The Victorian Transport Accident Scheme. Heather Evans General Manager, Strategy

Transcription

1 The Victorian Transport Accident Scheme Heather Evans General Manager, Strategy

2 Agenda 1. Overview of the Scheme 2. Recent Performance 3. Key Initiatives

3 Who is the TAC fully funded combined no-fault and common law scheme monopoly CTP insurer in Victoria with 3.6 million insured vehicles established by the Transport Accident Act 1986 owned by the Victorian government with independent Board & Managing Director 630 staff $6.8 billion assets - $5.6 billion liabilities

4 The TAC Scheme a hybrid no-fault/common law scheme cover ALL people injured in a transport accident on a no-fault basis other driver passengers pedestrians trains and trams limited common law rights for pecuniary loss and pain and suffering for the seriously injured medical excess ($564) and mandatory police reporting to reduce frivolous claims medical and like benefits continue for life - cannot be bought out a long-tail scheme, providing benefits for life benefits include medical, paramedical rehabilitation, lifetime support (eg attendant care), equipment, etcetera

5 The TAC Product Medical, Rehab, Home Services Lifetime Support Income Clients Pain & Suffering Economic Loss Impairment

6 Date of Accident except medical excess MEDICAL SERVICES HOSPITAL AND LIKE EXPENSES except the first five working days REHABILITATION LOSS OF EARNINGS 18 Months 3 Years Retirement Age if 50% or more impaired LOSS OF EARNING CAPACITY DISABILITY SERVICES LOSS OF EARNING CAPACITY someone to sue and serious injury COMMON LAW: PECUNIARY LOSS COMMON LAW: PAIN & SUFFERING IMPAIRMENT LUMP SUM IMPAIRMENT ANNUITY

7 Recent Performance

8 Sound financial performance. Profit from Internal Factors / / / / /04 actuarial release of $118 m funding ratio of 116% investment return of 13% $590 m after tax profit

9 Lowest road toll in 2003/04. Victorian Road Toll * * 12 months to October

10 Hospital claims also reducing. Hospitalised (> 1 day) Claim Lodgements Jul-02 Aug-02 Sep-02 Oct-02 Nov-02 Dec-02 Jan-03 Feb-03 Mar-03 Apr-03 May-03 Jun-03 Jul-03 Aug-03 Sep-03 Oct-03 Nov-03 Dec-03 Jan-04 Feb-04 Mar-04 Apr-04 May-04 Jun months to...

11 Majority of claims are minor injuries. 15% Minor Injuries 16,000 Moderate Injuries 2,900 Major Injuries 800 4% 81%

12 We are controlling paramedical benefits. 1.4 Paramedical/Rehab/Equipment Benefits Inflation Adjusted Payments Index / / / / / / / / / / / /04 Payment year Non-MID MID

13 Common Law benefits are stable. Average Settlement Size (June 2004 $'000) Jun-95 Jun-96 Jun-97 Jun-98 Jun-99 Jun-00 Jun-01 Jun-02 Jun-03 Jun-04 Transaction Period

14 Client satisfaction is at a record high. 7.2 Client Satisfaction Score Feb-00 Jun-01 Jun-02 Jun-03 Jun-04

15 Key Initiatives

16 Key Initiatives 1. Legislative Changes 2. Alternative Dispute Resolution Protocols 3. Clinical Justification 4. Lifetime Support Initiative

17 1. Legislative Changes

18 Why amend the TAC Act? address inequities improve efficiency improve benefits where gaps keep up to date with changing society clarify problematic definitions that lead to dispute

19 About the amendments. 37 clauses $11 million in extra new benefits each year $8 million extra impairment benefits to accompany improvement to dispute resolution anticipate full implementation by March passed by lower house of Parliament

20 What the amendments will do. simpler and faster calculation of loss of earnings decreased administration with self purchasing and travel allowance speedier determination of impairment and flexibility to make interim payments fairer and more logical eligibility criteria for home services and childcare benefits return to work travel benefit provides another option for vocational support

21 A walk through the key changes. 1. individual funding agreements 2. revised home services and childcare benefits 3. post hospital support benefit 4. travel benefits 5. income benefits 6. impairment reforms

22 Impairment benefits increase substantially. $300,000 $250,000 $200,000 Proposed $252,000 $150,000 $120,000 $100,000 $60,250 $77,710 $50,000 $0 $5,500 $30,000 $60,441 $863 $34,538 $17,269 Current Impairment Level (%)

23 2. Alternative Dispute Resolution Protocols

24 Protocols - Why change? improve decision quality and consistency reduce time to resolve disputes reduce common law timeframes reduce the costs of dispute management recognise plaintiff lawyer contributions through three non-legislative protocols agreed between the TAC, LIV and APLA.

25 Resolving civil disputes outside the adversarial system is a priority Central to our commitment to provide access to affordable high-quality justice.

26 Protocols Key Features early exchange of information pre-court meetings event-based legal cost funding model

27 3. Clinical Justification

28 Provider perspective: A Clinical Justification Approach Use of at least two Standardised Outcome Measures Improved Rehabilitation Attained pre-injury function When outcome measures are improving rehabilitation phase demonstrates a return to pre-injury status plateau marks end of rehabilitation Cease therapy management

29 The plateau. 80% Oswestry Score - Client 1 70% 60% 50% 40% the plateau 30% 20% 10% 0% Dec-03 Jan-04 Feb-04 Mar-04 Apr-04

30 Provider perspective: A Clinical Justification Approach Use of at least two Standardised Outcome Measures Improved Unchanged or Deteriorated Review diagnosis & management Rehabilitation Attained pre-injury function When outcome measures plateau consider working diagnosis watch red flags/yellow flags assess patient compliance/understanding consider placebo/dependence issues Cease therapy management

31 Guide to selection and interpretation of Standardised Outcome Measures

32 Summary clinical practice must be clinically justified goal setting - client & provider outcome measures provide a long term record of health evidence is required for selection and continuation of treatment the same parameters used in everyday practice should be applied to TAC clients

33 There is reduced servicing where efficacy of treatment cannot be demonstrated. Physiotherapy (private) Osteopathy Chiropractic Speech Therapy (private) 17% reduction 31% reduction 17% reduction 7% reduction rolling 12months to August

34 5. Empowering Clients: A Better Approach to Lifetime Support

35 Why focus on lifetime support? we always want to improve outcomes for clients play a role in supporting the Victorian Government s State DisAbility Plan ensure our financial resources are used effectively to support clients now and in the future

36 We knew there was a better way Medical Model Social Model decisions driven by medical opinion focus on recovery segregated environments decisions driven by client needs and goals focus on abilities community inclusion and lifestyle

37 Clients going home faced real challenges Community Life Accident Acute Phase Rehabilitation Phase Transition Phase Community Life Medical Focus Social Focus

38 Our new approach. person-centred practice focus on community life focus on outcomes CLIENT selfpurchasing options greater choice

39 Person-centred, not TAC-centred. Community TAC Providers Work Friends Leisure Family Personcentred practice Focus on outcomes Selfpurchasing options Focus on community life Greater choices

40 Focus on community life. Achievements Individualised planning in place 170 clients supported by Case Managers through transition home > 200 clients who were already living in the community have been engaged in elements of the new process completed research into client discharge experiences Focus on outcomes Personcentred practice Selfpurchasing options Focus on community life Greater choices

41 Greater choice home. Achievements clients with high support needs can have one carer per day, rather than multiple carers on multiple shifts more than 100 client living in more than 20 community houses now partnering with the health department and other disability groups in community house development 4 more rural clients living in the community and not in nursing homes Personcentred practice Focus on outcomes Selfpurchasing options Focus on community life Greater choices

42 Greater choice work. Achievements 12 clients in supported employment including: gardening window cleaning hospitality traineeships 5 clients in open employment Focus on outcomes Focus on community life More choice Personcentred practice Selfpurchasing options Greater choices

43 Greater choice leisure. Achievements clients now choose interest-based community activities agencies appointed in each Melbourne metro region and two rural regions to coordinate activities 114 clients participating in their preferred supported leisure options Focus on community life More choice Personcentred practice Focus on outcomes Selfpurchasing options Greater choices

44 Self-purchasing options. Achievements established a model that gives clients control over their services engaged with the community to develop the model brokerage pilot up and running with 7 clients participating legislation about to be passed to allow individualised Personcentred funding agreements practice Focus on outcomes Focus on community life Selfpurchasing options Greater choices

45 Focus on outcomes Achievements through individual plans, clients and TAC can track lifestyle changes now capturing home, work and leisure outcomes continuous improvement of client s discharge experience by responding to client and case manager feedback Personcentred practice Focus on outcomes Selfpurchasing options Focus on community life Greater choices

46 Summary of achievements Lifetime Support is a reality! person-centred planning is in place over 130 clients have engaged in various work, leisure or home options clients are better informed and engaged the approach is making a real difference to clients lives building expertise and infrastructure for all of Victoria TAC is gaining credibility in the community

47 Sustainable growth means long term security 35% 30% 25% 20% 15% 10% Annual Growth in Attendant Care Payments 31% 26% 17% 10% 8% 5% 0% 98/99 99/00 00/01 01/02 02/03 03/04

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