Third International Forum on Disability Management Creative Approaches to Disability Management by Insurers and Provide

1. 1 Third International Forum on Disability ManagementCreative Approaches to Disability Managementby Insurers and Providers Moving Towards a Robust, Comprehensive Return to Work System for Ontario Judy Geary, Vice President Program Development Workplace Safety and Insurance Board of Ontario

2. 2 WSIB Overview The WSIB� Largest Board in Canada Administers no-fault workplace insurance for employers and their workers Provides benefits for injured/ill workers, and for dependents of workers who have died as a result of a workplace injury or illness Monitors the quality of health care Assists in the early and safe return to work (RTW) for injured workers

3. 3 Overview The WSIB� Handles about 340,000 claims a year Employs close to 4,500 staff, located in 14 offices throughout the province of Ontario Covers approximately 4.5 million workers Is funded entirely from employer premiums In 2005, approximately 200,000 employers were registered, with premium revenue of just over $3 billion Vision: The elimination of all workplace injuries and illnesses

4. 4 Current RTW Model 1998 legislative changes placed a strong emphasis on prevention and early and safe return to work WSIB altered its approach to return to work, which we called �self-reliance� of the workplace parties Good progress made with this model since then However, experiencing more complex claims, with increasing persistency issues, adding to system costs Have gone back to drawing board to develop a new, more robust, comprehensive RTW system In recent years gains have been made with respect to RTW for much of the WSIB�s client base. However, these improvements have not changed the fundamental culture of persistency in Ontario. In fact, persistent, high context cases are actually moving in the opposite direction, i.e. increasing in number, duration, and complexity. If current trends continue, it is projected that by 2010: Lost Time Injuries will drop further to 70,000, while total costs will increase to over $321 million 20% of claims (14,000) will cost $257 million - an increase of about 5% ($12,229,803) over 2004 costs. In recent years gains have been made with respect to RTW for much of the WSIB�s client base. However, these improvements have not changed the fundamental culture of persistency in Ontario. In fact, persistent, high context cases are actually moving in the opposite direction, i.e. increasing in number, duration, and complexity. If current trends continue, it is projected that by 2010: Lost Time Injuries will drop further to 70,000, while total costs will increase to over $321 million 20% of claims (14,000) will cost $257 million - an increase of about 5% ($12,229,803) over 2004 costs.

5. 5 New Approach Looking at long-term opportunity to improve RTW outcomes, reduce costs and increase savings through a robust systems approach Three key outcomes: Reduce the number of claims that become high context cases (20%) and/or are at risk of becoming part of this population Prevent injured workers who are part of the 80% of non-persistent, non-high context cases from becoming part of the 20% population Achieve continuous improvement in RTW process and outcomes for all claims entering the system Anchored in the best available research and in the practical experience of other jurisdictions, the purpose of this new approach is to define and describe a new WSIB Return to Work direction that will create a new RTW system in Ontario that is robust, multi-dimensional, and multi-stakeholder in composition, and that is comprehensive in its application in workplaces across the province. Notwithstanding progress to date, the WSIB�s current approach to RTW falls short of being a robust, comprehensive systems approach that will provide for maximum positive outcomes. Building on our progress to date and best-evidence research, there is considerable room for significant, systemic improvement and the opportunity for a more fundamental transformation in how the WSIB and its system partners approach RTW. This more fundamental transformation is the longer term opportunity that will drive savings and outcomes improvements. Anchored in the best available research and in the practical experience of other jurisdictions, the purpose of this new approach is to define and describe a new WSIB Return to Work direction that will create a new RTW system in Ontario that is robust, multi-dimensional, and multi-stakeholder in composition, and that is comprehensive in its application in workplaces across the province. Notwithstanding progress to date, the WSIB�s current approach to RTW falls short of being a robust, comprehensive systems approach that will provide for maximum positive outcomes. Building on our progress to date and best-evidence research, there is considerable room for significant, systemic improvement and the opportunity for a more fundamental transformation in how the WSIB and its system partners approach RTW. This more fundamental transformation is the longer term opportunity that will drive savings and outcomes improvements.

6. 6 Multi-Dimensional RTW Framework This Framework is the core of the new approach we are takingThis Framework is the core of the new approach we are taking

7. 7 New Approach Evidence based Accommodates/addresses the different requirements of high-context/persistent cases as well as those that are not high-context/persistent Ensures RTW interventions are consistently pro-active, front-end and effective Engages all system partners Promotes and ensures collaboration between/among the four dimensions of the RTW framework Provides for a comprehensive and integrated suite of RTW program tools and levers for all system partners Ensures integration of effort with health care programs and services Is cost effective, sustainable, and accountable Guided by the multi-dimensional RTW framework I just talked about, the WSIB will redesign existing RTW policies and programs to create a new system. Guided by the multi-dimensional RTW framework I just talked about, the WSIB will redesign existing RTW policies and programs to create a new system.

8. 8 Linkages of New Approach This diagram summarizes the relationship between the new approach, the multi-dimensional RTW framework, and the new characteristics of the new system. This diagram summarizes the relationship between the new approach, the multi-dimensional RTW framework, and the new characteristics of the new system.

9. 9 Foundation of New Approach Building Blocks Four types of new initiatives will be required to implement the new direction � in effect, the building blocks of the new system. Each new initiative will be developed to reflect the multi-dimensional RTW framework that is the core of the new approach. These building blocks will be required to change how individual cases are dealt with by the WSIB, employers, health care providers, etc. but also to achieve system-level transformation, i.e. changing the broader provincial culture and attitudes towards RTW. Four types of new initiatives will be required to implement the new direction � in effect, the building blocks of the new system. Each new initiative will be developed to reflect the multi-dimensional RTW framework that is the core of the new approach. These building blocks will be required to change how individual cases are dealt with by the WSIB, employers, health care providers, etc. but also to achieve system-level transformation, i.e. changing the broader provincial culture and attitudes towards RTW.

10. 10 Sample Initiatives Series of integrated demonstration projects for both RTW and health care to apply best practice in occupational health and RTW. Develop holistic, integrated case management practice (and technology). Build business intelligence capability to enable differentiation of claim population to support targeted interventions. Executive speaking campaign. Promote NIDMAR Consensus Based Disability Management Audit to build workplace capability. Engage leading RTW researchers to articulate our knowledge needs CIHR Strategic Training Program Fund Centre of Research Expertise in Disability Outcomes Institute for Work and Health

11. 11 Summary At the WSIB, we continue to challenge ourselves as an organization to address the challenges we face: changing economies changing workplaces changing client expectations Forums such as this can foster greater creativity Sharing what works and what doesn�t shortens the learning curve tremendously We can all benefit from the exchange of information and ideas.