TAC 2015 Claims Model Transformation

Tracey Slatter Head of Claims

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Sole provider of personal injury insurance for transport accidents in state of Victoria

Victorias population 5.57 million 4.3 million vehicles registered Compulsory premiums paid with

annual vehicle registration

No-fault scheme TAC funds: treatment income

rehabilitation lifetime care TAC invests in: Marketing and road safety ($48.9M 11/12) Safer road infrastructure ($94.4M 11/12)

Overview

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Our clients

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$1.01B claim payments 2011/12 $10.9B liabilities as at June 2012 19,002 new claims 2011/12 44,410 people received funded

support in 2011/12

Claims division

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Spread of claims vs liabilities

Number of (active) claims managed by the TAC

Total liabilities as at 30 June 2012

Recovery (Mild to moderately

injured clients) 29,600

Independence (Severely injured

clients)5300

Recovery (Mild to moderately

injured clients)$890M

Independence (Severely injured

clients)$6.61B

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Client outcomes

Client experience

Scheme Viability

Road trauma Maximise potential of Arrive Alive and

explore step-out opportunities

Capital Management Optimise the balance sheet

Enablers Align to deliver on the TAC 2015 agenda

Goals Core Functions

Recovery Helping our clients back to work and

health sooner

Independence Maximising

independence of severely injured clients

Service Client centred strategies

TAC 2015 claims model transformation

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Benefit Delivery Portfolios based on injury type Multiple file handovers between

portfolios (5+) during life of claim Portfolio sizes and staff not

aligned to client needs Long tail claims scattered across

the teams

Missed opportunities for early intervention

Recovery

Model developed using regression analysis on five years of data 70,000 claims

Algorithm for automated

segmentation at intake Segmentation based on client

complexity Automated identification of high

potential CL claims at intake Introduction of Client Focus team

to specifically target risk claims New tools to assist return to work

and health

Recovery

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Recovery

The Recovery model places the client with the team best equipped to help them with their individual needs

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Measuring success RTW Complex - Overall Client Satisfaction with the TAC

6.316.55

6.84 7.03

0

1

2

3

4

5

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Jun-11 Aug 11 + Oct 11 Feb 12 + Apr 12 Jun-12

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Measuring success RAP - % of RTW outcomes

0%

10%

20%

30%

40%

50%

60%

70%

80%

Jun-12 Aug-12 Oct-12 Dec-12 Feb-13 Apr-13 Jun-13

% of RTW outcomes

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Measuring success

Six month income duration

0%

10%

20%

30%

40%

50%

60%

Jul-08 Dec-08 May-09 Oct-09 Mar-10 Aug-10 Jan-11 Jun-11 Nov-11 Apr-12 Sep-12 Feb-136 month income duration

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Measuring success

Six month income durations for high potential common law claims

0%

10%

20%

30%

40%

50%

60%

70%

80%

Jul-08 Dec-08 May-09 Oct-09 Mar-10 Aug-10 Jan-11 Jun-11 Nov-11 Apr-12 Sep-12 Feb-13High CLP 6 month income duration - High

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Independence Focus on client goals Clear pathways to achieving client

goals Single point of contact at the TAC

from accident through to discharge Regular face-to-face interaction More efficient discharge process Standardised client outcome

measures

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Independence

Early Support Coordinator Provides single point of contact from

accident through to discharge

Works with providers to ensure their plans align with client goals

Provides regular face-to-face interaction

Independence Plan Focuses on goals

Supports collaborative process between the TAC, providers and clients

Developed in partnership with the client,

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Measuring success Attendant care growth for clients achieving

full independence in Life Areas

0-3 Life Areas Maximised 4-7 Life Areas Maximised

Atte

ndan

t Car

e Gr

owth

Rat

e

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Measuring success

Early attendant care spend

$0.0

$0.5

$1.0

$1.5

Jul-1

1

Sep-

11

Nov

-11

Jan-

12

Mar

-12

May

-12

Jul-1

2

Sep-

12

Mill

ions

Actual Historical

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Measuring success

Attendant care spend: percentage variance to target

-0.4%

-0.2%

0.0%

0.2%

YTD

Und

er T

arge

t : O

ver T

arge

t

Clients with Independence Plans Clients Without Independence Plans

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Measuring success

The TAC system in terms of the acute hospital staff initiating contact with the organisation appears to be working well for those involved in catastrophic accidents. This is a valued service and one that appears not to require any improvement.

The ESCs have a direct and positive impact on the perceived quality of care received by TAC clients and on their satisfaction with the TAC.

Clients have found the face-to-face contact the most valued and welcome aspect of their relationship with their ESC.

Clients with an Independence Plan, generally acknowledged the process was positive and that having one had some positive consequences.

Market Access Consulting and Research, August 2012

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Service

FIRST SERVICE

How quickly and easily

we accept a claim and

get the clients the

initial services and benefits they

need

SERVICE & BENEFITS DECISIONS

HEALTH & DISABILITY SERVICES

PAYMENTS CUSTOMER SERVICE

How quickly and easily we

make decisions about services,

such as physiotherapy and benefits,

such as income replacement

payments

How easy it is to access

providers who will deal with the TAC and how well the

range of services

offered assists clients recover

and regain independence

How quick and easy it is for providers to

be accurately paid for

services and how we

minimise the need for

clients to be out of pocket

How easy it is for our clients to contact us, get the right information

and how well we listen to our clients, understand their needs

and respond promptly

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Service

Claim accepted within five days

More focus on resolving complex/high risk service and benefits decisions

Provider accounts paid or denied within 14 days

No claim form

Only 20 core questions to test eligibility

Data transfers from hospitals, ambulance and police

14 page hard-copy claim form

Client required to answer up to 220 questions to test eligibility

Claim acceptance takes up to 70 days

Client waits up to 100 days for first income payment

Providers frustrated with delayed payment of accounts

Income decision within five days

High-risk mitigation strategies applied across the board

$60 million CHE release

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Staff engagement

78% 77%77%75%73%73%

77%72%

85%83% 83%81%

83%85%81%

81%

85%87%85%86%

75%73%78%

40%

55%

70%

85%

100%

2005 2006 2007 2008 2009 2010 2011 2012

TW Australia National Norm TW Global High Performing Companies Norm TAC

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Staff morale

72%

67%69%68% 68%67%66%62%63%

69%65%

76%76%

73%73%

65%

74%71%

72%72%65%

73%76%

75%73%75%

72%70%68%

63%

40%

55%

70%

85%

100%

2000 2001 2003 2005 2006 2008 2009 2010 2011 2012

TW Australia National Norm TW Global High Performing Companies Norm TAC

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Ongoing evaluation

Client Outcomes measure

Comprises six underlying measures To be developed and refined over time Based on International Classification (ICF) of Functioning framework

Longitudinal Study

Two years Four time points Recovery clients only Pilot and time one underway

ISCRR evaluation

Critical action research methodology

Tracey Slatter Head of Claims

Transport Accident Commission

Thank you

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