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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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Presentation Transcript
  • What is PBO?
  • House Bill 7
  • Key Regulatory Goals
  • Assessments
  • Tiers
  • Incentives
  • Timelines
what is pbo
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
Who is using PBO?
  • Department of Energy
  • US Nuclear Regulatory Commission
  • Blue Cross/Blue Shield Texas
  • Texas Commission on Environmental Quality
house bill 7
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
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
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
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
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
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
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
Working Group Assistance
  • Identify key regulatory goals
  • Define assessment mechanism
  • Define tiers and tier placement strategy
  • Develop incentives for each tier
key regulatory goals
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
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
Assessment Sources
  • EDI data
  • ECS/837 data
  • Division data
    • Dispute resolution figures
    • Complaints
    • Form filings
  • Data calls
  • Poor performers
  • Generally average performers
  • Consistently high performers
tier examples
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
Incentives Examples
  • Reduced penalties
  • Self Audits
  • Payment modifiers
  • Faster payments
  • Waiver of conference fees
proposed timeframes
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