes Liz Cairns, Manager, National Serious Injury Service, ACC Dr Maree Dyson, Strategic and Technical Consultant Darryl Frank, Actuary, PricewaterhouseCoopers
Liz Cairns, Manager, National Serious Injury Service, ACC Dr Maree Dyson, Strategic and Technical Consultant Darryl Frank, Actuary, PricewaterhouseCoopers
Liz Cairns, Manager, National Serious Injury Service
– No fault – Everyone in NZ including workers, non-workers, & tourists – Any kind of personal injury caused by an accident (including assault, medical mishap, mental injury) – Funded by everyone through direct levies (workers, employers, car owners) and taxation
– Predominantly motor vehicle
– Brain injuries – Spinal cord injuries – Other e.g. severe burns, multiple amputations
Severe brain inj ury 19% Moderate brain inj ury 34% Spinal cord inj ury 42% Other 5%
– 390 are children 0-16 years 17 are aged 90+ years – Average age at injury = 28 years Average age now = 41 years – 74% male 26% female
Darryl Frank, Actuary, PricewaterhouseCoopers
Paym ent type Annual paym ents $ m Liabilities Multiplier Social rehabilitation (serious) 226 5,131 22.7 Social rehabilitation (non-serious) 182 868 4.8 Weekly compensation 948 5,290 5.6 Medical/ hospital 694 2,150 3.1 Other 223 1,595 7.2 TOTAL 2,274 15,033 6.6
– About 7 for ACC Scheme as a whole – About 23 for serious injury social rehabilitation costs
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Annual paym ents Liabilities Serious inj ury claim s All other claim s
Severe TBI , $2.03m Moderate TBI , $0.79m High- level tetra, $3.00m Low - level tetra, $2.05m Paraplegic, $0.84m I ncom plete, $0.42m Com parable, $0.48m
$1.2m of social rehabilitation (excludes treatment and weekly compensation)
Distribution of claim liabilities
0% 5% 10% 15% 20% 25% 30% 35% $0 - 100k $100k - 500k $500k - 1m $1 - 3m $3 - 5m $5 - 10m $10m +
Severe TBI, $1,604.21m Moderate TBI, $1,231.24m High-level tetra, $931.66m Low-level tetra, $417.09m Paraplegic, $526.96m Incomplete, $239.88m Comparable, $119.80m
– $5.1 billion is needed to fund social rehabilitation for existing seriously injured clients to the end of their lives
– Short payment history relative to the volume of future payments – Changes in provision of care and expectations of claimants, families and care providers – Changes in broader supply and demand for attendant care and like services – Changes in claims management approaches
– Uncertainty relating to care provided by families – Past management of claims not “optimal”. Difficult to assess ACC portfolio relative to “best practice”
– Age – Duration since injury – Injury Type (eg high level TBI, paraplegic etc) – Current payments
– each additional 1% p.a. growth in cost/ claim adds about $700m
Past and projected cost per claim
20,000 40,000 60,000 80,000 100,000 120,000 140,000 160,000 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019 2021 2023 2025 Payment year Average cost per claim
These should result in greater consistency of decision- making, leading to more predictable payment increases
TAC: pre-New division
New Division established
TAC growth rate in attendant care costs for catastrophically injured clients (delay years 4+)
Service Year ended September TAC: new Division for severely injured clients TAC: Lifetime Support established ACC "lagged"
0% 5% 10% 15% 20% 25% 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007
TAC changed claims management approach about 8 years ago Recent ACC experience similar to TAC’s prior to change
Introduction
Dr Maree Dyson, Strategic and Technical Consultant
Liability blow-out Isolation & dependence
Accelerating rate of growth in average cost per serious injury claim:
in 2005
in 2006
in 2007 Low participation rates in community activities & employment: Best Typical NZ SCI 80% 40% 18% TBI 56% 35% 9%
– Stabilise growth rate to sustainable rate – Improve client outcomes
2003 2004 2005 2006 2007 2008 2009 2010 Cost per claim
Sustainable grow th rate Sustainable grow th rate
Knowing our clients Managing the service gateway Targeted attendant care & alternatives Specialist case management Increased accountability
Person-centred planning Service-based planning
– Not routine – In response to change in needs and/ or circumstances only – Evidence based assessment tools
OBS, Lawton’s IADL measures – Decision-making tools
– Use of objective outcome measures (AusTOMs) – Closing the ‘service loop’
FIM+ FAM Lawton’s IADL Attendant Care Guidelines for SCI High medical support needs Overt Behaviour Scale (OBS) Human assistance Exceptional responses
– Supported Living
participation goals – Supported Employment
maintaining open, paid employment – 2009, Transition from School to Work
Efficiency and effectiveness reporting & purchasing Inputs
Client demographics and complexity indicators (e.g injury profile, age, disability)
Outputs
Various (e.g. ACC decisions, number of episodes of intervention, costs, hours of service, service duration)
Outcomes
Actual impact on clients’ lives (e.g. employment participation, goal achievement, increased participation, stability)
Reports Reports
ACC reporting: – Client complexity – Service utilisation – Costs – ACC decisions – Outcomes Provider monitoring: – Client complexity – Costs – Outputs – Outcomes
– Assist staff decision making – Provide more information to stakeholders – Improve actuarial modelling
communication
dependence) to 7 (complete independence)
assistance to complete the task
– SCI 19% variance – 7% for TBI
– FIM does not profile challenging behaviours – Ceiling effects – Other
age of 40 tend to have poorer outcomes than people injured at an earlier age
longitudinal data
likely:
– Traumatic Brain Injury Model Systems (TBIMS) data – ACC data
– Paraplegic – Injured under 15 years
– Injured over 50 years of age – Now over 50 and > 15 years post accident
– Using a standardised measure (ICAP) that describes the difference between chronological age and developmental age
Liz Cairns Manager, National Serious Injury Service
Support Coordinator Support Coordinator Service Coordinator Service Coordinator Senior Support Coordinator Senior Support Coordinator Area Team Manager Area Team Manager Support needs yet to be established
changing Support needs well- established and stable
National Service Manager National Service Manager Service Delivery Manager Service Delivery Manager Area Team Manager Area Team Manager
Central
Area Team Manager Area Team Manager
Auckland North
Area Team Manager Area Team Manager
Auckland South
Area Team Manager Area Team Manager
Midlands
Area Team Manager Area Team Manager
Southern
– Client segmentation into active management versus stable needs – Job roles differentiated to meet needs of different client segments (active management versus stable needs) – Case loads matched to the requirements of each role, so staff have time to do the job required – Mentoring role (Senior Support Coordinator) to support development of specialist skills & knowledge – Locate staff close to communities where clients reside, so they develop knowledge of local community services & supports
– 100 Support/ Service Coordinators handling 4,200 serious injury cases – Five regional Area Team Managers – National & regional KPIs specific to serious injury:
Northland & North Auckland South Auckland & W aikato Midlands Central Southern
Hours per w eek Current situation Recommended in ACC Spinal Guidelines CASE 1: Tetraplegic 168.0 28.5 - 91.5 CASE 2: Tetraplegic 58.0 98.5 - 105.5 CASE 3: Paraplegic 114.0 0.5 - 14.5 CASE 4: Paraplegic 0.0 0.5 - 10.0
Hours per w eek Current situation Recommended in ACC Spinal Guidelines CASE 1: Tetraplegic 168.0 28.5 - 91.5 CASE 2: Tetraplegic 58.0 98.5 - 105.5 CASE 3: Paraplegic 114.0 0.5 - 14.5 CASE 4: Paraplegic 0.0 0.5 - 10.0
Hours per w eek Current situation Recommended in ACC Spinal Guidelines CASE 1: Tetraplegic 168.0 28.5 - 91.5 CASE 2: Tetraplegic 58.0 98.5 - 105.5 CASE 3: Paraplegic 114.0 0.5 - 14.5 CASE 4: Paraplegic 0.0 0.5 - 10.0
Support Needs Assessment service trial Oct – Dec 2007
have on average 20 hours less attendant care compared to newly- injured from this time last year – $4.7m not added to liability
reduced by 440 hours per week, saving: – $5380 per week – $270,00 per year – $5.5m liability
held stable New clients ( 2 0 ) Existing clients ( 1 0 2 )
– Increase in attendant care hours 21.0 hours – Liability impact $134,000
Stair lift so client can get out of house & access the community themselves $57,000
– 11 service providers nationwide – 123 clients receiving service – Outcomes → reduced attendant care & increasing participation
– 40% of referred long term unemployed clients now in paid employment (6 spinal & 9 brain injury)
– Hemi case study
– Assessment costs $300k less than same period last year – Housing modifications: $1.5m less than same period last year – Vehicles: $2.8m less than same period last year – Attendant care see next slide… .
– Attendant care
Age group % of clients % using attendant care Median attendant care hours per week Baseline: 31 Mar 08 30 Sep 08 0-14 years 8.4 54.0% 27.0 28.0 15-24 years 13.2 38.9% 28.0 25.0 25-44 years 37.3 33.8% 17.0 17.0 45-64 years 32.5 34.3% 17.0 16.0 65+ years 8.7 44.0% 17.0 17.0
– Includes 87 hours for “supervision” – Hemi socially isolated & not engaged with his local community – Partner struggling with being Mum to 3 kids & being Hemi’s full-time carer
– “Supervision” replaced with personal alarm for emergencies
– Carving – Kapa haka – Hemi & his partner get some time out from each other while he’s at the marae
– Reduction in attendant care hours (supervision)
– Personal alarm + > $1,000 per year
2003 2004 2005 2006 2007 2008 2009 2010 Cost per claim
Sustainable grow th rate Sustainable grow th rate
Liz Cairns, Manager, National Serious Injury Service, ACC Dr Maree Dyson, Strategic and Technical Consultant Darryl Frank, Actuary, PricewaterhouseCoopers