Natalie Dubrowin, SANO Consulting Michelle Holian, DE

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Natalie Dubrowin, SANO Consulting Michelle
Holian, DETDaniel Smith, Taylor Fry
Intensive Case Management Review of DET
Victorian Schools
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Overview

• Background current processes
• DET data
• Risk streaming model
• Practical applications of model
• High risk claims
• Low/medium risk claims
• Evaluation
• Implementation
• Learnings

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Background

• 1625 schools
• Departmental structure
• Self-managing schools
• Nine regions
• Central policy coordination (HR)
• 2004 - WorkCover financial accountability policy
• devolved limited WorkCover premium costs
• max 10,000 cost to school
• reinforcing local management of issues

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Confirmed Premium Rate including Initial Premium
Rate for 2004/2005
(using 04/05 Initial Premium figures)
1.80
1.60
1.40
1.20
1.00
Premium Rate
(Premium/Remuneration)
0.80
0.60
0.40
0.20
0.00
1994/1995
1995/1996
1996/1997
1997/1998
1998/1999
1999/2000
2000/2001
2001/2002
2002/2003
2003/2004
2004/2005
A 17 surcharge was applied to the WorkCover
premium from 2000/2001 to fund common law and GST
folw-on costs. This surcharge has now been
absorbed into calculation of
premium and is not shown separately on statements.
10 GST
17 Surcharge
Base Premium
The 10 GST cost also commenced in 2000/2001.
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HSW Improvement Strategy 2004-2006

• Based upon five core strategies
• Safety Culture
• Injury Prevention
• Targeted injury reduction
• Improved Return to Work Outcomes
• Improved WorkCover Premium Management

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Current Processes

• Schools deal directly with Agent
• WorkCover Management Kit
• Agent streaming RAT (Risk Asst Tool)
• Case conferencing
• ORP referral for all time loss claims
• Medical Advisory Service

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Drivers

• WorkCover premium Standard claim numbers
  increased up to 2002/2003
• Requirement for early identification of high risk
  claims
• Need for improvement in case management practices
  including communication with all stakeholders

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Deliverables
Risk Streaming Tool
Claims Injury Management Strategy
Injury Management Package
Communication
Improved Claims and Injury Management
RTW Outcomes
WC Costs
Evaluation
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Initial Review
Risk Streaming Tool - EHB
HIGH RISK
MED/LOW RISK
High risk reviews Weeks 2 4 every 4 weeks
Med/Low risk reviews Week 2
Injury Management Package -Workflows -Templates -T
oolbox
Contextual Issues Template
If gt 2 weeks post date of injury NO RTW has
been achieved, Escalate to High Risk
Employee meetings Week 4 every 4 weeks
Case Conferencing Every 4 weeks every 4-8
weeks (as appropriate)
RTW
Post RTW follow-up Weeks 2 6
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Risk Streaming Tool

• Statistical evaluation
• Used to identify claimants at the time of
  incident/notification of incident
• Why stream?
• Who to manage / focus resources

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Significant Variables

• Standard variables
• DET specific variables
• Job code (primary or secondary)
• Absence type prior to accident date
• Action type prior to accident date
• 2nd most recent action prior to accident date
• Region name
• Accident month

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High Risk Strategy
Initial Review
Risk Streaming Tool - EHB
HIGH RISK
Injury Management Package -Workflows -Templates -T
oolbox
High risk reviews Weeks 2 4 every 4 weeks
Low/Medium Risk Strategy
Contextual Issues Template
Employee meetings Week 4 every 4 weeks
Case Conferencing Every 4 Weeks every 4-8
weeks (as appropriate)
RTW
Post RTW follow-up Weeks 2 6
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DET Injury Management Model

• Initial Review
• Risk Streaming
• Injury Management Package
• Exception based workflows
• Templates
• Toolbox of resource information
• Contextual issues

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DET Injury Management Model

• Employee meetings
• 3 Point Contact
• Contacting the employee, treater and supervisor
• Multidisciplinary Case conferencing
• Critical intervention points
• Post RTW follow-up

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Initial Review
Risk Streaming Tool - EHB
HIGH RISK
MED/LOW RISK
High risk reviews Weeks 2 4 every 4 weeks
Med/Low risk reviews Week 2
Injury Management Package -Workflows -Templates -T
oolbox
Contextual Issues Template
If gt 2 weeks post date of injury NO RTW has
been achieved, Escalate to High Risk
Employee meetings Week 4 every 4 weeks
Case Conferencing Every 4 weeks every 4-8
weeks (as appropriate)
RTW
Post RTW follow-up Weeks 2 6
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Low/Medium Risk Strategy
Initial Review
Risk Streaming Tool - EHB
MED/LOW RISK
Med/Low risk reviews Week 2
Injury Management Package -Workflows -Templates -T
oolbox
High Risk Strategy
If gt 2 weeks post date of injury NO RTW has
been achieved, Escalate to High Risk
RTW
Post RTW follow-up Weeks 2 6
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Low/Medium Risk Reviews

• Initial review
• Has the employee
• RTW
• Full-time, pre-injury position
• Escalation points

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Evaluation of Outcomes

• Feedback Survey
• Actuarial evaluation 3 months post case
  conferencing
• Payment development patterns measured in the
  project group against a control group

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Outcomes
Risk Streaming Tool
Claims Injury Management Strategy
Injury Management Package
Communication
Improved Claims and Injury Management
RTW Outcomes
WC Costs
Evaluation
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Implementation

• Strategy for managing all high risk claims
• Further staff resources
• Training
• Alignment of processes and incentives of
  Authorised Agent
• VWA engagement

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Learnings

• Assist Principals to manage workers compensation
  claims more effectively
• Understand risk drivers
• Seek structured and timely information
• Take control via a systematic process and
  informed decision-making
• More strategic approach to enhance health and
  quality of life outcomes of injured employees
• Reduce costs to Government education system