intervening early to prevent unnecessary disability christine bloomfield achrf 2012

7/23/2019 Intervening Early to Prevent Unnecessary Disability Christine Bloomfield ACHRF 2012

1/16

Intervening Early To Prevent

Unnecessary Disability.The ACC experience

Christine Bloomfield, Rehabilitation Practice Manager


2/16

Today

Claims flow

Streaming claims to claims managers

Predictive factors

Streaming/targeting resources

Vocational rehabilitation services

Outcomes improved rehab rates


3/16


4/16

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


5/16

5

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


6/16

6

Conversion & duration models


7/16

7

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


8/16

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


9/16

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


10/16

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


11/16

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


12/16

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


13/16

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


14/16

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


15/16

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


16/16

intervening early to prevent unnecessary disability christine bloomfield achrf 2012

Documents