There is a better way to manage workplace injury claims and rehabilitation for the overall benefit of employee wellbeing, according to industry experts who gathered at the recent WorkReady event series, hosted by CommInsure.
The free events, which ran in Brisbane, Melbourne, Hobart and Sydney from 14 – 23 November 2017, discussed workers’ compensation and group insurance systems with an audience of almost 200 employers and superannuation fund representatives.
The panel of speakers from Willis Towers Watson, Swiss Re and CommInsure, along with Health Executive and Leadership Consultant, Mark Newton, argued that current rehabilitation services are missing a level of collaboration that best serves the employee.
“The different systems can often provide different or competing services or solutions, making the administration of claims difficult for employers and downright confusing for members. This can lead to an over emphasis on the administration of the claim and not enough emphasis on the member,” said Ciaran Curley, CommInsure’s Head of Claims Strategy and Optimisation.
Here’s five key take outs from the WorkReady events:
1.Major challenges in claims management – but things are getting better
According to Michelle Ware, Workplace Risks Manager at Willis Towers Watson, a major challenge in the workers’ compensation landscape is the variation between the 11 state, territory and federal jurisdictions.
“Each jurisdiction has a completely different set of regulations, premium models, benefits for injured workers and employer responsibilities. This makes it difficult for employers who are operating in all jurisdictions to manage their workers’ compensation arrangements,” she said.
Similarly, Newton described the current health services ecosystem as being complex and inefficient. Clinical variation (for example, across regions, facilities, funding types and clinicians), along with a lack of integration between systems and governments, has led to complexity for all stakeholders involved.
“We have an inefficient and sub-optimal set of arrangements. This results in waste, over-testing, over-diagnosis, ineffective care and sometimes even inappropriate care,” he said.
2.The right diagnosis at the right time is critical
Carly Van Den Akker, Claims Rehabilitation Manager at Swiss Re, argued that the best approach is to act early on claims and tailor rehabilitation to the individual. This is particularly important for mental health conditions, which are estimated to cost the Australian economy $40 billion annually in direct and indirect costs and lost productivity.
Following a workplace injury, an employer needs to intervene quickly and take appropriate steps to ensure the correct diagnosis is made at the earliest opportunity by the right professional.
“Focus first on the person, and second on the liability,” she recommended.
3.Returning to work should be part of the recovery plan
Helping the employee return to work should be seen as part of the treatment plan, with Van Den Akker advising that going back to good work is an important part of the recovery journey.
“There is compelling evidence that ‘good’ work is generally positive for health and wellbeing, and that long term work absence, work disability and unemployment generally have a negative impact on health and wellbeing,” she said.
4.Leverage technology and data to improve processes
Newton put forward a case for leveraging technology to improve rehabilitation schemes: “There is certainly benefit from leveraging data to deploy an integrated rehabilitation and return to work program.”
He recommended that the industry considers implementing strategies such as electronic Evidence Based Medicine systems, automated decision making, real-time approval and auto referrals to registered diagnostic providers.
5.Collaboration and integration are the keys to success
Summing up, Curley put a call out for stakeholders to collaborate more closely:
“We need to create a model that is more integrated, promotes greater collaboration and supports better outcomes for all stakeholders.
“It’s a first step but one that we think is important. Recognising the challenges faced by many and finding ways we can better collaborate to drive improved member outcomes should be a challenge we all get behind.”
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 ‘Contributing lives, thriving communities’: Report of the National Review of Mental Health Programmes and Services, November 2014