A perfect partnership: improving the financials and delivering better client outcomes Liz Cairns, Manager, National Serious Injury Service, ACC Dr Maree Dyson, Strategic and Technical Consultant Darryl Frank, Actuary, PricewaterhouseCoopers November 2008
Introducing ACC’s serious injury clients Liz Cairns, Manager, National Serious Injury Service
ACC - unique in the world – No fault – Everyone in NZ including workers, non-workers, & tourists – Any kind of personal injury caused by an accident (including assault, medical mishap, mental injury) – Funded by everyone through direct levies (workers, employers, car owners) and taxation
ACC’s serious injury clients • Injury causes – Predominantly motor vehicle • Permanently disabled after an accident – Brain injuries – Spinal cord injuries – Other e.g. severe burns, multiple amputations • ACC fund life long care and support
ACC’s serious injury clients Other Severe brain 5% inj ury 19% Spinal cord inj ury 42% Moderate brain inj ury 34%
ACC’s serious injury clients • ACC receives 1.5 million + claims per year • 250 – 300 are serious injury claims • Currently ACC has 4,172 serious injury clients • Size of the serious injury client base will continue growing for another 20-25 years
ACC’s serious injury clients • Currently 4,172 clients with a serious injury: – 390 are children 0-16 years 17 are aged 90+ years – Average age at injury = 28 years Average age now = 41 years – 74% male 26% female
Serious injury - actuarial perspective Darryl Frank, Actuary, PricewaterhouseCoopers
Context – overall ACC Scheme Annual paym ents Paym ent type $ m Liabilities Multiplier Social rehabilitation (serious) 226 5,131 22.7 Social rehabilitation (non-serious) 182 868 4.8 Weekly compensation 948 5,290 5.6 Medical/ hospital 694 2,150 3.1 Other 223 1,595 7.2 TOTAL 2,274 15,033 6.6 • Ratio of liabilities to annual payments: – About 7 for ACC Scheme as a whole – About 23 for serious injury social rehabilitation costs
Context – overall ACC Scheme 100% 90% 80% 70% 60% Serious inj ury claim s 50% All other claim s 40% 30% 20% 10% 0% Annual paym ents Liabilities • Serious injury claims are about 10% of payments and over 30% of liabilities
Average cost per person Com parable, I ncom plete, $0.48m Severe TBI , $0.42m $2.03m Paraplegic, $0.84m Moderate TBI , $0.79m Low - level tetra, $2.05m High- level tetra, $3.00m • Over the person’s lifetime, , ACC will fund an average of $1.2m of social rehabilitation (excludes treatment and weekly compensation)
Number of $1million + claims Distribution of claim liabilities 35% 30% 25% 20% 15% 10% 5% 0% $0 - 100k $100k - $500k - $1 - 3m $3 - 5m $5 - 10m $10m + 500k 1m • Nearly half of all claims have liabilities of more than $1m, this represents over 80% total of serious injury liabilities.
A liability overview Comparable, Incomplete, $119.80m $239.88m Paraplegic, $526.96m Severe TBI, $1,604.21m Low-level tetra, $417.09m High-level tetra, $931.66m Moderate TBI, $1,231.24m • If ACC stopped business today… – $5.1 billion is needed to fund social rehabilitation for existing seriously injured clients to the end of their lives
Modelling challenges • In any scheme these benefits are the most challenging to model… .. – Short payment history relative to the volume of future payments – Changes in provision of care and expectations of claimants, families and care providers – Changes in broader supply and demand for attendant care and like services – Changes in claims management approaches • Challenge is greater in ACC… . – Uncertainty relating to care provided by families – Past management of claims not “optimal”. Difficult to assess ACC portfolio relative to “best practice”
Modelling approach • Due to small number of claims, and variability in cost per claim, serious injury claims are modelled individually • Takes into account – Age – Duration since injury – Injury Type (eg high level TBI, paraplegic etc) – Current payments • Allow for mortality (higher than population mortality) • Growth in average cost per claim is the greatest challenge… …
Modelling of liabilities Past and projected cost per claim 160,000 140,000 Average cost per claim 120,000 100,000 80,000 60,000 40,000 20,000 0 2001 2003 2005 2007 2009 2011 2013 2015 2017 2019 2021 2023 2025 Payment year • • Continuation of past trends could lead to significant Past growth in average cost per claim has been liability increases significant – each additional 1% p.a. growth in cost/ claim adds about $700m
New NSIS has similarities with TAC • Dedicated staff managing serious injury claims • Focus on liability impact of decision making • Focus also on client outcomes, not just cost • More objective assessment approach (using measures such as FIM) • Improved data capture • Alternatives to Attendant Care These should result in greater consistency of decision- making, leading to more predictable payment increases
TAC experience TAC changed claims management approach about 8 years ago Recent ACC experience similar to TAC’s prior to change TAC growth rate in attendant care costs for catastrophically injured clients (delay years 4+) 25% Introduction New Division of Lifetime Support 20% established 15% 10% 5% 0% 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 -5% -10% -15% -20% Service Year ended September TAC: pre-New division TAC: new Division for severely injured clients ACC "lagged" TAC: Lifetime Support established
Serious injury - strategy Dr Maree Dyson, Strategic and Technical Consultant
Situation 30 June 2007 Low participation rates in Accelerating rate of growth community activities & in average cost per serious employment: injury claim: Best Typical NZ • 4.2% in 2005 SCI 80% 40% 18% • 5.8% in 2006 TBI 56% 35% 9% • 14.3% in 2007 Liability blow-out Isolation & dependence
Strategy • Simple objectives: – Stabilise growth rate to sustainable rate – Improve client outcomes Sustainable Sustainable grow th rate grow th rate Cost per claim 2003 2004 2005 2006 2007 2008 2009 2010
Strategic approach Targeted attendant Knowing our clients Managing the Increased Specialist care & alternatives case management service gateway accountability
Knowing our clients Service-based Person-centred planning planning
Managing the gateway • Assessment: – Not routine – In response to change in needs and/ or circumstances only – Evidence based assessment tools • incorporating FIM & FAM, OBS, Lawton’s IADL measures – Decision-making tools • Outcomes: – Use of objective outcome measures (AusTOMs) – Closing the ‘service loop’
Targeted Attendant Care FIM+ FAM Lawton’s IADL Attendant Care Human assistance Guidelines for SCI High medical support needs Exceptional responses Overt Behaviour Scale (OBS)
Technological alternatives to attendant care
Life alternatives to attendant care
Facilitating alternatives to attendant care • New disability support services: – Supported Living • Focus on independence & participation goals – Supported Employment • Focus on finding & maintaining open, paid employment – 2009, Transition from School to Work • Focus on the 16+ group
Increasing accountability Inputs Outputs Outcomes Client demographics and Various (e.g. ACC Actual impact on clients’ complexity indicators decisions, number of lives (e.g. employment (e.g injury profile, age, episodes of intervention, participation, goal disability) costs, hours of service, achievement, increased service duration) participation, stability) ACC reporting: Provider monitoring: Reports Reports – Client complexity – Client complexity – Service utilisation – Costs – Costs – Outputs – ACC decisions – Outcomes – Outcomes Efficiency and effectiveness reporting & purchasing
Benchmarking • Can we bring some benchmarks to the use of Attendant Care to: – Assist staff decision making – Provide more information to stakeholders – Improve actuarial modelling • SCI Guidelines • Functional Independence Measure (FIM)
Improving information, decisions & modelling FIM™ is an 18-item instrument • Covering areas such as mobility, transfers, communication FIM™ is directly relevant to the need for • Item scores range from 1 (indicating complete dependence) to 7 (complete independence) attendant care, but… • Scores of 5 or less indicate the person needs human assistance to complete the task Can the FIM™ to predict attendant care hours?
Recommend
More recommend
