Performers Waiver by abo34093


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									Performance-Based Oversight

             April 19, 2006
What is PBO?
House Bill 7
Key Regulatory Goals
             What is PBO?
Encourages and rewards excellence and
 continuous improvement
Fosters improved and timely communications
Establishes performance objectives, measures
 and expectations
Focuses on results rather than prescriptive
           Who is using PBO?
 Department of Energy
 US Nuclear Regulatory Commission
 Blue Cross/Blue Shield Texas
 Texas Commission on Environmental Quality
                    House Bill 7
4 basic goals of the workers’ compensation system
    Each employee shall be treated with dignity and respect
     when injured on the job
    Each injured employee shall have access to a fair and
     accessible dispute resolution process
    Each injured worker shall have access to prompt, high-
     quality medical care
    Each injured employee shall receive services to facilitate
     the employee’s return to employment
                   House Bill 7
 9 legislative goals
    Promote safe and healthy workplaces through appropriate
     incentives, education, and other actions
    Encourage the safe and timely return of injured employees
     to productive roles in the workplace
    Provide appropriate income benefits and medical benefits
     in a manner that is timely and cost-effective
    Provide timely, appropriate, and high-quality medical care
     supporting restoration of the injured employee’s physical
     condition and earning capacity
                 House Bill 7
 Minimize the likelihood of disputes and resolve them
  promptly and fairly when identified
 Promote compliance with this subtitle and rules adopted
  under this subtitle through performance-based incentives
 Promptly detect and appropriately address acts or
  practices of noncompliance with this subtitle and rules
  adopted under this subtitle
 Effectively educate and clearly inform each person who
  participates in the system as a claimant, employer,
  insurance carrier, health care provider or other participant
  of the person’s rights and responsibilities under the
  system and how to appropriately interact within the
              House Bill 7
Take maximum advantage of technological
 advances to provide the highest levels of service
 possible to system participants and to promote
 communication among system participants
               House Bill 7
Develop and use key regulatory goals to
 assess insurance carriers and health care
At least biennially, assess the performance of
 insurance carriers and health care providers
Based on the assessment, develop regulatory
                  House Bill 7
 The tiers should distinguish among:
    Poor performers
    Generally average performers
    Consistently high performers
 Develop incentives within each regulatory tier that
  promote greater overall compliance and performance
 Focus regulatory oversight on those identified as
  poor performers
        DWC PBO Activities
Internal cross- agency team
  Strategic Plan
  Concept Paper
Research of Performance-Based Oversight
Presentation from Blue Cross/Blue Shield
Interview of TCEQ management
    Working Group Assistance
Identify key regulatory goals
Define assessment mechanism
Define tiers and tier placement strategy
Develop incentives for each tier
       Key Regulatory Goals
Used to assess the insurance carriers and
 heath care providers
Must align with the general regulatory goals
 of the division
Key Regulatory Goals Examples
Timeliness of Income Benefits
Timeliness of Medical Bill Processing
Minimizing Disputes
Return-To-Work Outcomes
Workplace Safety
Conducted at least biennially
Conducted through analysis of data
  Maintained by Division
  Self-reported data
Data Accuracy
         Assessment Sources
EDI data
ECS/837 data
Division data
  Dispute resolution figures
  Form filings
Data calls
Poor performers
Generally average performers
Consistently high performers
              Tier Examples
Quantifiable measures – 90%, 95%, etc
  Defined measures
  Can be conducted at any time for any time period
Bell Curve
  Performance relative to peers on same duty
  Consistent time period
Defined Distribution
  Known number of entities
Developed by rule
Defined for each tier
Publicly recognize high performers
Allow high performer designation as a
 marketing tool
        Incentives Examples
Reduced penalties
Self Audits
Payment modifiers
Faster payments
Waiver of conference fees
         Proposed Timeframes
 Develop Key Regulatory Goals – 5/31/06
 Identify Assessment Mechanism – 7/31/06
 Develop Incentives – 7/31/06
 Identify Tiers and Tier Placement Strategy – 7/31/06
 Initiate Assessments – 8/31/06
 Complete Initial Assessments – 9/30/06
 Tier Placement – 10/15/06
Discussion Topics
   Timeliness of Income Benefits

Area to Measure How to Measure   Data Used to
 Timeliness of Medical Bill Processing

Area to Measure How to Measure   Data Used to
          Minimize Disputes

Area to Measure How to Measure   Data Used to
     Return-To-Work Outcomes

Area to Measure How to Measure   Data Used to
           Workplace Safety

Area to Measure How to Measure   Data Used to
Area to Measure How to Measure   Data Used to
Area to Measure How to Measure   Data Used to

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