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Employer Centric Service From Research, through Policy to Reality
Tania McFarlane (Claims), Emily Mason (Policy), Mel Pande (Research)
November 2012
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
Some context
New Zealands injury prevention and rehabilitation scheme
Supports injured peoples 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
ACCs vision is to lead the world in injury prevention, care and recovery
The size of it
4.4m
1.7m CLAIMS
PER YR
1 EVERY
seconds
The Challenge
Employer
Claims Management
Insurance Levy collection and account
management
ACC
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
Joined up ACC staff
Customer Centric
value proposition
We will help you
manage costs and
increase productivity
Timeframes March 2011: Initial research and concept development
June 2011: Business Case Investigation `Trial
July 2011 - March 2012: Trial
April 2012 - May 2012: Evaluation
June 2012: Business case Delivery
September 2012: Go live
Making it happen
The role of Policy:
Conceptualise
Challenge, challenge, challenge
Coordinate
Condense information
Communicate concisely
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
The Map
Employer
EmployeeTreatment/
Rehabilitation
Provider
Best Practice RTW (Based on the Better@Work Philosophy)
A coordinated and simple approach between all
parties is essential to facilitate early RTW
ACC
Resources and templates to assist employers with IM.
Tailored IM support via Injury Management
Consultants
ACC manages claims from registration through to exit.
Employer contact is variable
and with multiple ACC
contacts.
A variety of services are available where an external
coordinator works with all
parties to achieve early
RTW (eg Stay at Work,
Better@Work and Fit for
Work trials)
Generally none. Some employers have a dedicated
case manager but this is
done on an arbitrary/ad hoc
basis
Larger employers who meet specific criteria can access
the Accredited Employer Programme
Temporary Earthquake Employer Service
Online materials for employer self-management:
alternative duties for specific industry types
factsheets/ guides
value statement re benefits of injury
management
Employer 0800 number/email for basic enquiries
Employer-Centric Case Management Model
Online information (eg information on entitlements)
Management of non-work injuries
Dedicated key employer contact under Employer-
Centric Case Management
model
Claims briefing/ progress report
Targeted education via workshops
Specialist email and phone support via 0800 number/
Tailored IM support via IMCs, for example:
expert advice
training/ support for in-house RTW coordinator
gap analysis and assistance towards
moving to risk-sharing
options
Incentives and rewards/ sanctions and penalties
Cost-benefit tools to calculate return on
investment for employers
Additional online resources
Absenteeism and wellbeing management services
On-site case management
Self-management options
Key Person Cover
Roll out Employer-Centric Case Management Model
for all Work and Earner
Account injuries
Risk-sharing options
STANDARD CUSTOMER
(default product)
STRATEGIC/ HIGH-VALUE/PRIORITY
CUSTOMER
(+add-ons)
STANDARD CUSTOMER
(default product)
STRATEGIC/ HIGH-VALUE/PRIORITY
CUSTOMER
(+add-ons)
INJURY MANAGEMENT (IM) CLAIMS MANAGEMENT (CM)
CU
RR
EN
T S
TA
TE
PR
OP
OS
ED
FO
R T
RIA
L
(fro
m 1
Oct 2011)
AD
D-O
NS
FO
R F
UTU
RE
CO
NS
IDE
RA
TIO
N
(out of sc
ope)
Consider upgrading products and services to
meet market needs
Proposed Employer-Centric Suite of Services
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 ACCs 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 ACCs 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 ACCs 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).
- Vocational Services Review
- GP Certification Project
Claims
administrator/
coordinator
team
(centralised)
Key Employer
Contacts
(grouped by
industry type)
Relationship
Manager
Employer has injured employee*
*Not med-fee only
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
Custo
mer
valu
e to A
CC
Customer need/ willingness to pay
CUSTOMER SEGMENTATION (indicative)
Standard CustomerStrategic/ High-value/
Priority Customer
Work injury claim is
streamed to relevant
industry group
(non-work injuries =
status quo)
Work/non-work injury
claim is streamed to
dedicated Key
Employer Contact
within relevant
industry group
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
High
Low
High
Standard Customer
Access to standard/ core services
Strategic/ High Value/ Priority Customer
Access to add-ons
Small to Medium employer or Self-employed
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
IPS Customer
Project to
inform
segmentation
(Aug-Sep 11)
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).
Making it happen
The role of Business Lead:
Courage and conviction
Communicator/translator
Connector/conduit
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 Injuriesthis 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
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
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