Insurer and care provider iCare has proposed value-based care as an approach, along with a more robust regulatory framework, to overcoming structural weaknesses in the healthcare system and helping injured NSW workers.
iCare made the call in its submission to the State Insurance Regulatory Authority’s (SIRA) consultation on the “Regulatory requirements for health care arrangements in the NSW workers compensation and CTP schemes.”
iCare acknowledged the positive contribution of medical and allied health service providers to the wellbeing of people in NSW, but said structural weaknesses in the system allowed for over-servicing by some service providers and inappropriate behaviour by a small group of others.
The insurer noted that medical costs, and the utilisation of medical services, in the NSW workers’ compensation system have been rising rapidly, with medical costs up by 40% in the last four years alone and now accounting for a third of the scheme’s overall costs.
iCare explained that value-based care is about improving the health outcomes that matter to patients, the experience of receiving care, the experience of providing care, and the effectiveness and efficiency of care.
This is expected to benefit injured workers in NSW through improved processes and governance, indexed health care provider fees, clearer guidelines for healthcare providers, and more effective use of data and evidence to correctly assess what interventions injured workers will gain the best outcomes from.
Other issues iCare said it is taking action to address include rising healthcare costs, implementing a medical strategy to enhance medical decision-making protocols, and ensuring the latest evidence better informs the treatment provided to injured workers.
