Early learnings from the implementation of an Individualised Funding model for seriously injured clients

Presenter: Fiona Cromarty

OUTLINE

Overview of TAC

Explanation of Individualised Funding (IF) model

Progress on implementation of model

The evaluation approach

Some interesting learnings

Sole provider of personal injury insurance for transport accidents in state of Victoria

Victorias population 5.57 million

4.3 million vehicles registered

Compulsory premiums paid with annual vehicle registration

No-fault scheme limited Common Law

TAC funds: treatment income rehabilitation lifetime care lump sums

TAC invests in: Road safety Safer road infrastructure

OVERVIEW OF THE TAC

Number of (active) claims managed by the TAC

Total liabilities as at 30 June 2013

SPREAD OF CLAIMS VS LIABILITIES

Independence (Severely injured clients) 5,300

Recovery (Mild to moderately injured clients) 29,600

Recovery (Mild to moderately injured clients) $1.04B

Independence (Severely injured clients) $6.41B

Potential IF clients

Individualised Funding (IF) is a way for clients with a severe injury to self-manage the services they need, when they need them

It recognises the importance of people's right to have choice and control over their services and the need for services to be flexible

Clients who have been approved for IF receive a monthly funding allocation and accept responsibility for managing and arranging their purchasable services to meet their needs in an individual and unique way

It is also known as self-purchasing or self-directed funding

SO WHAT IS INDIVIDUALISED FUNDING

HOW DOES INDIVIDUALISED FUNDING WORK?

Client receives money into IF bank

account

Client pays

providers

TAC calculates package

TAC reviews: Clients self

assessment form

Claim history

Deposited on first business day of the month

Using online banking or debit card

Client keeps

receipts for

auditing

Client contacts the TAC if their needs

change

TAC contacts client for progress checks at 3, 6 & 12 months

TAC reviews clients

allocation every 12 months 2 years

Client manages own funds and services

Reviews and progress checks

Client signs

Individual Funding

Agreement

TAC assesses

client eligibility

and suitability

Eligibility: severe injury

Suitability of client and calculating the package

THE TACS INDIVIDUALISED FUNDING JOURNEY

In 2004, the TAC piloted Self

Purchasing with seven clients

In 2001, TAC board endorsed Self Purchasing

as key component of

Lifetime Support model

Legislation amended to allow for introduction of

Individual Funding

Agreements into the Transport Accident Act

(1986)

Client uptake low due to complex administration requirements

In 2011, Independence

model implemented as part of the TACs

long-term strategy

In 2013, the Independence

models philosophy of

client empowerment

highlighted need to review current

self-directed funding model

In 2014, implemented re-designed self-

directed funding model with focus on efficiency and

being user friendly

IMPROVEMENTS MADE: Self-Purchasing vs. Individualised Funding

Self-Purchasing Individualised Funding The bank Commonwealth Westpac

Payment Cheques Online banking (BPAY, bank transfer) or debit card

Viewing account balance Physically attend bank and request balance

View through online banking

Deposit amounts Varied deposit amount depending on amount spend in previous month (top up system)

Consistent deposit amount (TAC contacts if amount in account exceeds 20% of yearly allocation)

Individual Funding Agreement

Old agreement of 22 pages Simplified agreement of 6 pages

Contact at the TAC Support Coordinator with other non-self purchasing clients

Support Coordinator with only other Individualised Funding clients

Record keeping Monthly reconciliation process of sending all invoices to the TAC

Keep invoices and produce only if the TAC requests for audit

Demand for IF has been less than what was anticipated Target by 31st October was 46 actual is 15 Goal of 70 clients on IF by 1st January will not be achieved Target did not consider client demand for IF product based on reduction in FTE -

reality is client demand is less than anticipated. Target did not take into account 5 month timeframe to get each person onto IF

PROGRESS TO DATE

IDENTIFICATION ASSESSMENT PANEL IFA SIGNED ACTIVE IF

PROJECTION ACTUAL PROJECTION ACTUAL PROJECTION ACTUAL PROJECTION ACTUAL PROJECTION ACTUAL FEB 2 2 2 2 2 2 MAR 3 3 3 3 3 3 APR 85 85 4 3 0 0 0 0 1 1 MAY 44 52 11 12 3 3 2 3 0 0 JUN 20 32 11 9 10 5 3 2 2 2 JUL 20 12 11 3 10 8 10 1 3 3 AUG 20 32 11 7 10 3 10 2 11 2 SEPT 20 51 11 21 10 2 10 3 12 1 OCT 20 1 11 1 12 3 10 1 12 1 NOV 20 11 10 10 12 DEC 20 11 10 10 12 TOTAL 269 265 92 56 80 29 70 17 70 15

Evaluation Framework

Process review

Banking Solution

Set-up Process

Benefit Realisation

Client Experience

Client Outcomes

Scheme Viability

APPROACH TO EVALUATION

Stage 1. Review of new banking solution only

Qualitative research done with 6 clients

who had been on self

purchasing

Conducted by internal staff

member

Objectives were to identify: Was the new

banking solution and improvement?

Where there other suggestions for improvement?

Findings:

New system very easy to use

Used words like efficient,

convenient, straightforward

Training well set-out

Client pack more useful than

other material provided

Only minor improvements

suggested

Stage 2. Evaluation of

early adopters experience

Longitudinal qualitative

methodology with 10 clients

Conducted by external provider

Objectives were to: Understand

how easy it is to progress through set-up

Explore what is, and isnt working

Identify opportunities for improvement

Findings:

Nil to date due to slow update

PROCESS REVIEW

BENEFIT REALISATION Benefit type Measurement

method Who will do evaluation?

Current performance

Client outcomes Change in pre and post CIQ scores Specific questions in CES

TAC internal External provider

Not known Not known

Client experience Specific questions in CES Decrease in number contacts with TAC

External provider TAC claims system data

Not known Not known

Scheme viability Reduction in of claims administration costs Nil growth in claims payments for IF clients

TAC internal On track to $2.1m reduction in FTE Allocations 4% below projections Utilisation of packages averaging at 78%

CES = Client Experience Survey

OTHER INTERESTING LEARNINGS Most clients contacted like the sound of the model but arent compelled to take it on

Clients want a face to face visit by someone with an in-depth knowledge of the model

There have been more face to face visits than anticipated

Some clients have talked about wanting to keep in contact with TAC, and value the relationship even if it isnt always great

The clients have moved onto the IF model love it and they start to behave like consumers, therefore becoming more discerning with their spending

When clients hear the size of their monthly allowance they are usually amazed at how much it is!

The uptake that TAC has seen is very similar to that seen at the ACC and the NDIS

NEXT STEPS

The evaluation of the implementation of the IF model has only just begun and will continue into 2016

TAC will continue building client awareness of the new Individualised Funding model

Current knowledge indicates that a realistic target for IF uptake is 5 new claims per month, translating to a revised

target of 60 active IF clients by 1st July 2015

TAC will consider the strategic question does IF become the preferred claims management pathway?

THE LAST WORD

As far as accountability, reconciliation and that stuff. It gives you a sense of trust.

Youve lost that big brother mentality. Trust and responsibility as well. Heres the

funding, this is your package, away you go. To manage yourself.

Fiona Cromarty Transport Accident Commission

Any questions?

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