Performance based oversight l.jpg
This presentation is the property of its rightful owner.
Sponsored Links
1 / 29

Performance-Based Oversight PowerPoint PPT Presentation


  • 171 Views
  • Uploaded on
  • Presentation posted in: General

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

Download Presentation

Performance-Based Oversight

An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Performance based oversight l.jpg

Performance-Based Oversight

April 19, 2006


Overview l.jpg

Overview

  • What is PBO?

  • House Bill 7

  • Key Regulatory Goals

  • Assessments

  • Tiers

  • Incentives

  • Timelines


What is pbo l.jpg

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 l.jpg

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 l.jpg

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 76 l.jpg

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 77 l.jpg

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 78 l.jpg

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 79 l.jpg

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 710 l.jpg

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 l.jpg

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 l.jpg

Working Group Assistance

  • Identify key regulatory goals

  • Define assessment mechanism

  • Define tiers and tier placement strategy

  • Develop incentives for each tier


Key regulatory goals l.jpg

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 l.jpg

Key Regulatory Goals Examples

  • Timeliness of Income Benefits

  • Timeliness of Medical Bill Processing

  • Minimizing Disputes

  • Return-To-Work Outcomes

  • Workplace Safety


Assessments l.jpg

Assessments

  • Conducted at least biennially

  • Conducted through analysis of data

    • Maintained by Division

    • Self-reported data

  • Data Accuracy


Assessment sources l.jpg

Assessment Sources

  • EDI data

  • ECS/837 data

  • Division data

    • Dispute resolution figures

    • Complaints

    • Form filings

  • Data calls


Tiers l.jpg

Tiers

  • Poor performers

  • Generally average performers

  • Consistently high performers


Tier examples l.jpg

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 l.jpg

Incentives

  • Developed by rule

  • Defined for each tier

  • Publicly recognize high performers

  • Allow high performer designation as a marketing tool


Incentives examples l.jpg

Incentives Examples

  • Reduced penalties

  • Self Audits

  • Payment modifiers

  • Faster payments

  • Waiver of conference fees


Proposed timeframes l.jpg

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 l.jpg

Discussion Topics


Timeliness of income benefits l.jpg

Timeliness of Income Benefits


Timeliness of medical bill processing l.jpg

Timeliness of Medical Bill Processing


Minimize disputes l.jpg

Minimize Disputes


Return to work outcomes l.jpg

Return-To-Work Outcomes


Workplace safety l.jpg

Workplace Safety


  • Login