Opportunities to work with health
and disability providers.
Clare Amies
Health Services Group
WorkSafe Victoria/ TAC
Expanding our approach:
– Medical and community service models both important
– Need to invest in community providers: allied health and
disability providers
– A partnership approach: understanding there is a shared
commitment to maximising client outcomes
– Improve capacity to improve injured workers and
TAC clients experience and outcomes
– Examples: Network Providers;
Disability Services Strategy: ReNew
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Network Providers – Focus on
RTW and RTH
A key strategic program for WorkSafe and TAC
Aim
 Improve health and return to work outcomes for injured
workers and TAC clients
Strategy
 Establish networks of healthcare providers that have an
interest in treating injured workers and TAC clients
 Partnering with providers to develop their skills and
experience in managing compensable injuries
 Shared accountability on reviewing
performance and continuous
quality improvement
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Network Providers – Key features
Key Features
 Clients retain right to choose
healthcare provider
 Specialised group of highly skilled
and experienced providers:
– Occupational physiotherapists
– Network occupational
therapists
– Network pain management
programs
 Higher remuneration for providers
 Training and education for providers
Aimed at improving health and
RTW outcomes for injured workers
and TAC clients through…
 Expectations and shared goal setting
 Increased client engagement during
recovery
 Earlier contact with the employer
 Focus on RTW as a
treatment modality
 Early management of
persistent pain
 Service agreements with providers
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How are we tracking:
–
–
–
–
Still in pilot phase
Expanded provider numbers in physiotherapy
Keen interest from providers to be involved
All Networks are showing positive impacts in initial
evaluations e.g. RTW, return to Health
– All Networks have ongoing model refinements e.g.
better understanding of who certain interventions
work for, therefore better targeting service
models to IW’s or TAC clients needs
– Client experience of Network Providers
more positive
(client survey on provider satisfaction
– WorkSafe & TAC)
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Network Providers - Evaluation of Network Pain
Improved RTW outcomes:
– For WorkSafe
– Network outperformed Non-Network pain management in reducing the number of
days/month in receipt of weekly compensation for clients who were on a partial return to work
at the time of commencing the pain management program.
– Network outperformed Non-Network in the cohort of claims considered to be in receipt of
intermittent compensation for the 12 months prior to the pain management program
– For TAC
– There was a greater percentage reduction in the number of active claims in receipt of LOE in
the Network cohort post pain program compared to Non-Network
Improved clinical outcomes:
– For WorkSafe
– Both Network and Non-Network pain management programs decrease medical and allied
health expenditure across the services examined with Network marginally outperforming
Non-Network pain management
– Pain management programs are particularly effective at reducing ongoing physiotherapy,
allied health and GP expenditure
– The structured nature of pain management supports superior clinical reporting
– For TAC
– Network decreased medical and allied health expenditure across selected key service types
by 50%, far outperforming Non-Network which experience a 30% increase across these
services.
Network Building
– 100% of Network Pain Management providers felt positive about being part of the initiative.
– 80% of respondents indicated their interactions with TAC claims and WorkSafe claims had
improved substantially
Network Providers - Evaluation of
Network Occupational Physiotherapy
RTW outcomes
Health outcomes
Those off work and first physio within 90 days
(n=172):
– 14% improvement in return to work
percentage at 3 months
– No difference in return to work percentage at
6 months
– 15% reduction in days off work following first
physiotherapy session
–
–
–
–
Financial outcomes
–
Those off work & first physio within 90 days
(n=172):
– 10% reduction in income replacement paid
– 25% reduction in healthcare costs
– No difference in physio costs
Those at work & first physio within 90 days
(n=224):
– 25% reduction in
healthcare costs
–
La Trobe University study
OP clients vs standard physiotherapy clients
21 matched participants
Significant improvement in OP clients RTUA
and physical health
scores between 3 to 6 months
Maintenance of mental health scores
between 3 to 6 months
for OP clients
Findings provide support for Occupational
Physiotherapy
Network Providers - Evaluation of Network OT
Measure 2 Liability Impact: : The difference between
Attendant Care (AC) Actual and Attendant Care
Expected comparing Network OT vs Non Contracted
OT's
–
Tool: PWC AC Projections versus Actual post initiative
implementation
–
Result: 0 to 3.5% less growth in AC on network OT
claims compared with AC on non network claims.
Measure 3 Health Outcomes: Goal orientated Therapy
Outcome,
–
Tool: SMART Goals and GAS Results (Network OT
only)
–
Result: TAC Business Intelligence has completed a
statistical analysis of the GAS data which shows that
75% of all clients / injured workers therapy goals have
been achieved as expected or greater. HSG have
invested considerable resources into increasing the
Network OT’s capabilities around setting good SMART
goals and GAS indicators. With this investment and
time it could be expected for this goal attainment
percentage to increase.
Client Focus - Maxim ising Independence
Treatm ent focuses on em pow ering the client to m anage their ow n injury
(Results from quarterly clinical audits beginning October 2010)
120.0%
Percentage results
Measure 1 Provider Capability : Treatment focuses on
empowering the client to manage their own injury,
–
Tool: Quarterly Clinical Audit (Network OT Treatment
Plans vs non contracted OT OTSPs)
100.0%
80.0%
Non Contracted OT's
60.0%
Netw ork OT's
40.0%
20.0%
0.0%
Alw ays demonstrated
(100%)
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Alw ays demonstrated
(100%)
Alw ays demonstrated
(100%)
2
3
Quarterly audit num ber
Network OT's are consistently showing better results than
non contracted OT's on this measure.
GAS Results for Network OT as at August 2011
Provider Strategy - Independence
The Provider Strategy focuses on three service areas:
Attendant Care, Allied Health, Hospitals
Why a Provider Strategy?
• Existing services not always aligned with creating independence
for clients
• Currently purchase limited service models with limited focus
on individual needs
• Growth in attendant care and paramedical costs
• Qualitative research indicates lack of client satisfaction
• Lack of clear evidence base or outcome measures
• Provider feedback re: lack of clear expectations
and alignment in the sector
• Workforce capacity & capability
issues in attendant care
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Key streams of work:
Service models:
– New support models to align with the TAC housing and accommodation strategy to
build and purchase suitable housing
– Develop or purchase service models to align with the TAC Independence model (e.g.
within or outside attendant care)
Provider Capability/Capacity:
– As with Networks, work with our providers to improve the capacity/capability of our
community providers
TBI/ABI and Behaviours of Concern:
– Develop greater understanding of the support needs and current gaps for
clients
– Identify service models that better meet client needs
Partnerships:
– Identify opportunities to partner with other funders, peak bodies
and/or providers
– Opportunities to partner on capability initiatives,
new service models, developing evidence base
on service models
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ReNew Services –
Neurobehavioural rehabilitation program for
TAC clients (E.W Tipping)
– New service model for TAC clients; based on the U.K. BIRT
model (established August 2011)
– For Victorians who have sustained a TBI/ABI and who
require rehabilitation for behaviours we can find challenging
– 20 bed Residential Unit and a transitional unit to
become operational
– Evaluation and performance frameworks developed
with ReNew, regular reporting implemented
– Worked closely with E.W. Tipping and BIRT
on the service model and ongoing to ensure
appropriateness/effectiveness of model
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