claims-model-transformation tracey slatter achrf 2012
DESCRIPTION
ACHRF 2012TRANSCRIPT
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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
6
7
8
Jun-11 Aug 11 + Oct 11 Feb 12 + Apr 12 Jun-12
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14
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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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15
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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
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Tracey Slatter Head of Claims
Transport Accident Commission
Thank you
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