ACC Better at Work Evaluation GP Certification Claimant Early Return to Workanne Anne Dowden John...

7/23/2019 ACC Better at Work Evaluation GP Certification Claimant Early Return to Workanne Anne Dowden John Wren ACHRF 2012

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Certification Behaviour Change

2ndACHRFAuckland, New Zealand

8-9 November 2012

Dr John Wren

Principal Research Advisor

ACC Research

Anne Dowden

Partner - EvaluationResearch New Zealand

ACC Better@Work EvaluationGP Certification & Claimant Early Return to Work


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Overview

WHYBetter@Work (B@W)the business case

WHAT was B@Wintervention description & model

WHAT& HOW - the evaluation

FINDINGS - six key learning areas

Conclusions& Recommendations


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The Business Case

Research evidencethat early return to work promotesbetter patient health outcomes

Hypothesisthat cost savings of 5% to 20% available to

ACC Scheme

Implementation

> Phased roll-out (three geographic settings over three years)

- Taupo, Hawkes Bay, West / North Auckland

> Evaluation at 12 and 30 months


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Change

GP certification

Active role primary health care

Wider culture change shift for early return to work

Less time

on full WC

B@W Concept


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B@W Desired Outcomes

Earlier (faster) return to work (RTW) of injured workers

ChangeGP Certification Behaviourfrom Certification for Unfit for

Dutiesto Fit for Selected Duties

Cost savingsto ACC Schemethrough less time on full weekly

compensation (WC)

Better patient outcomes- treatment, rehabilitation and satisfaction


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B@W 3 key enablers of change

Economicmotivators> Profit sharing for GPs

> Fair reimbursement to GPs for extra effort engaging with patients

Motivationalinfluencers> GP education, from trusted source, that B@W is good for patients

Processmotivators

> Making it easier for GPs to Certify Fit for Work and Fit for Selected

Duties (E-ACC18 initiative)

> Providing dedicated and embedded B@W Co-ordinator in GP Practices


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Five key learning areas

1. Acceptance of B@W concept

2. GPs as influencers for early RTW

3. Co-ordinator role

4. Social Group Dynamics: other levers at play

5. Summary of Factors motivating GPs

6. Potential level of cost savings


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1.Acceptance of B@W concept

GPs

Great, a service that worksGood: there is a safe role

Employers

I dont have suitable work

Well maybe that will work

Its good to be involvedGreat to know theyre safe

PHO & A+Ms

Revenue stream

Link to GPs

Best practice!

Unions

Just ACC cost savings?

Not sure about this

Injured workers

Ok .. if you say so

I dont think there is work

Good: someone to sort it with the bossGreat: got to get back

Better@Work

ACC

This is an excellent idea

Seeding the RTW idea on day one isexactly right


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1.A stakeholder perspective

B@W feels different tostakeholders Proactive

Early communication

Early action

Very accessible

Injured workers Personal relationship

Learning RTW culture

Active participant

Employers Learning RTW culture

Involved in decisions

B@W is different for GPs Professional assessment of

workplace Collegial

Occupational rehab expert

Coordinates all parties

Better@Work

ACC is providing a great service to GPs.


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2. Influence of GPs

on clients early RTW decisions

GPs important because they are seen as.

Trustworthyand have clients interests as central

Independentof ACC and employer

Informedabout rehabilitation


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3. B@W Co-ordinators

Co-ordinator role seen as criticalto the process

in supporting GPs and clients early RTW decisions

for all except most straightforward situations

Multiple roles

negotiator(facilitator between the parties)

navigator(knowledgeable about ACC scheme and access to aides)

rehab/ workplaceexpert(knowledgeable about safe duties)

safety net for all parties(monitoring safe return to work)


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4. Social Group Dynamics

Worker motivation hinges on:

Individual motivation & skills

High value workers RTW regardless Low value workers have significant barriers to RTW

Employer motivation hinges on:

Importance of worker to business:

higher importance more value in early RTW

Perceived/actual lack of work to do

Fear of exposure to new Health and Safety Risk

Social Group Dynamics as Key Influencing Factors

on early RTW


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Some Union and Health Professionals

have negative perceptions of early RTW concept

believe it is not in best interests of clients

believe it is cost shifting to employers by ACC

4. Social Group Dynamics

Social Group Dynamics as Key Influencing Factors

on early RTW


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5. Factors motivating the GP

Money isnt everything for GPs - but may be important forPractice Managers

GP Certification process that aids change

Easy physical process that enables GPs to change their certification

behaviour is critical

Lessons from electronic claims form (eACC18)

Having trusted and dedicated coordinator role focused on

facilitating early RTW deemed to be critical by GPs


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6. Potential level of cost savings -

hypothesis

Employer wages/salary paymentsACC weekly compensation

Less time on full weekly compensation

Better@Work is a graduateddecrease in weekly comp hours:

Means this:

ACC weekly compensationEmployer wages/salary payments

Earlier RTW


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6. Potential level of cost savings - actual

Logically early RTW should see cost savings

BUT: limited evidence of large reduction in no. of clients

and time spent on fullweekly compensationattributable to

Better@Work

At best 5% could be identified

Better@Work

ACC Weekly compensation

Employer wages/salary payments


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Lead evaluators conclusions

Achieving GP Certification change requires multiple levelsofintervention

GPCertification behaviour changealone, does not lead directly

to early return to workit is but the first stepin a complex social

dynamic

Cost savings are at best incremental, and likely to be traded-off

by increased cost of support required to aid early-RTW

B@W best suited. least suited.

Data sensitivity

Attribution


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Lead evaluators conclusions

B@W has significant intangible value

Enables idea of early RTW (from a trusted source) to be seeded

before expectationsabout time off work become set

is a positive interaction so enhancesGP relationship with ACC

enhances GP understanding of rehabilitation in general, and ACC

pathways specifically

legitimisesand supports GPs in promoting early RTW (for patients and

employers)

provides structure and focus for GPs to actively managerehabilitation

and early RTW


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Please note:

Reflections & Recommendationsfor Future Implementers andEvaluatorsis attached

Questions

Dr John Wren

[email protected]

Anne Dowden

[email protected]


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Dr John Wren

Principal Research Advisor

ACC Research

Anne Dowden

Partner - EvaluationResearch New Zealand

Reflections & Recommendationsfor Future Implementers and Evaluators


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Early-RTW bestsuited for the middle of the rangeinjuriesthose that are neither minor nor major injuries

Minor injuries do not require time off work, or very little time off, and can

be readily managed by GPs

Major injuries need recovery time but are managed by specialists who

provide (relatively urgent) treatment within the first days or first week

following the injury

Conclusions


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Conclusions

B@W bestsuited:

manual work

useful when a small business where the bossthinks the worker must

RTW only when fully fit or not at all

an important role where an injured worker is not motivated/needs a pushor there is a psychological barrier to RTW

B@W least suited:

is typically not needed for office work

less suited to highly mobile casual work such as casual agricultural work

highly motivated injured workerswho are so keen they can negotiate

RTW without ACC and will RTW with one leg missing


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Data sensitivity challenges

Change was more gradual than expected (hours, not days or weeks)

Measuring change in GP Certificate days not readily accessible

Data limitations undermined ability to monitor implementation progress, and

degree of achievement of desired outcomes

Reflections

NO monitoring data

graduated RTW hours


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Reflections

Beware of Attributionchallenges

Several programmes / interventions impact claim pathway

ACC wide culture change

Economic drivers: Recession behaviour of workers, GPs

What else contributed

to the change?


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Reflections

Attributionchallenges

culture change & programmes

eACC18 design > > > > Roll out > > > >

2007 2008 2009 2010 2011

Stay at Work service

Fit for work

extension

Service Delivery Model

Better@Workpilot

RIS Return to independence service

Claims Management STCC, Branches


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Evaluation Recommendations

Monitoringneeds to be sensitive enough to capture gradualchanges in amount of weekly compensation paid, hours / days

return to work, and GP certification

Monitorattitudinal and behavioral factors

All key stakeholders: GPs/A+Ms, injured workers, employers and

possibly staff/case workers

barriers to change in GP certification

barriers in actual early RTW

progress towards long term, sustained culture change of early RTW

ACC Better at Work Evaluation GP Certification Claimant Early Return to Workanne Anne Dowden John...

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