21 Point Action Plan Update (as at 3 March 2021)
Following the Independent Compliance and Performance Review of the Nominal Insurer (managed by icare), on 13 December 2019 the SIRA Chief Executive issued a 21-Point Action Plan to drive fact-based and steady improvement in the Nominal Insurer.
SIRA is continuing to monitor icare’s performance against the 21-Point Action Plan and has been providing regular updates on progress in the interests of transparency and accountability.
As at 3 March 2021, 13 actions have been completed and eight actions remain in progress.
Progress against each of the actions is below and the detailed actions are available in the 21-Point Action Plan.
icare actions required by SIRA
Status: Completed
icare has now submitted the Nominal Insurer business plan for 2020/2021. The business plan addressed many of the requirements outlined in the 21-Point Action Plan. While the updated plan represents a significant improvement on earlier versions, more work is underway to finalise return to work targets. SIRA has also requested that icare monitor performance against business plan deliverables and benchmarks.
Status: Progressing
icare has implemented data quality improvement measures that have resulted in more accurate and timely data submissions to SIRA. But despite significant improvements, icare data still does not meet the regulatory requirements. icare has advised that it expects that data will meet regulatory requirements from June/July 2021 when its data remediation is expected to conclude. icare and SIRA continue to meet monthly to monitor data improvement activities.
Status: Completed
icare has completed a comprehensive review of the Nominal Insurer premium formula, however implementation has been delayed by the decision to defer premium increases due to COVID-19. SIRA and icare will continue to monitor any further premium calculation amendments at the Joint Premium and Prudential Oversight Committee meetings.
Status: Completed
icare is reporting its premium review arrangements to SIRA in accordance with the Market Practice and Premiums Guidelines, as well as details of premium review complaints. In addition, icare has issued information to employers on how to review their premiums.
icare actions recommended by SIRA
Status: Completed
icare has implemented changes to its claims management model to increase the allocation of dedicated case managers.
Status: Progressing
icare has implemented return to work remuneration incentives for employers covered by the Authorised Provider Model. Pending the approval of the icare Board, icare has advised SIRA that it expects to provide more detailed internal return to work performance targets in the near future.
Status: Progressing
Following delays due to the COVID-19 pandemic, icare advised SIRA that it will consider this recommendation later in 2021 as part of its service model provider review.
Status: Completed
SIRA continues to invite icare to the SIRA Tripartite Reference Group meetings to discuss progress of the 21-Point Action Plan and performance of the Nominal Insurer.
icare has now established its own Nominal Insurer Advisory Committee.
Status: Completed
On 1 March 2021, icare published its independent review of icare governance, accountability and culture on its website.
SIRA regulatory actions related to the NI
Status: Progressing
The first and second quarterly reviews conducted in February and August 2020 found some improvements in the claims performance of the Nominal Insurer, however further improvement is required. SIRA has deferred the quarterly reviews for the time being to allow icare’s new leadership team time to implement improvements. SIRA will undertake the next review in the second half of 2021.
Status: Progressing
Following delays due to the COVID-19 pandemic, SIRA has undertaken a healthcare review and a detailed analysis of potential leakage in medical expenditure. SIRA has requested that icare provide quarterly updates against actions it had identified to improve its governance around medical payments. SIRA will undertake a medical payment process audit in late 2021 to determine if there have been improvements.
Status: Completed and ongoing
SIRA has and will continue to provide advice to Government on options to improve scheme performance and outcomes, including prudential supervision.
Status: Completed and ongoing
SIRA and icare boards continue to constructively engage on matters relating to the performance of the workers compensation system.
Status: Completed and ongoing
SIRA has and will continue to provide advice to Government on legislative policy matters to improve scheme performance and outcomes as required.
SIRA regulator commitments
Status: Progressing
SIRA has refined its performance metrics and is developing a range of new measures to inform monitoring and supervision, with a focus on return to work and creating more consistency in regulatory monitoring. SIRA has commenced onboarding icare to the SIRA Insurer Accountability Portal so that it has greater regulatory oversight and icare can more quickly respond to emerging issues.
Status: Progressing
SIRA has developed a return to work measurement framework and enhanced return to work metrics. SIRA will soon undertake further roundtable sessions with insurers to provide details of the new framework. Additionally, SIRA is contributing to the national return to work strategy and will lead a NSW return to work strategy.
Status: Progressing
SIRA is actively engaging with professional medical colleges to increase awareness of the Health Benefits of Good Work initiative among GPs and other health providers. SIRA has endorsed the Health Benefits of Good Work initiative and the supporting evidence has been included in SIRA’s training packages for physiotherapists and psychologists. SIRA is continuing to incorporate evidence of the Health Benefits of Good Work in its training and frameworks.
Status: Completed
In December 2020, SIRA published its Healthcare Review Final Report. The review identified trends and drivers of rising healthcare costs and set the agenda for regulatory action in response. SIRA is now finalising its response to the findings and is taking action on implementing value-based care.
Status: Completed
Following delays due to the COVID-19 pandemic, SIRA has now published its first customer experience survey and is undertaking its first repeat survey. Planning for an employer survey is also underway.
Agreed joint SIRA and icare actions
Status: Completed and ongoing
SIRA and icare boards continue to meet every six months.
Status: Completed and ongoing
SIRA and icare are continuing the current level of escalated monitoring and communication through the Joint Premium and Prudential Oversight Committee and Joint Claims Assurance Committee.