Approved Rehabilitation Provider Renewal outcomes for providers and case managers

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Approved Rehabilitation Provider Renewal outcomes for providers and case managers. Alex O’Shea – Director SRC Policy Section. Comcare’s Strategic Framework. - PowerPoint PPT Presentation

Transcript of Approved Rehabilitation Provider Renewal outcomes for providers and case managers

  • Approved Rehabilitation Provider Renewal outcomes for providers and case managers Alex OShea Director SRC Policy Section

  • Comcares Strategic Framework

    The framework identifies a range of connected strategies delivered by Comcare to achieve the employer objectives. These strategies include providing advice and education, investigating compliance and supporting rehabilitation.

  • Provider renewal - The SRC Act requires itapproved rehabilitation providers (ARPs) must apply every 3 takes up resources for Comcare and providersallows for review of standardsComcare must be satisfied that . . .

  • 3 stage process of renewalApplication self-audit of closed cases against standardsapproach to managing complex cases

    Assessment of past performance against:-RTW outcome - 90%, median cost - $1,590 (now $1,890), median duration - 19 weeks, service standards (timeframes etc)future performance assessment Written decision

  • The outcomeThere were 180 ARPs in the system at December 2006. Comcare received 130 renewal applications and most were renewed

    a small number of applicants were not renewed about 20%, including large and multi-state ARPs, were granted conditional re-approval.

  • Other outcomesComcare strengthened its communications with ARPs

  • Other outcomes (continued)Comcare observed successful and unsuccessful ARP employer service delivery models

  • Other outcomes (continued)Comcare observed strengths and weaknesses in its RTW model

  • Messages for case managersknow the ARP outcome and service delivery standardsengage ARPs who deliverdevelop Service Level Agreements with ARPs

  • Messages for case managersbuild robust RTW management systems which:Build strong employer commitmentHave clear policies and proceduresPlan and implement actions and get resourcesAre regularly reviewedAllow for continuous improvement

  • Messages for ARPsUnderstand role of ARP in this jurisdictionDevelop service level agreements (SLAs)Use audit checklists and report on performanceSeek feedback from case managersHave management systemsUndertake Comcare training

  • Messages for ComcareComcare will work with conditionally approved providers to ensure their performance meets standardsMonitoring performance is important for everyone Comcare, employers and ARPsWork is being conducted through HWCA on a model of national provider approval

  • Website:

    Phone: 1300 366

    Represented diagrammatically, this strategic framework sets out how we work with our employers and their employees to achieve the vision of Australias Safest Workplaces.

    Achieving this vision is critically dependent on our relationship with employers and, through them, their employees.

    This framework defines the key employer objectives that Comcare works to deliver.

    Being clear about these objectives allows us to define the products, services and processes through which we deliver a difference for employers-prevention of injury employers have safe and healthy workplaces-compliance with legislation employers meet their duty of care-support during injury employers assist injured employees.

    Comcare undertakes the supporting rehabilitation function at the system level.

    This includes the approval and renewal of approval of rehabilitation providers and as this presentation hopes to illustrate passing on lessons and messages from this process to improve the supporting rehabilitation function.

    S34 of the SRC Act Approved Rehabilitation Providers (ARP) are approved by Comcare to operate in this jurisdiction and must apply for renewal each 3 years to ensure ongoing approval (SRC Act requirement). At the end of 2006 there were some 180 ARPs.

    A formal application is required. Comcare must assess each application against criteria and standards established under the SRC Act.

    To renew an ARP applicant, Comcare must be satisfied that the ARP meets criteria and has met the required outcome standards (effectiveness, availability and cost) and service standards (qualitative and quantitative measures) over the previous renewal period, has delivered at least one program and demonstrates the capacity to meet the standards in the next renewal period.

    Comcare reviewed the standards prior to the renewal exercise after consulting with the jurisdiction on need for any changes

    There were 3 stages in the renewal process:

    The provider completes the application for renewal (including a self assessment tool involving an audit of selected closed return to work plans against the existing operational standards). Applicants were also asked to explain their approach in managing complex cases those involving psychosocial factors and how they would manage such cases as consistent with evidence based medicine.

    Comcare assesses the application and providers performance against the criteria and operational standards. This process was interactive and consultative in nature, and provided an opportunity for dialogue and clarification concerning strategic and quality assurance issues and priorities as seen by both sides.

    Comcare issued a written decision either renewing, renewing with conditions or refusing to renew the providers approval.OutcomesComcare completed a successful renewal project which ran from late 2006 to 30 June 2007 and renewed the approval of 133 ARPs to operate in the new period. Comcare has also approved some 15 new providers to operate in this jurisdiction since 1 January 2007.

    A small number of ARPs were not renewed as they had not met the standards in force for the last approval period. Another 30 ARPs did not apply for renewal as they would have been unlikely to have met the required standards.

    Of the providers renewed, approximately 20% were granted conditional approval due to inconsistent performance being noted either against a specific criteria or operational standard (service or outcome standard) or inconsistent performance across their service delivery sites. These included a number of major and multi-state ARPs.

    Comcare has imposed additional conditions of approval on the conditionally approved ARPs with each of these ARPs being required to put in place specific strategies to address the issues noted in the renewal assessment.

    They will need to satisfy Comcare that they can achieve satisfactory performance prior to 31 December 2008 to ensure their ongoing approval. CommunicationARPs now have a greater awareness of their performance against the outcome standards and service delivery standards especially the need to measure their performance and report outcomes to employer case managers

    National ARPs have a greater awareness of variations in performance between their regions and the need to improve outcomes in poorly performing regions

    ARPs need to improve their understanding of RTW service provision in the SRC jurisdiction, especially in seeking to achieve the goal of RTW to same job-same workplace and the role of the case manager in identifying suitable duties

    Service Delivery models

    Most licensees and ACT Government have in place service delivery agreements with ARPs which specify outcome goals, reporting against standards and other service delivery issues such as the role of the case manager and the nature of vocational rehabilitation services to be provided by the ARP. These models generally achieved better outcomes.

    Those employers who did not manage ARP service delivery up front generally achieved poorer performance outcomes sometimes from the same ARP with a service delivery arrangement with a licensee!

    The more involvement from the employer (cases which were workplace based and where the case manager undertook active case management) were more successful

    Cases without a delay in referral to the ARP were more successful

    ARP were being asked to continue their involvement and keep plans open despite their professional recommendation being to close a plan. (ARP involvement at this stage was largely case management activity)

    Significant delays and costs were seen to arise from delays in the employer identifying suitable duties

    The Model strengthsAn employer based case manager (decision maker on RTW under the SRC Act), rather than in the claims agent, is best placed to effect early intervention, identify suitable duties for early RTW and to engage an ARP to deliver an outcomes based vocational rehabilitation plan tailored to the needs of the employee and the workplace

    ARPs have the capacity to become and remain experienced, expert and engaged in RTW service delivery in the SRC Act jurisdiction

    This capacity was best observed when employers and ARPs develop a strong relationship and clear expectations of service delivery and performance and especially the respective roles of the employer case manager and the contracted ARP

    The Model weaknessespoor case management is a weak point in the system. If case managers do not refer early, if they are unable to identify suitable duties, if they rely on the ARP to deliver case management services, and if they do not manage ARP service delivery effectively poor outcomes will result.

    Poor ARPs are also a weak point. If they have not invested in SRC Act RTW-model knowledge; if they do not have management systems which track their performance against the achievement of outcomes and service standard goals; if they deliver ongoing services outside the workplace based model; if they deliver services not in keeping with evidence based medicine or which do not recognise unaddressed psycho-social barriers poor outcomes will result