Employer Centric Service From Research, through Policy to Reality

Transcription

1 Employer Centric Service From Research, through Policy to Reality Tania McFarlane (Claims), Emily Mason (Policy), Mel Pande (Research) November 2012

2 Today Some context Employer Centric Service - background The challenge The solution Making it Happen Research Policy Business Lead Project Management The Results The Key to Success

3 Some context New Zealand s injury prevention and rehabilitation scheme Supports injured people s return to work, independence or everyday life as safely and quickly as possible Monopolistic environment government policy agenda No fault personal injury cover work and non-work Everyone in NZ, including overseas visitors ACC s vision is to lead the world in injury prevention, care and recovery

4 The size of it 4.4m 1.7m CLAIMS PER YR 1 EVERY seconds

5 The Challenge Employer Insurance Levy collection and account management Claims Management ACC

6 The Solution Current service Levy focused account management Claims management services for injured worker Current value proposition We provide claims services for injured workers Value add service Tailored service based on your business needs Dedicated Claims Manager Customer Centric value proposition We will help you manage costs and increase productivity Joined up ACC staff

7 Timeframes March 2011: June 2011: Initial research and concept development Business Case Investigation `Trial July March 2012: Trial April May 2012: June 2012: September 2012: Evaluation Business case Delivery Go live

8 Making it happen The role of Policy: Conceptualise Challenge, challenge, challenge Coordinate Condense information Communicate concisely

9 Making it happen The role of Research: A key, early partner Willingness to be flexible and tailor approach Adapted to business needs without compromising research best practice Delivered on measuring benefits

10 The Map Best Practice RTW (Based on the Philosophy) A coordinated and simple approach between all parties is essential to facilitate early RTW Employer ACC Treatment/ Employee Rehabilitation Provider - Vocational Services Review - GP Certification Project CURRENT STATE Proposed Employer-Centric Suite of Services INJURY MANAGEMENT (IM) CLAIMS MANAGEMENT (CM) STRATEGIC/ HIGH-VALUE/PRIORITY STRATEGIC/ HIGH-VALUE/PRIORITY STANDARD CUSTOMER STANDARD CUSTOMER CUSTOMER CUSTOMER (default product) (default product) (+add-ons) (+add-ons) Ø Resources and templates to Ø Temporary Earthquake Ø ACC manages claims from Ø Generally none. Some assist employers with IM. Employer Service registration through to exit. employers have a dedicated Ø Tailored IM support via Employer contact is variable case manager but this is Injury Management and with multiple ACC done on an arbitrary/ad hoc Consultants contacts. basis Ø A variety of services are Ø Larger employers who meet available where an external specific criteria can access coordinator works with all the Accredited Employer parties to achieve early Programme RTW (eg Stay at Work, Better@Work and Fit for Work trials) High Customer value to ACC Low CUSTOMER SEGMENTATION (indicative) Strategic/ High Value/ Priority Customer Access to add-ons Large employer or Accredited employer who is capable and willing to support RTW Large employer who does not have capability to support RTW Medium employer who is capable and willing to support RTW and a key influencer of other employers Standard Customer Access to standard/ core services Small to Medium employer or Selfemployed Customer need/ willingness to pay High IPS Customer Project to inform segmentation (Aug-Sep 11) ADD-ONS FOR FUTURE PROPOSED FOR TRIAL CONSIDERATION (from 1 Oct 2011) (out of scope) Ø Online materials for employer self-management: alternative duties for specific industry types factsheets/ guides value statement re benefits of injury management Ø Employer 0800 number/ for basic enquiries Ø Consider upgrading products and services to meet market needs Ø Specialist and phone support via 0800 number/ Ø Tailored IM support via IMCs, for example: expert advice training/ support for inhouse RTW coordinator gap analysis and assistance towards moving to risk-sharing options Ø Incentives and rewards/ sanctions and penalties Ø Cost-benefit tools to calculate return on investment for employers Ø Additional online resources Ø Absenteeism and wellbeing management services Ø Employer-Centric Case Management Model Ø Online information (eg information on entitlements) Ø Management of non-work injuries Ø Roll out Employer-Centric Case Management Model for all Work and Earner Account injuries Ø Risk-sharing options Ø Dedicated key employer contact under Employer- Centric Case Management model Ø Claims briefing/ progress report Ø Targeted education via workshops Ø On-site case management Ø Self-management options Ø Key Person Cover Proposed Employer-Centric Claims Management Model for Trial from October 2011 Key Risks Risks for the Trial The approach will not work if: o ACC is unable to match employers to claims o there is not a culture change in ACC to see the employer as the customer (from a claims management perspective). The approach will be less successful if: o ACC s customers are mostly low injury volume employers o the value proposition (financial value of these products) for employers is not understood or articulated. ACCIS will not be operational so there will not be a system to match products to employers. There will be limited skills/capability/capacity of IPS staff to deliver IMC services and products as a result of the restructure. It will also take time to develop staff in new roles due to the scale of change under the restructure. Short timeframes of the trial may limit ACC s ability to effectively test trial products and services. Risks for Future Development of Service The service needs to fit with product development for expanded risk-sharing options for small/ medium employers and an expanded AEP (IPS). There are a number of barriers for more radical options (eg legislation, systems, resourcing, need for more research and direction). In addition, these options will need to be further developed by IPS (ie flowing out of the IPS Customer Project & overarching blueprint). If the definition for customer segments (eg high-value customer) is not fit-for-purpose across both IPS and Claims Management there will be inconsistencies in service delivery, which may impact on Scheme costs and ACC s ability to meet customer needs. Employers may not want to pay for add-ons (but may be interested in levy discounts). Product pricing must be right. Potential limitations for ACC if the Work Account is opened up for choice of insurer (eg statutory limits on products and services that can be offered). ACC will trial standard and add-on products and services with pre-selected medium to large employers (nationally), and standard products with small to medium employers within 2 pre-selected industries (regionally). Employer has injured employee* *Not med-fee only Strategic/ High-value/ Standard Customer Priority Customer Work/non-work injury Work injury claim is claim is streamed to streamed to relevant dedicated Key industry group Employer Contact (non-work injuries = within relevant status quo) industry group Relationship Manager Claims Key Employer administrator/ Contacts coordinator (grouped by team industry type) (centralised) Key Employer Contact (KEC) Employer claims portfolio management: Respond to queries and channel as appropriate (eg referral to online tools) Build/maintain relationship with employer(s) Up sell to add-on services/products Claims Management - o Undertake risk assessment o Gather relevant information \ o Stream to appropriate management party (including de-escalation of claim to claims coordinator if required) o Complete action plan o Set up relevant entitlements (eg weekly compensation) and services (eg Stay at Work) in a timely manner o Employer liaison (eg support for employers to engage in RTW process) o Liaise with Prevention and Management Consultants, and Relationship Managers as appropriate o Provide regular reporting to high-priority employers re claims experience (eg claims dashboard) Key skills: Industry Knowledge Rehabilitation knowledge Claims Management experience Strong telephony skills Claims Coordinator/ Administrator Claims and Administrative support: General claims administration (eg manage purchase orders, invoice discrepancies, payment information gathering etc) Provide other assistance as delegated by KEC including management of simple claims if required Relationship Manager Key business relationship for high-value employers: Will need to link in closely with KEC to ensure coordinated services/ communication with employer

11 Making it happen The role of Business Lead: Courage and conviction Communicator/translator Connector/conduit

12 So far, so great We have received the very best of service, the results have been amazing and the close communication has been very much appreciated. We have gone from a second class service from ACC to first class service which has saved us time, money & most importantly produced very good RTW results Trial employer Really appreciate your proactive stance to our work related Injuries this is a 1st for me, (re ACC action) in my 7.5 years here. You show all the signs of being from a private & commercial background, as opposed to a governmental one.. ECS employer

13 ECS: Key to success Structural arrangements: The project was a high priority for senior management, and owned by one of the Executive Timeframes and budgets were challenging, but obtainable The project team was hand selected from across the business Findings from evaluations were crucial and acted upon Project management team institutional knowledge Phased roll out meant changes could be implemented and improvements made on an ongoing basis, without compromising evaluation results

14 ECS: Key to success The soft stuff From the outset the project team: Lived uncomfortably Respected each other Concentrated on the areas that were hardest Rolled with the punches

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