Employer Centric Service

From Research, through Policy to Reality

Tania McFarlane (Claims), Emily Mason (Policy), Mel Pande (Research)

November 2012

Today

Some context

Employer Centric Service - background

The challenge

The solution

Making it Happen

Research

Policy

Business Lead

Project Management

The Results

The Key to Success

Some context

New Zealands injury prevention and rehabilitation scheme

Supports injured peoples return to work, independence or
everyday life as safely and quickly as possible
Monopolistic environment government policy agenda
No fault personal injury cover work and non-work
Everyone in NZ, including overseas visitors
ACCs vision is to lead the world in injury prevention, care and
recovery

The size of it
4.4m

1.7m
CLAIMS
PER YR

1 EVERY

seconds

The Challenge
Employer

Insurance

Claims Management

Levy collection and account

management

ACC

The Solution
Current service
Levy focused account
management
Claims management
services for injured
worker

Current value
proposition
We provide claims
services for injured
workers

Value add service

Tailored service
based on your
business needs
Dedicated Claims
Manager
Joined up ACC staff

Customer Centric
value proposition
We will help you
manage costs and
increase productivity

Timeframes
March 2011:

Initial research and concept development

June 2011:

Business Case Investigation `Trial

July 2011 - March 2012: Trial

April 2012 - May 2012:

Evaluation

June 2012:

Business case Delivery

September 2012:

Go live

Making it happen
The role of Policy:
Conceptualise
Challenge, challenge, challenge
Coordinate

Condense information
Communicate concisely

Making it happen
The role of Research:
A key, early partner
Willingness to be flexible and tailor approach
Adapted to business needs without compromising research best
practice
Delivered on measuring benefits

The Map
Best Practice RTW

Proposed Employer-Centric Suite of Services

(Based on the Better@Work Philosophy)

A coordinated and simple approach between all
parties is essential to facilitate early RTW

INJURY MANAGEMENT (IM)

STANDARD CUSTOMER
(default product)

CURRENT STATE

Employer

ACC

Employee

Treatment/
Rehabilitation
Provider

STRATEGIC/ HIGH-VALUE/PRIORITY
CUSTOMER
(+add-ons)

Resources and templates to

assist employers with IM.
Tailored IM support via
Injury Management
Consultants

Temporary Earthquake
Employer Service

Online materials for

employer self-management:
alternative duties for
specific industry types
factsheets/ guides
value statement re
benefits of injury
management
Employer 0800 number/
email for basic enquiries

Specialist email and phone

support via 0800 number/
email
Tailored IM support via
IMCs, for example:
expert advice
training/ support for inhouse RTW coordinator
gap analysis and
assistance towards
moving to risk-sharing
options

Consider upgrading
products and services to
meet market needs

Incentives and rewards/

sanctions and penalties
Cost-benefit tools to
calculate return on
investment for employers
Additional online resources
Absenteeism and wellbeing
management services

- Vocational Services Review

- GP Certification Project

IPS Customer
Project to
inform
segmentation
(Aug-Sep 11)

Strategic/ High Value/ Priority Customer

Lo

Medium employer who is capable and willing to support RTW and a key
influencer of other employers

Standard Customer
Access to standard/ core services

ADD-ONS FOR FUTURE

CONSIDERATION
(out of scope)

Customer value to ACC

Access to add-ons
Large employer or Accredited employer who is capable and willing to
support RTW
Large employer who does not have capability to support RTW

PROPOSED FOR TRIAL

(from 1 Oct 2011)

CUSTOMER SEGMENTATION (indicative)

High

Small to Medium employer or Selfemployed

Customer need/ willingness to pay

High

CLAIMS MANAGEMENT (CM)

STANDARD CUSTOMER
(default product)

STRATEGIC/ HIGH-VALUE/PRIORITY
CUSTOMER
(+add-ons)

ACC manages claims from

registration through to exit.
Employer contact is variable
and with multiple ACC
contacts.
A variety of services are
available where an external
coordinator works with all
parties to achieve early
RTW (eg Stay at Work,
Better@Work and Fit for
Work trials)

Generally none. Some

employers have a dedicated
case manager but this is
done on an arbitrary/ad hoc
basis
Larger employers who meet
specific criteria can access
the Accredited Employer
Programme

Employer-Centric Case
Management Model

Dedicated key employer

contact under EmployerCentric Case Management
model

Online information (eg

information on entitlements)
Management of non-work
injuries

Roll out Employer-Centric

Case Management Model
for all Work and Earner
Account injuries
Risk-sharing options

Claims briefing/ progress

report
Targeted education via
workshops

On-site case management

Self-management options
Key Person Cover

Proposed Employer-Centric Claims Management Model for Trial from October 2011
Key Risks
Risks for the Trial
The approach will not work if:
o ACC is unable to match employers to claims
o there is not a culture change in ACC to see the employer as the customer (from a claims
management perspective).
The approach will be less successful if:
o ACCs customers are mostly low injury volume employers
o the value proposition (financial value of these products) for employers is not understood or
articulated.
ACCIS will not be operational so there will not be a system to match products to employers.
There will be limited skills/capability/capacity of IPS staff to deliver IMC services and products
as a result of the restructure. It will also take time to develop staff in new roles due to the scale
of change under the restructure.
Short timeframes of the trial may limit ACCs ability to effectively test trial products and
services.
Risks for Future Development of Service
The service needs to fit with product development for expanded risk-sharing options for small/
medium employers and an expanded AEP (IPS).
There are a number of barriers for more radical options (eg legislation, systems, resourcing,
need for more research and direction). In addition, these options will need to be further
developed by IPS (ie flowing out of the IPS Customer Project & overarching blueprint).
If the definition for customer segments (eg high-value customer) is not fit-for-purpose across
both IPS and Claims Management there will be inconsistencies in service delivery, which may
impact on Scheme costs and ACCs ability to meet customer needs.
Employers may not want to pay for add-ons (but may be interested in levy discounts). Product
pricing must be right.
Potential limitations for ACC if the Work Account is opened up for choice of insurer (eg
statutory limits on products and services that can be offered).

ACC will trial standard and add-on products and services with pre-selected
medium to large employers (nationally), and standard products with small to
medium employers within 2 pre-selected industries (regionally).

Employer has injured employee*

*Not med-fee only

Standard Customer

Strategic/ High-value/
Priority Customer

Work injury claim is

streamed to relevant
industry group
(non-work injuries =
status quo)

Work/non-work injury
claim is streamed to
dedicated Key
Employer Contact
within relevant
industry group

Claims
administrator/
coordinator
team
(centralised)

Relationship
Manager

Key Employer
Contacts
(grouped by
industry type)

Key Employer Contact (KEC)

Employer claims portfolio management:
Respond to queries and channel as appropriate (eg
referral to online tools)
Build/maintain relationship with employer(s)
Up sell to add-on services/products
Claims Management o Undertake risk assessment
o Gather relevant information \
o Stream to appropriate management party (including
de-escalation of claim to claims coordinator if
required)
o Complete action plan
o Set up relevant entitlements (eg weekly
compensation) and services (eg Stay at Work) in a
timely manner
o Employer liaison (eg support for employers to engage
in RTW process)
o Liaise with Prevention and Management Consultants,
and Relationship Managers as appropriate
o Provide regular reporting to high-priority employers re
claims experience (eg claims dashboard)
Key skills:
Industry Knowledge
Rehabilitation knowledge
Claims Management experience
Strong telephony skills

Claims Coordinator/
Administrator
Claims and Administrative
support:
General claims
administration (eg manage
purchase orders, invoice
discrepancies, payment
information gathering etc)
Provide other assistance
as delegated by KEC
including management of
simple claims if required

Relationship Manager
Key business relationship
for high-value employers:
Will need to link in closely
with KEC to ensure
coordinated services/
communication with
employer

Making it happen
The role of Business Lead:
Courage and conviction
Communicator/translator
Connector/conduit

So far, so great
We have received the very best of service, the results have been amazing
and the close communication has been very much appreciated. We have
gone from a second class service from ACC to first class service which has
saved us time, money & most importantly produced very good RTW results
Trial employer
Really appreciate your proactive stance to our work related Injuriesthis
is a 1st for me, (re ACC action) in my 7.5 years here. You show all the signs
of being from a private & commercial background, as opposed to a
governmental one..
ECS employer

ECS: Key to success

Structural arrangements:
The project was a high priority for senior management, and owned by
one of the Executive
Timeframes and budgets were challenging, but obtainable
The project team was hand selected from across the business
Findings from evaluations were crucial and acted upon

Project management team institutional knowledge

Phased roll out meant changes could be implemented and
improvements made on an ongoing basis, without compromising
evaluation results

ECS: Key to success

The soft stuff
From the outset the project team:
Lived uncomfortably
Respected each other
Concentrated on the areas that were hardest
Rolled with the punches