Healthcare reform
SIRA’s goal for health care – value-based care
SIRA’s vision is that “the workers compensation and CTP schemes assist injured persons in their recovery through value-based healthcare”.
What does value-based healthcare mean?
Value-based healthcare is focused on achieving measurable improvements in an injured persons’ health outcomes. Value is measured by looking at the health outcomes of injured people in the schemes relative to the resources used. It will effectively direct resources to areas where they will achieve the greatest health outcomes.
Value-based healthcare in WC and CTP will support recovery and improve return to activity, return to work and quality of life outcomes for people injured at work and on the road.
Implementation plan for value-based health care
SIRA has published an implementation plan for value-based healthcare in the WC and CTP schemes.
The plan has been informed by an extensive co-design process with scheme participants, including injured people with lived experience of the scheme, clinicians, insurers, unions, employers, academics and experts.
The plan includes 21 initiatives (work on some has already started) in four streams:
- Stream 1: Measure health outcomes and costs and improve data quality
- Stream 2: Support enhanced clinical practice
- Stream 3: Streamline administration and reduce leakage
- Stream 4: Develop scheme capacity in value-based healthcare
Health outcomes framework
To progress the implementation of value-based care in the workers compensation and CTP schemes, SIRA has published the Value-Based Healthcare Outcomes Framework.
The framework provides a series of metrics for monitoring and reporting healthcare outcomes and costs in the schemes. It will enable SIRA to measure the value of healthcare – through the health and quality of life outcomes that are achieved - and report comparatively on insurer performance.
SIRA continues to work with scheme participants, including healthcare providers and their peak bodies, to co-design an implementation plan for the framework.
SIRA healthcare costs and outcomes dashboard
A new dashboard on healthcare costs and outcomes in the workers compensation and CTP schemes has been published on the SIRA website. The dashboard provides a transparent account of utilisation, costs and performance trends.
Fee reform
As part of the larger healthcare review, SIRA commissioned a fee benchmarking study to benchmark NSW workers compensation scheme health practitioner fees against other jurisdictions and payers. The report of the study found that the scheme is out of step with other Australian workers compensation schemes and the NSW CTP scheme.
In response, SIRA has made changes to the surgeon fees orders which will commence on 1 July 2022, and will be making further changes to other fees during 2022.
Healthcare review
Healthcare costs account for more than $1 billion each year in SIRA’s personal injury schemes. The review of healthcare in the NSW workers compensation and CTP schemes aimed to ensure that injured people have access to the right healthcare, at the right time, for optimal recovery and return to work.
The final report of the review outlines SIRA’s findings about trends and drivers of healthcare expenditure, and next steps, including the implementation of SIRA’s health outcomes framework to progress the schemes towards value-based care.
SIRA undertook a consultation to inform revised regulatory requirements relating to the healthcare arrangements within the schemes, to manage costs and improve outcomes for injured motorists and workers. The consultation paper and submissions have now been published online.