Improving outcomes for clientsat risk of mental health issuesBruce Crossett, 14th October 2011, ACHR Forum

Agenda

> Mental Health challenges in the TAC scheme

> Changes we have made in the past few years to start to address this important issue

> The key challenges ahead

16,000 claims received P/A

TAC scheme & mental health impacts

49% clients haveidentified mental health

issues in high cost teams(8000 claims)

Mental Health flags;

-Psychology/Psychiatric treatment

-Mental health related pharmacy

-Mental health flagged during Common Law process

24,000 claimsunder mgt

at any time

PersistentPain

MentalHealth

RTW

No Complexities

RecoveryTotal ave cost per

year

$81M

$29M

$11M

$42M

$54M

$15M

$12M

$56M

Recovery – Combined Liabilities (CL & NF)

BI Analysis – Author: Gary WinboltVersion 1.0 – March 2011

PersistentPain

MentalHealth

RTW$20K

$36K$32K

$79K $81K

$77K

$151K

No Complexities

RecoveryAve cost per claim per year

% of claims

32%

2%

2%3%

3%

1%

2%

54%

$9K

Recovery – No Fault Analysis

TAC scheme & mental health impacts

TAC scheme & mental health impacts

SI Granted, 10-29% Impairment Score(granted narrative)

0

100

200

300

400

500

600

00/01 01/02 02/03 03/04 04/05 05/06 06/07 07/08 08/09

Granting year

Mental injury component Physical injury only All granted

Mental injury claims increasing

Measurable effect from Richards v Wylie in 2000 : mental or behavioural disturbances taken into account in determining seriousness of the physical injury

Widening between claims with a mental injury as a component compared to pure physical injuries

“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 impairment, but also to any mental or behavioural disturbances flowing from the physical injury …”

Page 20

Mental Health claims – our past approach (pre 2010)

> Segmented by injury group

> Manual business rules determined when claims would transition out of low risk teams into high risk teams

> Mental health claims distributed across all teams> No consistent early identification or early intervention for mental health

claims

LongHospital Stay Orthopaedic Soft Tissue

Return to work needs Return to health needsor

or or

Recovery Model (part of TAC’s 2015 strategy)

> 2 years in the planning> Went live in October 2010> 150 staff in new roles and new teams/structure> 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”

Recovery Model

Early Identification

Risk Screening

ActiveManagement

Client

Outcomes

The Algorithm – claim segmentation

> Developed in-house based on 5 years of claims history> Predicts the probability of high cost/complexity

> Using claim form information to segment the claim overnight to a team following acceptance

> 85% accuracy - measured by claims requiring subsequent movement to another team within 3 months

Recovery Model

Early Identification

Risk Screening

ActiveManagement

Client

Outcomes

InjuryTime from accident to claim

lodgement

Common Law

potential

Pre-Existinginjuries

Previous Claims Age

Low Risk(70% of claims)

Active Managementor Complex

(18%)

Early Support(12%)

Client Conversational Tool

> Drawn from the Rehab Progress Checklist (ACC in NZ) and the Trauma Screening Questionnaire (UK )

> A series of questions to identify “high needs” in relation to RTW, mental health or persistent pain

> First run as a pilot pre Recovery Go-Live

> ISCRR currently undertaking a full evaluation

> Key challenge - once clients are identified with “high needs” what next? Treatment options? Medical v non medical etc

Recovery Model

Early Identification

Risk Screening

ActiveManagement

Client

Outcomes

Active Management

> Pilot planned in 2012 - motivational interviewing techniques for Rehabilitation Coordinators in complex RTW cases

> Client Profiling by Team - presence of mental health issues can very from 10% in one team to 70% in another

> Need to provide the right training and supports to staff and the approach to managing clients will vary considerably between teams

> Mental Health Strategy – Health Services Group Initiative (jointly being undertaken with WorkSafe Victoria)

Recovery Model

Early Identification

Risk Screening

ActiveManagement

Client

Outcomes

Recovery Model

Early Identification

Risk Screening

ActiveManagement

Client

Outcomes

Recovery Branch - History of Recent Actuarial Releases

-20.0

-15.0

-10.0

-5.0

0.0

5.0

10.0

2007 2008 2009 2010 2011

Year ending 30 June

($m

illio

n)

> Longitudinal study commences in early 2012 – Recruiting a group of TAC clients shortly after they make their claim

> Track their progress over a two year period > Survey them 3-4 times along that journey> Understanding what we do that really makes a difference

Client Outcomes