Transcript Insert heading

Improving outcomes for clients
at risk of mental health issues
Bruce Crossett, 14th October 2011, ACHR Forum
Agenda
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Mental Health challenges in the TAC scheme
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Changes we have made in the past few years to start to
address this important issue
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The key challenges ahead
TAC scheme & mental health impacts
16,000 claims
received P/A
24,000 claims
under mgt
at any time
Mental Health flags;
49% clients have
identified mental health
issues in high cost teams
(8000 claims)
-Psychology/Psychiatric
treatment
-Mental health related pharmacy
-Mental health flagged during
Common Law process
TAC scheme & mental health impacts
Recovery – Combined Liabilities (CL & NF)
Recovery – No Fault Analysis
Recovery
Recovery
Ave cost per
claim per year
% of claims
No
Complexities
RTW
$20K
3%
$32K
RTW
54%
$81M
$42M
$81K
$151K
2%
3%
Mental
Health
$9K
32%
$79K
No
Complexities
Total ave cost per
year
$56M
$29M
$54M
2%
$36K
$11M
$15M
2%
$77K
1%
Persistent
Pain
Mental
Health
Version 1.0 – March 2011
$12M
Persistent
Pain
BI Analysis – Author: Gary Winbolt
TAC scheme & mental health impacts
Mental injury claims increasing
SI Granted, 10-29% Impairment Score
(granted narrative)
600
500
400
Widening
between claims
with a mental
injury as a
component
compared to
pure physical
injuries
300
200
100
0
00/01
01/02
02/03
03/04
05/06
04/05
06/07
07/08
08/09
Granting year
Mental injury component
Physical injury only
Measurable effect from Richards v Wylie in 2000 :
mental or behavioural disturbances taken into account
in determining seriousness of the physical injury
All granted
“If it is decided that, in a given case, the test in paragraph (a ) is appropriate because
the plaintiff’s relevant condition has been brought about predominantly by the relevant
physical injuries, in deciding whether the relevant impairment is serious and long term,
regard is to be had not only to the physical cause of the impair ment, but also to any
mental or behavioural disturbances flowing from the physical injury …”
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Mental Health claims – our past approach (pre 2010)
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Segmented by injury group
Long
Hospital Stay
or
Orthopaedic
Return to work needs
or
or
Soft Tissue
Return to health needs
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Manual business rules determined when claims would transition out of
low risk teams into high risk teams
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Mental health claims distributed across all teams
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No consistent early identification or early intervention for mental health
claims
Recovery Model (part of TAC’s 2015 strategy)
Recovery
Model
Early
Identification
Risk
Screening
Active
Management
Client
Outcomes
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2 years in the planning
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Went live in October 2010
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150 staff in new roles and new teams/structure
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24,000 active claims realigned overnight
Vision of the model – “Identify clients needs as early as
possible and place them in the team best equipped to assist
them in achieving their return to work or health goals”
Vision for our staff - “To have the skills, confidence and
knowledge to proactively facilitate the clients recovery”
The Algorithm – claim segmentation
Recovery
Model
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Developed in-house based on 5 years of claims history
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Predicts the probability of high cost/complexity
Early
Identification
Risk
Screening
Injury
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Active
Management
Common
Law
potential
PreExisting
injuries
Previous
Claims
Age
Time from
accident
to claim
lodgement
Using claim form information to segment the claim overnight
to a team following acceptance
Low Risk
(70% of claims)
Early Support
(12%)
Active Management
or Complex
(18%)
Client
Outcomes
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85% accuracy - measured by claims requiring subsequent
movement to another team within 3 months
Client Conversational Tool
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Drawn from the Rehab Progress Checklist (ACC in NZ) and
the Trauma Screening Questionnaire (UK )
Early
Identification
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A series of questions to identify “high needs” in relation to
RTW, mental health or persistent pain
Risk
Screening
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First run as a pilot pre Recovery Go-Live
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ISCRR currently undertaking a full evaluation
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Key challenge - once clients are identified with “high needs”
what next? Treatment options? Medical v non medical etc
Recovery
Model
Active
Management
Client
Outcomes
Active Management
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Pilot planned in 2012 - motivational interviewing techniques
for Rehabilitation Coordinators in complex RTW cases
Early
Identification
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Client Profiling by Team - presence of mental health issues
can very from 10% in one team to 70% in another
Risk
Screening
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Need to provide the right training and supports to staff and the
approach to managing clients will vary considerably between
teams
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Mental Health Strategy – Health Services Group Initiative
(jointly being undertaken with WorkSafe Victoria)
Recovery
Model
Active
Management
Client
Outcomes
Client Outcomes
Recovery Branch
- History of Recent Actuarial Releases
10.0
Recovery
Model
5.0
($million)
0.0
Early
Identification
2007
2008
2009
2010
2011
-5.0
-10.0
-15.0
Risk
Screening
-20.0
Year ending 30 June
Active
Management
Client
Outcomes
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Longitudinal study commences in early 2012 – Recruiting a
group of TAC clients shortly after they make their claim
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Track their progress over a two year period
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Survey them 3-4 times along that journey
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Understanding what we do that really makes a difference