Insurance Medics

Insurance companies are in the healthcare business when it comes to auto insurance in private sector provinces. The sooner they make this realization and offer quality rehabilitation treatment, the easier it is to give customers the right kind of claims experience.

While June 1990 may seem like the distant past, it is only relatively recently that insurance companies in Ontario have taken on responsibility for their customers’ health and well-being following an auto collision. That date, of course, marked the introduction of no-fault auto insurance in Ontario, causing a ripple effect across the country. The message in all private sector auto insurance provinces is the same: like it or not, insurers are in the healthcare business. Companies ignore this reality at their peril.

Gone are the days of mere claims adjudication, in which insurance companies simply cut cheques for specified amounts and cut loose claimants to fend for themselves. During the past 16 years, insurers have increasingly provided comprehensive rehabilitation support services in partnership with recognized healthcare facilities.

EVOLUTION OF HEALTH CARE

Frankly, this has not always been a smooth process. When governments introduce new insurance systems, it often catches various parties off-guard. That was certainly the case in 1990. Suddenly, rehab facilities were expected to step in and treat various kinds of auto collision injuries ranging from soft tissue to psychological and severe brain trauma. Many clinics were on a steep learning curve: they had to ramp up knowledge of insurance regulations, as well as invest in resources and staff. The wide variance in quality among clinics was readily apparent.

At the same time, insurance companies were adjusting to no-fault claims handling processes and their increased involvement in healthcare issues. This spawned a great deal of discussion and negotiation around regulations, effective treatment practices, medical evaluation/assessment, data collection and accreditation of facilities. It remains an experiment in progress.

INSURANCE AND HEALTH CARE TODAY

Fast forward to the here and now: there is growing evidence of maturity in the relationship between insurance company and healthcare provider – and consumer. In today’s healthcare environment, customers are much more knowledgeable and comfortable with multiple choices in treatment providers. Many consumers have access to a range of treatment options through group benefit plans, delisted services in physiotherapy and occupational therapy and, increasingly, private clinics. Many customers look to private insurance companies for assurance of quality in recommended healthcare providers.

An example of this is Aviva Canada’s Premiere Healthcare program. Launched in October 2005, Premiere Healthcare is a unique, innovative approach to soft tissue injury claims; the approach recognizes that an insurance company is indeed in the healthcare business. This does not mean that an insurer dictates what healthcare providers do or challenges rehabilitation professionals on technical aspects of treatment. Far from it. In fact, Premiere Healthcare puts evidence-based treatment practices in the hands of the rehab professional, allowing Aviva claims advisors to streamline health delivery for customers.

With Premiere Healthcare, treatment is customized to individual needs. Customers are active and informed participants throughout their recovery. They have a choice of healthcare providers that are convenient to them. They also bypass many of the administrative forms currently needed to complete access to benefits and go right to pre-approved treatment.

Premiere Healthcare is a program that offers a continuum-of-care model, emphasizing quick treatment of the injured claimant and eliminating many of the bureaucratic delays typically associated with filing an injury claim. Instead of extensive paperwork, customers get referred to one of seven pre-approved rehabilitation networks, operating more than 300 clinics. To date, approximately 6,000 customers in Ontario and Atlantic Canada have registered in the Premiere Healthcare program. Early results show extremely positive feedback to this new approach to injury claims, particularly in the areas of duration of disability, client satisfaction and healthcare costs.

PARTNERSHIP WITH PATIENTS

The emphasis is on a mutual shared view of the client, laying the groundwork for true partnership and collaboration. Each party, the insurance company and the healthcare provider, has a specific role to play. The insurer’s role is to help customers find a convenient facility, book their first appointment within a day, make sure they get effective service within a day and take care of the details so that customers can concentrate on getting better.

The healthcare provider also has a role to play. For example, in the Premiere Healthcare program, Aviva’s network of service providers is accountable to the customers it shares with its partner Aviva. Aviva expects its clinics to meet detailed service standards, deliver services that reflect best practices based on scientific evidence and help clients understand their injuries.

First and foremost, Premiere Health-care acknowledges that insurers have a responsibility – a contractual one – to help clients recover after a car accident. The notion of auto insurers providing an option to a preferred healthcare provider network is brand-new. This new approach is connected with some inherent risks.

HEALTHCARE NETWORKS: RISKS, ACCREDITATION

The primary risk is quality assurance. How can we establish an independent, third-party review of healthcare programs? When an insurer sets foot in the realm of establishing or setting healthcare service delivery standards, it has gone that extra step beyond just paying the claim. Now it is holding out an assurance of quality.

Premiere Healthcare addressed quality assurance with the requirement that Aviva’s healthcare partners gain accreditation over a specified time period through the Commission on Accreditation of Rehabilitation Facilities (CARF). As an insurer, Aviva recognized it does not have the professional experience to assess one clinic over another. Instead, it uses a third party that understands healthcare delivery at various levels.

CARF is an independent evaluator that specializes in the medical and rehabilitation fields. It has accredited 38,000 programs in the United States, Canada, Western Europe and South America. CARF has been in the accreditation field since 1966, and has accredited more than 1,100 programs in Canada. It has surveyors and consultants who go on site and verify conformity to quality standards on both the business and on the clinical service side of a clinic’s operations. It typically takes one year to gain CARF accreditation.

All of Aviva’s Premiere Healthcare partners are committed to and in the process of gaining accreditation. Austin Rehab Group is the first partner to achieve a three-year accreditation in 14 programs in general occupational rehabilitation and comprehensive occupational rehabilitation. In business since 1993, Austin Rehab Group is a full service provider of multidisciplinary rehabilitation programs for persons who have suffered musculoskeletal injuries.

Aviva knows it will take time to gain this independent, third-party standard of quality in healthcare delivery. Once achieved, a demonstrable benchmark tells consumers they are receiving treatment from an accredited, proven facility. It would be nice to see this trend take hold among insurance companies across Canada.

Customers are the ultimate beneficiaries of this accreditation. They know, beyond a degree on the wall or the suggestion of a friend or family member, that a certain facility is qualified according to leading clinical, business and service standards. Accreditation is also a healthy sign of progress in the ongoing relationship of insurance companies and healthcar
e providers in the treatment of auto collision injury clients.

Was the industry ready for a program like Premiere Healthcare in June 1990? Quite frankly, the answer is no – for both insurance companies and healthcare providers. But the maturation of the industry since then makes it possible for insurers and their healthcare partners to offer customers a better claims experience. Through partnership and accreditation, we can recommend to clients a level of healthcare quality we can stand behind.

And that is a process that simply helps customers get better.