PerformanceBased Oversight

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Performance-Based Oversight

• April 19, 2006

2
Overview

• What is PBO?
• House Bill 7
• Key Regulatory Goals
• Assessments
• Tiers
• Incentives
• Timelines

3
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

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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_solution
  s/index.htm
• Texas Commission on Environmental Quality
• http//www.tceq.state.tx.us/compliance/enforcement
  /history/index.html

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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 employees return to employment

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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 employees physical condition and earning
  capacity

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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
  persons rights and responsibilities under the
  system and how to appropriately interact within
  the system

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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

9
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

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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

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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

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Working Group Assistance

• Identify key regulatory goals
• Define assessment mechanism
• Define tiers and tier placement strategy
• Develop incentives for each tier

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Key Regulatory Goals

• Used to assess the insurance carriers and heath
  care providers
• Must align with the general regulatory goals of
  the division

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Key Regulatory Goals Examples

• Timeliness of Income Benefits
• Timeliness of Medical Bill Processing
• Minimizing Disputes
• Return-To-Work Outcomes
• Workplace Safety

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Assessments

• Conducted at least biennially
• Conducted through analysis of data
• Maintained by Division
• Self-reported data
• Data Accuracy

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Assessment Sources

• EDI data
• ECS/837 data
• Division data
• Dispute resolution figures
• Complaints
• Form filings
• Data calls

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Tiers

• Poor performers
• Generally average performers
• Consistently high performers

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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

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Incentives

• Developed by rule
• Defined for each tier
• Publicly recognize high performers
• Allow high performer designation as a marketing
  tool

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Incentives Examples

• Reduced penalties
• Self Audits
• Payment modifiers
• Faster payments
• Waiver of conference fees

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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

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Discussion Topics
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Timeliness of Income Benefits
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Timeliness of Medical Bill Processing
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Minimize Disputes
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Return-To-Work Outcomes
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Workplace Safety
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