ACC Update Strategic direction, ACC32 process, Service updates

Transcription

1 ACC Update Strategic direction, ACC32 process, Service updates Jon Gaupset Kim Eland 13/06/2015

2 1 Shaping Our Future

3 Create a model of trust Opportunities to simplify current processes and support providers through better monitoring Develop a provider profile to identify and adjust our monitoring practises o Recognise those who are performing well and provide support to those that need it o Better feedback loops / sharing of data and information o Collaboration with professional bodies 3

4 Build closer partnerships Greater collaboration and shared understanding through initial and on-going education and support o Use of sector websites for messaging / dashboard data / e-learning opportunities o Working with educational institutions o Local relationships (i.e. Knowledge Cafes) o Shared best practice resources o Continued external sector input into service design 4

5 Better integration with practice management systems Earlier identification of client need o Reduce your time spent doing ACC administration o Enable faster cover / entitlement decisions o Support providers with decision-making tools o Quicker, easier access to ACC funded services 5

6 2 ACC32 process

7 Current state 60,000 ACC32s lodged each year Approx. 90% lodged by physiotherapists Around 90% approved 5-10% require Clinical Advisor (CA) 7

8 Background Trial commenced in 2014, working with 200+ physiotherapy providers Phone and web-based processes being trialled Largely approval by Claims Officers, but if criteria not met Clinical Advisor to discuss with provider Trial still in progress whilst options are considered 8

9 Key feedback Simplicity of process Predictability and timeliness of response / decision-making Ability to speak directly with Clinical Advisor 9

10 Intent for future process Reduction in administrative constraints and greater emphasis on delivery of client outcomes Design a process to work with the sector, for the client: o o o o Extend the existing phone-based service (post-surgery requests) to work for a wider range of requests Reduce form completion requirements for low risk / high volume requests More predictable and consistent decision-making Greater direct communication with providers to allow faster resolution 10

11 Alignment with ACC s strategic direction Model of trust Closer partnerships Earlier identification of / responsiveness to client need 11

12 3 Electronic invoicing

13 Changes Project: Moving from ACC legacy billing format Electronic Data Capture (EDC) to a newer more empowering format, eschedule. Driver: Duplicate vendor and provider records exist to support EDC resulting in the risk of privacy breaches. Process: Once practices are upgraded to eschedule then ACC can remove the duplicate records.

14 Benefits for you eschedule - may contain details for treatments performed by different providers on different ACC claims on different dates for a single organisation (vendor) For practice managers / administrators - simplified billing with ACC where: User is notified immediately by the system of submission failures rather than being notified later by ebusiness staff Consolidated payments are received for the practice rather than payments for each provider Reduction in remittance advices Increases self-service i.e. less reliance on support calls to ACC.

15 Electronic Invoicing PMS - already capable and all Practices are using ealth, Excellent, Gensolve, Incisive (SPMS), Orthosintegrator, Phys-iOS, Quick-as PMS - already capable and we are still in contact with Practices re using eschedule Houston nearly completed MyPractice major push soon Peak (Account 4 IT) nearly completed PMS - nearly ready to go so we will be contacting you Medtech 32, Medtech Evolution PMS - where we are soon to start to working with the vendor Clinicade, COMRAD, File Maker Pro, NZ Physio Pro, Profile for Mac, Profile for Windows

16 Elective Services Pathway Programme Update

17 Elective Services Pathways Programme Six work streams Priority: OUTCOMES FUNDING SERVICE INTEGRATION Outcomes Framework Sharing evidence-based data Outcome Measures Elective Services Funding Framework Elective Surgery Funding Model Transparent pricing Purchase value Right treatment Right place Right time Three supporting work streams to be progressed subsequently: BUSINESS IMPROVEMENTS WORKFORCE COMMUNICATIONS

18 Elective Services Pathways Programme Three phases Sector working group makes 129 recommendations Work programme planning & set up Review Phase 1 Scoping & analysis Phase 2 3.1: Detailed scoping Redesign Phase 3 3.2: Development 3.3: Implementation BAU Need for review identified (Aug 13) Approval to set up work programme (Nov 14)

19 Programme and priority work streams update - summary June 2015 PROGRAMME Putting structures in place for three year programme Elective Services Pathway Programme external advisory group being established OUTCOMES FUNDING SERVICE INTEGRATION Outcomes advisory group being established. Identifying requirements for quality indicators and framework underway. Elective Services funding framework and elective surgery funding model discussions with sector started last week. Evaluation of GPs with a specialist interest in musculoskeletal medicine service (GPSI) started this month. 19 Author/Unit

20 Contact us Jane Kelley Elective Services Pathway Programme Director ACC Justice Centre Level 8 PO Box 242 Wellington NZ ESPathway@acc.co.nz acc.co.nz 20

21 3 Vocational and Pain Management Update on Key Initiatives

22 Vocational Medical Services To be implemented on 01 July 2015 Consolidates Clinical Review Fitness for Work Service, Initial Medical Assessment and Vocational Independence Medical Assessment Introduces two new components to support vocational rehabilitation and the Stay at Work service Those providing service under the Vocational Rehabilitation contract can utilise/direct refer for components of this service 22

23 Vocational Medical Services Two new components: 1. Vocational Medical Assessment Medical Assessor case conference or liaison support for the General Practitioner, Vocational Rehabilitation Service Provider or ACC Staff 2. Vocational Medical Review Medical Assessor consultation either as an early intervention, ongoing intervention or new intervention during the clients vocational rehabilitation 23

24 Changing the Way We Support Clients with Pain Full redesign of ACC s Pain Management services is underway Potential implications for all eight Pain Management contracts including Functional Reactivation Programmes. Consultation on the key themes underpinning the redesign in May 2015 generated minimal additional feedback A new service design concept is now being developed and will be published for consultation in July 2015 ACC will approach the market in late 2015 to select participants to work with on the more detailed process design and a regional pilot. New service in 2016 More information can be found by searching for Redesigning Pain Management at 24 Author/Unit

25 Vocational and Pain Management Services Contact Nic Johnson Category Manager Vocational and Pain Management Services Phone: Author/Unit

26 4 Physiotherapy services

27 Invoicing Type 2014 Calendar Year Claims (thousands) Treatments (millions) Spend (millions) Regulations (Hour) $39.0 Regulations (Flat) $2.3 Total Regulations $41.3 Contract $62.9 Total $104.1 Spend Share 60% 38% Regulations (Hour) Regulations (Flat) Contract 2%

28 Claims (thousands) Treatments (millions) Spend (millions) ACC claims, treatments and spend by calendar year Claims, treatments and spend under regulations (hour) are growing by +14.2%, +17.7% and +14.1% a year whereas claims, treatments and spend under contract are growing by +2.2%, +2.6% and +1.5% a year $70 $60 $50 $40 $30 $20 $10 $0 Calendar Year Regulations (Hour) Regulations (Flat) Contract Total Regulations Calendar Year Regulations (Hour) Regulations (Flat) Contract Total Regulations Calendar Year Regulations (Hour) Regulations (Flat) Contract Total Regulations

29 Regulations (Hour) Regulations (Flat) Contract Total Regulations Cost Per Claim Average Treatments Per Claim Estimated Average Treatment Time (minutes) ACC cost per claim and average treatments per claim by calendar year and estimated average treatment time Average treatments per claim is about 5.1 across time and payment type, but estimated average treatment time differs by payment type. $ $200 $ $160 $140 $120 $ Calendar Year Calendar Year 0 Regulations (Hour) Regulations (Flat) Contract Total Regulations Regulations (Hour) Regulations (Flat) Contract Total Regulations

30 Contract Currently expires 2017 Open to feedback on how the contract could work better No significant review currently planned at the moment - outcomes of the Elective Services Review may create some opportunities Accreditation framework 30 Author/Unit

31 Physiotherapy service Contact Jon Gaupset Category Manager Primary Care Phone: Jacqui Collinge Category Advisor Primary Care Phone: Author/Unit

32 Thank you