Research for Actuarial Impact

October 2013

ISCRR and TAC research collaboration

• ISCRR mission to:

– Conduct research aligned with compensation scheme issues and

objectives

– Facilitate translation of research evidence into policy

– Lead to improved health, vocational and social outcomes

TAC mission to:

To reduce road trauma and support those it affects

To reduce future liability by targeting growth areas in spend for

Independence clients

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ISCRRs Impact assessment framework Measurable change in a Scheme KPI

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Developing the ROI hypothesis

Occurs at Research Planning and Development Phase

Identify impact of research

Identify need and research question

Source evidence for projected clinical or service impact

Hypothesise impact

Apply hypothesised impact to current treatment or service costs

Apply actuarial calculation

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Calculating the ROI hypothesis

Research question

Hypothesis of clinical impact

Estimate of service impact

Estimate of cost impact

Estimate of actuarial impact

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Estimating research impact

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Research question

Hypothesis of clinical impact

Estimate of service impact

Estimate of cost impact

Estimate of actuarial impact

Neurotrauma Strategy

• $20 million investment in research for clients who have incurred a brain or spinal cord injury to:

– Improve client outcomes

– Improve client experience

– Maintain scheme viability

Key criteria

– Need – to inform policy and practice

– Probability of impact – of meaningful changes within 5 years

– Reward – return on investment for client health and outcomes and/or cost savings

– Capacity – ability of NT research sector to do the work

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Research areas ranked against key

criteria

Activity

Criterion

Investment Need Prob. Impact Reward Capacity

Priority 1. Models of life-time care Very high High High Low 35%

Priority 2. Improving Rehabilitation & Disability management

High Mod High High 35%

Priority 3. Bench to bedside Low Low Very high High 15%

Priority 4. Capacity Building Mod Mod Mod High 15%

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Secondary complications of Spinal Cord

Injury (SCI)– bowel function

• Spinal cord severance causes loss of conscious

control of bowel and bladder so that bowel cannot be

emptied voluntarily at convenient time

• People with SCI live with this condition for 50-60 years.

A survey by Widerstrom-Noga (1999) showed 85.6%

people with SCI reported problems with bowel control

• When asked: “if one problem could be solved what

would it be” the most common answer was bladder and

bowel problems (ranked as most important by 34% of

people with SCI)

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Research proposal

• To restore bowel control following SCI, thus:

– significantly reducing attendant care requirements of people with SCI;

– and reducing their eventual need for surgery;

– treating the symptoms of bowel incontinence so their quality of life and ability to participate in society is greatly improved.

By:

– Completing animal proof of principle experiments for use of Capromorelin (a colokinetic drug);

– Conduct a RCT of use of Capromorelin in humans with SCI and matched non-injured controls

– Conduct a repeat dose study using Capromorelin

– Prepare and promulgate guidelines for diagnosis, treatment and maintenance care for bowel problems arising from SCI

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Bowel management

• Clinicians estimate effect in people with SCI (up

to 10 years post-injury) as:

– 40% paraplegics will reduce care need by 1

hr/day

– 40% quadriplegics will reduce care needs by

½ hr/day

– 20% no reduction of care needs

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The research impact questions

Does a blinded RCT demonstrate the efficacy of Capromorelin usage?

Does usage reduce care needs by 1 hr/day for 40% paraplegics; ½ hr/day for 40% quadriplegics; no effect on 20% people with SCI?

Does the reduced care needs translate to reduced service purchase of attendant care by 1 hr or ½ hr per visit ?

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Behaviours of Concern (BoC)

Traumatic brain injury (TBI) can result in behaviours such as aggression, agitation, sexual inappropriateness and lack of initiation

These behaviours result in social isolation, relationship breakdown and dislocation from accommodation creating a significant burden for the person with TBI and their families and carers

BoC represents the greatest source of stress to caregivers of people with TBI (Ponsford and Schonburger 2010)

Behavioural strategies to manage BoC are multi faceted and must be individualised. Knowledge of “active ingredients” of such strategies, and skills and expertise to implement them, is poor.

Clients with BoC are excessively reliant on attendant care “just in case” and this is increasing over time

Pool of clients with BoC supported by TAC estimated at approximately 600 clients

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Research proposal

• To audit files of TAC clients with BoC to document nature of BoC; pre- and post-injury trajectory

• Qualitative study to capture lived experience of BoC for those with BoC by comparison with those who have had BoC but resolved without need for attendant care

– What has contributed to the BoC

– What has made them worse

– What has made them better

– What are the specific strategies and modifications including family interactions, activities of daily living, the environment, social interactions, therapeutic or pharmacological interventions

To identify “active ingredients” of positive BoC management for trialling.

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Research Impact questions

What are the active ingredients of positive behaviour intervention and support?

Is there evidence that they reduce “just in case” attendant care usage?

Does the reduced care needs translate to reduced service purchase of attendant care and if so by how much?

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Process for assessing ROI

Work with TAC Business Intelligence to test the clinical and/or

service impacts of proposed research with

Claims staff

Business Intelligence analysts

Actuaries

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TAC Scheme – an actuarial perspective

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Total Scheme liability (ie, value of all future payments to current claims) amounts to nearly $10 billion.

Liability figures feed directly into Scheme financial statements, and results/performance measures – including Actuarial release.

Branch

Liability

30 June 2013

($m)

Independence $ 5,592

Recovery $ 748

Resolution $ 1,963

$ 8,302

Claims Handling $ 799

Tax Credits ($ 394)

Prudential Margin $ 871

Total $ 9,578

Results

• Bowel ROI

• Around 150 Spinal Team clients receive 1:1 attendant care

• Equates to reduction of 90 hours of attendant care per day across branch

• Taking clients less than 10 years after their accident:

• Calculates to ~$0.6m p.a. reduction in costs

• Liability impact of ~$25 million savings

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Results - BoC

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Total liability for Attendant

Care > $4 billion

Around $400 million of

this liability is directly

related to Behaviours of

Concern

10% reduction in care

directly associated with

BoC would have a liability

impact in the order of $40

million

UNDERSTANDING

ACTUARIAL IMPACT

HELPS TO MEASURE

THE VALUE OF

RESEARCH

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Thank you

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