acc better at work evaluation gp certification claimant early return to workanne anne dowden john...
TRANSCRIPT
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Certification Behaviour Change
2ndACHRFAuckland, New Zealand
8-9 November 2012
Dr John Wren
Principal Research Advisor
ACC Research
Anne Dowden
Partner - EvaluationResearch New Zealand
ACC Better@Work EvaluationGP Certification & Claimant Early Return to Work
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Overview
WHYBetter@Work (B@W)the business case
WHAT was B@Wintervention description & model
WHAT& HOW - the evaluation
FINDINGS - six key learning areas
Conclusions& Recommendations
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The Business Case
Research evidencethat early return to work promotesbetter patient health outcomes
Hypothesisthat cost savings of 5% to 20% available to
ACC Scheme
Implementation
> Phased roll-out (three geographic settings over three years)
- Taupo, Hawkes Bay, West / North Auckland
> Evaluation at 12 and 30 months
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Change
GP certification
Active role primary health care
Wider culture change shift for early return to work
Less time
on full WC
B@W Concept
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B@W Desired Outcomes
Earlier (faster) return to work (RTW) of injured workers
ChangeGP Certification Behaviourfrom Certification for Unfit for
Dutiesto Fit for Selected Duties
Cost savingsto ACC Schemethrough less time on full weekly
compensation (WC)
Better patient outcomes- treatment, rehabilitation and satisfaction
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B@W 3 key enablers of change
Economicmotivators> Profit sharing for GPs
> Fair reimbursement to GPs for extra effort engaging with patients
Motivationalinfluencers> GP education, from trusted source, that B@W is good for patients
Processmotivators
> Making it easier for GPs to Certify Fit for Work and Fit for Selected
Duties (E-ACC18 initiative)
> Providing dedicated and embedded B@W Co-ordinator in GP Practices
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Five key learning areas
1. Acceptance of B@W concept
2. GPs as influencers for early RTW
3. Co-ordinator role
4. Social Group Dynamics: other levers at play
5. Summary of Factors motivating GPs
6. Potential level of cost savings
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1.Acceptance of B@W concept
GPs
Great, a service that worksGood: there is a safe role
Employers
I dont have suitable work
Well maybe that will work
Its good to be involvedGreat to know theyre safe
PHO & A+Ms
Revenue stream
Link to GPs
Best practice!
Unions
Just ACC cost savings?
Not sure about this
Injured workers
Ok .. if you say so
I dont think there is work
Good: someone to sort it with the bossGreat: got to get back
Better@Work
ACC
This is an excellent idea
Seeding the RTW idea on day one isexactly right
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1.A stakeholder perspective
B@W feels different tostakeholders Proactive
Early communication
Early action
Very accessible
Injured workers Personal relationship
Learning RTW culture
Active participant
Employers Learning RTW culture
Involved in decisions
B@W is different for GPs Professional assessment of
workplace Collegial
Occupational rehab expert
Coordinates all parties
Better@Work
ACC is providing a great service to GPs.
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2. Influence of GPs
on clients early RTW decisions
GPs important because they are seen as.
Trustworthyand have clients interests as central
Independentof ACC and employer
Informedabout rehabilitation
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3. B@W Co-ordinators
Co-ordinator role seen as criticalto the process
in supporting GPs and clients early RTW decisions
for all except most straightforward situations
Multiple roles
negotiator(facilitator between the parties)
navigator(knowledgeable about ACC scheme and access to aides)
rehab/ workplaceexpert(knowledgeable about safe duties)
safety net for all parties(monitoring safe return to work)
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4. Social Group Dynamics
Worker motivation hinges on:
Individual motivation & skills
High value workers RTW regardless Low value workers have significant barriers to RTW
Employer motivation hinges on:
Importance of worker to business:
higher importance more value in early RTW
Perceived/actual lack of work to do
Fear of exposure to new Health and Safety Risk
Social Group Dynamics as Key Influencing Factors
on early RTW
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Some Union and Health Professionals
have negative perceptions of early RTW concept
believe it is not in best interests of clients
believe it is cost shifting to employers by ACC
4. Social Group Dynamics
Social Group Dynamics as Key Influencing Factors
on early RTW
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5. Factors motivating the GP
Money isnt everything for GPs - but may be important forPractice Managers
GP Certification process that aids change
Easy physical process that enables GPs to change their certification
behaviour is critical
Lessons from electronic claims form (eACC18)
Having trusted and dedicated coordinator role focused on
facilitating early RTW deemed to be critical by GPs
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6. Potential level of cost savings -
hypothesis
Employer wages/salary paymentsACC weekly compensation
Less time on full weekly compensation
Better@Work is a graduateddecrease in weekly comp hours:
Means this:
ACC weekly compensationEmployer wages/salary payments
Earlier RTW
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6. Potential level of cost savings - actual
Logically early RTW should see cost savings
BUT: limited evidence of large reduction in no. of clients
and time spent on fullweekly compensationattributable to
Better@Work
At best 5% could be identified
Better@Work
ACC Weekly compensation
Employer wages/salary payments
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Lead evaluators conclusions
Achieving GP Certification change requires multiple levelsofintervention
GPCertification behaviour changealone, does not lead directly
to early return to workit is but the first stepin a complex social
dynamic
Cost savings are at best incremental, and likely to be traded-off
by increased cost of support required to aid early-RTW
B@W best suited. least suited.
Data sensitivity
Attribution
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Lead evaluators conclusions
B@W has significant intangible value
Enables idea of early RTW (from a trusted source) to be seeded
before expectationsabout time off work become set
is a positive interaction so enhancesGP relationship with ACC
enhances GP understanding of rehabilitation in general, and ACC
pathways specifically
legitimisesand supports GPs in promoting early RTW (for patients and
employers)
provides structure and focus for GPs to actively managerehabilitation
and early RTW
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Please note:
Reflections & Recommendationsfor Future Implementers andEvaluatorsis attached
Questions
Dr John Wren
Anne Dowden
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Dr John Wren
Principal Research Advisor
ACC Research
Anne Dowden
Partner - EvaluationResearch New Zealand
Reflections & Recommendationsfor Future Implementers and Evaluators
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Early-RTW bestsuited for the middle of the rangeinjuriesthose that are neither minor nor major injuries
Minor injuries do not require time off work, or very little time off, and can
be readily managed by GPs
Major injuries need recovery time but are managed by specialists who
provide (relatively urgent) treatment within the first days or first week
following the injury
Conclusions
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Conclusions
B@W bestsuited:
manual work
useful when a small business where the bossthinks the worker must
RTW only when fully fit or not at all
an important role where an injured worker is not motivated/needs a pushor there is a psychological barrier to RTW
B@W least suited:
is typically not needed for office work
less suited to highly mobile casual work such as casual agricultural work
highly motivated injured workerswho are so keen they can negotiate
RTW without ACC and will RTW with one leg missing
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Data sensitivity challenges
Change was more gradual than expected (hours, not days or weeks)
Measuring change in GP Certificate days not readily accessible
Data limitations undermined ability to monitor implementation progress, and
degree of achievement of desired outcomes
Reflections
NO monitoring data
graduated RTW hours
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Reflections
Beware of Attributionchallenges
Several programmes / interventions impact claim pathway
ACC wide culture change
Economic drivers: Recession behaviour of workers, GPs
What else contributed
to the change?
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Reflections
Attributionchallenges
culture change & programmes
eACC18 design > > > > Roll out > > > >
2007 2008 2009 2010 2011
Stay at Work service
Fit for work
extension
Service Delivery Model
Better@Workpilot
RIS Return to independence service
Claims Management STCC, Branches
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Evaluation Recommendations
Monitoringneeds to be sensitive enough to capture gradualchanges in amount of weekly compensation paid, hours / days
return to work, and GP certification
Monitorattitudinal and behavioral factors
All key stakeholders: GPs/A+Ms, injured workers, employers and
possibly staff/case workers
barriers to change in GP certification
barriers in actual early RTW
progress towards long term, sustained culture change of early RTW