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Performance-Based Oversight. April 19, 2006. Overview . What is PBO? House Bill 7 Key Regulatory Goals Assessments Tiers Incentives Timelines. What is PBO?. Encourages and rewards excellence and continuous improvement Fosters improved and timely communications

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Performance-Based Oversight

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Performance-Based Oversight

April 19, 2006


Overview

  • What is PBO?

  • House Bill 7

  • Key Regulatory Goals

  • Assessments

  • Tiers

  • Incentives

  • Timelines


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 requirements


Who is using PBO?

  • Department of Energy

    • http://www.orau.gov/pbm/initiatives/bmop.html

  • US Nuclear Regulatory Commission

    • http://www.nrc.gov/what-we-do/regulatory.html

  • Blue Cross/Blue Shield Texas

    • http://www.bcbstx.com/provider/bluechoice_solutions/index.htm

  • Texas Commission on Environmental Quality

    • http://www.tceq.state.tx.us/compliance/enforcement/history/index.html


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 system


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

  • §402.075

  • Develop and use key regulatory goals to assess insurance carriers and health care providers

  • At least biennially, assess the performance of insurance carriers and health care providers

  • Based on the assessment, develop regulatory tiers


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


Assessments

  • 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

    • Complaints

    • Form filings

  • Data calls


Tiers

  • 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


Incentives

  • 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


Timeliness of Medical Bill Processing


Minimize Disputes


Return-To-Work Outcomes


Workplace Safety


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