Table 2 Indicators by stakeholder and action area PoC indicators Employer indicators Insurer / agent indicators System indicators Action area 1: Developing management practices for psychological claims Empowerment and satisfaction. Timely access to treatment, injury management and rehabilitation services. RTW as well as health and social outcomes. PoC perception of communication: proactive, timely, responsive, collaborative. Premiums. Worker productivity. Costs associated with making reasonable work adjustments. Satisfaction with claims process and communication. Disputation level. The number of days between lodgement and eligibility decision. Proportion with an appropriate claim and injury management/ rehabilitation strategy in place. Proportion with sustainable recovery/RTW. Communication and relationships. Assessment and risk identification. RTW planning. Implementation of services. Timely and appropriate assistance for the PoC. Monitoring and review. Disputation and dispute resolution rate. RTW rate. Claims costs. Number of days between lodgement and eligibility decision. Proportion with an appropriate claim and injury management/ rehabilitation strategy in place. Proportion with sustainable recovery/ RTW. Proportion of claims with GP/ employer case conferences. Affordability, efficiency and sustainability of the arrangements. Action area 2: Optimising claims management Higher PoC satisfaction and social and health outcomes. Improved communication and collaboration with employers, treating practitioners and stakeholders. Training provided to case managers. Higher staff satisfaction and reduced turnover among claims managers. Improved use of specialist expertise and decision-support tools to inform decision making. Reduced time spent on eligibility decisions. More timely decisions and action on claims.
Action area 3: Engaging and supporting employers Better claims experience thanks to timely intervention, supportive interactions with employers, positive rehabilitation and treatment experience, as well as successful RAW/RTW. Satisfaction, recovery and wellbeing. Increased worker productivity and reduced absenteeism, staff turnover and separation costs. Reduced costs associated with reasonable work adjustments. Employers feeling supported throughout the process, including understanding of claim decisions and assistance in resolving interpersonal issues between a PoC and others in the workplace. Improved claims metrics, including the number and duration of claims as well as the durability of RAW/RTW for a PoC. Metrics should be used as part of a holistic assessment of performance, taking into account the limitations of these measures. Stronger relationships between stakeholders that build capacity for developing alternative pathways for people with psychological injuries. Action area 4: Bringing evidence to treatment and rehabilitation Improved health, social and RAW/RTW outcomes. Increased PoC satisfaction with the quality and of treatment. Increased PoC satisfaction with quality of rehabilitation programs. Improved collaboration with GP’s, for example case conferencing. Increase in interventions for psychological injuries and rehabilitation. Improved for insurers and agents and the PoC concerned when it comes to health services (reduction in waste). based
Action area 5: Effective decision making supported by analytics and automation Satisfaction of person on claim. Quality of decisions measured by PoC health and social outcomes. Premiums. Satisfaction amongst PoC, Employer, Staff and Stakeholders. Retained business. Timeliness of decisions, end-to-end turnaround time of claims. Consistency in claims processing and decisions, including those relating to evidence-based care, which would improve efficiency and effectiveness. Fewer unnecessary referrals to health and medical advisors, which would reduce costs and unintended harm. Integrated claims processing amongst all parties, which would improve efficiency and effectiveness. This might also lead to improved relationships, which in turn might lead to greater capacity for upstream interventions to support people at time of need, rather than crisis. RTW metrics, claims costs and subsequently premiums. Data sources Data sources can be either quantitative or qualitative. It is important to have indicators that will show change in the short and medium term, and these are often derived from qualitative data, such as changes in attitudes, knowledge and practice, and changes in satisfaction, as well as outcome indicators that will give the hard facts, in terms of improved claims’ costs, productivity measures and health outcomes, but take much longer to be measured. Do’s and don’ts Here are some basic do’s and don’ts in recording progress. Things to do: Monitor and evaluate at all stages of the claims management process. Recognise that although monitoring and evaluation have significant cost, time and human resource implications, they are essential for successful programs. Make sure those involved in the monitoring and evaluation are appropriately trained and understand the importance of monitoring and evaluation.