Part 1: Introduction
Our 2014 audit
1.1
In 2014, we looked at how the Accident Compensation Corporation (ACC) used case management to rehabilitate injured people effectively and efficiently.1 In particular, we focused on how well ACC worked to deliver high-quality and fair2 services in a way that focused on claimants.3
1.2
We also looked at how ACC worked with claimants with more serious injuries, including those with complex rehabilitation needs and challenges. Although claimants with more serious injuries make up a small proportion of ACC's overall claims, they need resource-intensive case management.
1.3
We found that ACC could do more to provide claimants with a consistent, high-quality service focused on their needs. Experiences were more negative for longer-term claimants who had complex needs but did not meet the highest injury seriousness criteria.
1.4
We recommended that ACC:
- set out the possible treatment steps for a given injury, based on scientific evidence, in the information systems that case managers use;
- strengthen the overall approach and tools that it uses to guide, monitor, review, and manage the quality of case management services;
- review the adequacy and appropriateness of case management services for long-term clients (claimants) with complex needs who do not meet the highest injury seriousness criteria and improve those services where necessary; and
- more actively manage the transfer of clients (claimants) to other public agencies to reduce the potential for people to miss out on services they are entitled to and to appropriately prepare people for transfer to another public entity.
Our follow-up work
1.5
In 2014, we carried out two performance audits of ACC. One was on ACC's case management approach to rehabilitation, and the other was on how ACC dealt with complaints.
1.6
In 2018, we carried out follow-up work to our audit of how ACC deals with complaints. As part of that work, we saw clear signs that ACC was moving towards a culture that is more centred on its customers. We noted that ACC was becoming more welcoming of customer feedback and more open to using it to improve service delivery.4 5 In that work, we found that ACC expected its staff to focus on each claimant's individual needs, and make decisions and resolve issues to help meet those needs. We did not look at case management in our 2018 follow-up, because ACC was still testing and refining a new approach, called Next Generation Case Management (NGCM).
1.7
This report is a follow-up to our audit on ACC's case management approach.6 It looks at the extent to which the changes ACC has made have addressed the four recommendations we made in 2014.
Next Generation Case Management approach
1.8
In 2014, ACC was implementing a change programme called Shaping Our Future. This programme included taking a more "customer-led" approach to case management. The change programme was intended to improve service delivery and claimant experience.
1.9
ACC's later assessment of its case management model was that it was complex and inconsistent, and that it no longer supported ACC's strategic objectives. In response, ACC designed NGCM. ACC expects NGCM to:
- improve the consistency of customer services through simpler and more transparent processes;
- allow ACC to better meet the diverse needs of claimants; and
- lead to faster recovery because of better targeted and integrated rehabilitation interventions and better co-ordinated support for claimants who are unlikely to fully recover from their injury.
1.10
ACC began a pilot of NGCM in 2017 with a selection of claimants in Hamilton and then in Hastings. The pilot was called Launch Pad.7
1.11
Since Launch Pad, ACC has been rolling out NGCM in five tranches throughout New Zealand. ACC has recently rolled out the fifth and final tranche of NGCM, and all staff have migrated to their new roles.
1.12
ACC implemented Launch Pad using a "test and learn" approach. This involved testing and refining NGCM over an extended period with a subset of claimants at a small number of sites. This helped ACC identify and implement further improvements to NGCM.
1.13
Under NGCM, claimants are assigned to a particular "Recovery team", based on their individual needs for an effective recovery (as opposed to the type or severity of injury). For claimants who ACC case manages,8 four teams provide different levels of recovery support: "Enabled", "Assisted",9 "Supported", and "Partnered". Figure 1 provides ACC's description of the support the four Recovery teams provide.
1.14
Recovery teams are arranged according to the degree of case management support claimants need. For example, claimants managed by the Enabled Recovery team are assessed as needing the least case management. However, claimants managed by Partnered Recovery teams have more complex needs and require more case management attention.
Figure 1
The different types of support the four Recovery teams provide
| Recovery team | Description | Example |
|---|---|---|
| Enabled Recovery | Claimants primarily manage their own recovery using an online portal to select services and regularly check in. Claimants can contact an ACC team for support. | An office worker with a fracture who can still work most of the time. |
| Assisted Recovery | Claimants primarily manage their own recovery. A member of the ACC team will contact them if there is something specific to discuss. | A teacher with a dislocated shoulder who may need additional services throughout recovery. |
| Supported Recovery | Claimants have a dedicated ACC contact who works with the client to recover. | A farmer with a disc prolapse where co-ordination will help manage multiple providers,* a challenging work environment, and additional services that may be needed throughout recovery. |
| Partnered Recovery | Claimants build a relationship with a dedicated ACC contact who supports them to manage their injury or recovery. | A claimant with paraplegia who needs expert support to co-ordinate specialised services. This may continue for an indefinite period. |
* In this report, we refer to organisations or individuals who provide treatment and rehabilitation services collectively as "providers".
Source: Accident Compensation Corporation.
1.15
Figure 2 describes the numbers of claims assigned under each Recovery team as at 25 August 2020.
Figure 2
ACC case-managed claims – Claims numbers and allocation percentages by Recovery team, as at 25 August 2020
| Recovery team | Current claims assigned | Claims yet to be transferred* | Total | Percentage of total claims** |
|---|---|---|---|---|
| Assisted/Enabled Recovery*** | 54,525 | 72 | 54,597 | 61% |
| Supported Recovery | 14,770 | 3,271 | 18,041 | 20% |
| Partnered Recovery | 12,922 | 3,431 | 16,353 | 18% |
| Total | 82,217 | 6,774 | 88,991 |
* Claims in interim management in already rolled-out sites while their own site is being readied and transferred to NGCM.
** Percentage figures have been rounded and might not add up to 100. *** The disaggregated percentages of the total number of claims of each of these two teams are not currently available.
Source: Accident Compensation Corporation.
1.16
The Assisted and Enabled Recovery teams manage most of the claims that ACC case manages.
How we did our work
1.17
To carry out our follow-up work, we reviewed a series of self-assessments and supporting documents that ACC provided. We also interviewed senior ACC staff.
1.18
We did not seek the views of claimants, or of organisations or individuals who provide treatment and rehabilitation services. However, we have reviewed ACC's performance measures about the feedback it receives from these groups.
The structure of our report
1.19
In Part 2, we discuss ACC's progress in better integrating evidence-based recovery and rehabilitation information into the systems and processes that case managers use when making decisions.
1.20
In Part 3, we discuss how ACC assures the quality of its case management services and engagement with claimants. We also discuss how that approach helps build staff capability and how claimant feedback informs ongoing improvements.
1.21
In Part 4, we discuss ACC's approach to ensuring more consistency and fairness in its services to claimants with complex needs.
1.22
In Part 5, we discuss ACC's progress in helping claimants prepare for transition to the support of other public organisations.
1: Controller and Auditor-General (2014), Accident Compensation Corporation: Using a case management approach to rehabilitation, Wellington.
2: Our focus on fairness comes from the Injury Prevention, Rehabilitation, and Compensation (Code of ACC Claimants' Rights) Notice 2002. This Code is about how ACC will work with claimants to make sure they receive the highest practicable standard of service and fairness. It sets out the eight rights of claimants and the corresponding obligations on ACC. Right 2 is for claimants to be treated fairly and to have their views considered. ACC's corresponding obligations are to (a) treat claimants fairly, (b) listen to and consider their views, and (c) take into account, and be responsive to, any impairment they may have.
3: In this report, we use the term "claimants" to refer to people with injuries whose cases are being managed by ACC.
4: Office of the Auditor-General (2018), Accident Compensation Corporation: How it deals with complaints (Progress in responding to the Auditor-General's recommendations), Wellington.
5: In this report, we use the term "customers" when talking collectively about claimants, levy payers, and providers of treatment and rehabilitation services.
6: Office of the Auditor-General (2014), Accident Compensation Corporation: Using a case management approach to rehabilitation, Wellington.
7: Launch Pad has been working in an NGCM-like way since 2017. However, Launch Pad sites did not go live with new NGCM technology and processes until August 2019.
8: ACC does not directly case manage some claimants who have specific non-complex injuries and do not have wider individual rehabilitation needs. These people are allocated to a fifth Recovery Team – Provider Recovery. In Provider Recovery, providers directly support people with a particular injury that has a well-understood pathway for treatment. This support is provided under an agreement between ACC and the providers.
9: Claimants assessed as needing Enabled or Assisted support are managed nationally in five hubs (Manukau, Hamilton, Wellington, Christchurch, and Dunedin).