Improving outcomes for clients

at risk of mental health issues

Bruce 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

TAC scheme & mental health impacts

16,000 claims
received P/A

24,000 claims
under mgt
at any time
Mental Health flags;

49% clients have

identified mental health
issues in high cost teams
(8000 claims)

-Psychology/Psychiatric
treatment
-Mental health related pharmacy
-Mental health flagged during
Common Law process

TAC scheme & mental health impacts

Recovery Combined Liabilities (CL & NF)

Recovery No Fault Analysis

Recovery

Recovery

Ave cost per

claim per year
% of claims

No
Complexities

RTW
$20K

3%
$32K

RTW

54%

$81M

$42M

$81K
$151K
2%

3%

Mental
Health

$9K
32%

$79K

No
Complexities

Total ave cost per

year

$56M

$29M
$54M

2%
$36K

$11M

$15M

2%
$77K
1%

Persistent
Pain

Mental
Health

Version 1.0 March 2011

$12M

Persistent
Pain

BI Analysis Author: Gary Winbolt

TAC scheme & mental health impacts

Mental injury claims increasing
SI Granted, 10-29% Impairment Score
(granted narrative)
600
500
400
Widening
between claims
with a mental
injury as a
component
compared to
pure physical
injuries

300
200
100
0
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

Measurable effect from Richards v Wylie in 2000 :

mental or behavioural disturbances taken into account
in determining seriousness of the physical injury

All granted

If it is decided that, in a given case, the test in paragraph (a) is appropriate because
the plaintiffs 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

Long
Hospital Stay

or

Orthopaedic

Return to work needs

or

or

Soft Tissue

Return to health needs

>

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

Recovery Model (part of TACs 2015 strategy)

Recovery
Model

Early
Identification

Risk
Screening

Active
Management

Client
Outcomes

>

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

The Algorithm claim segmentation

Recovery
Model

>

Developed in-house based on 5 years of claims history

>

Predicts the probability of high cost/complexity

Early
Identification

Risk
Screening

Injury

>

Active
Management

Common
Law
potential

PreExisting
injuries

Previous
Claims

Age

Time from
accident
to claim
lodgement

Using claim form information to segment the claim overnight

to a team following acceptance

Low Risk
(70% of claims)

Early Support
(12%)

Active Management
or Complex
(18%)

Client
Outcomes

>

85% accuracy - measured by claims requiring subsequent

movement to another team within 3 months

Client Conversational Tool

>

Drawn from the Rehab Progress Checklist (ACC in NZ) and

the Trauma Screening Questionnaire (UK )

Early
Identification

>

A series of questions to identify high needs in relation to

RTW, mental health or persistent pain

Risk
Screening

>

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

Active
Management

Client
Outcomes

Active Management

>

Pilot planned in 2012 - motivational interviewing techniques

for Rehabilitation Coordinators in complex RTW cases

Early
Identification

>

Client Profiling by Team - presence of mental health issues

can very from 10% in one team to 70% in another

Risk
Screening

>

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

Active
Management

Client
Outcomes

Client Outcomes
Recovery Branch
- History of Recent Actuarial Releases
10.0

Recovery
Model

5.0

($million)

0.0

Early
Identification

2007

2008

2009

2010

2011

-5.0
-10.0
-15.0

Risk
Screening

-20.0
Year ending 30 June

Active
Management

Client
Outcomes

>

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