Research for Actuarial Impact

October 2013

ISCRR and TAC research collaboration

ISCRR mission to:
Conduct research aligned with compensation scheme issues and
objectives
Facilitate translation of research evidence into policy
Lead to improved health, vocational and social outcomes

TAC mission to:

To reduce road trauma and support those it affects
To reduce future liability by targeting growth areas in spend for
Independence clients

ISCRRs Impact assessment framework

Measurable change in a Scheme KPI

Developing the ROI hypothesis

Occurs at Research Planning and Development Phase

Identify impact of research

Identify need and research question

Source evidence for projected clinical or service impact

Hypothesise impact

Apply hypothesised impact to current treatment or service costs

Apply actuarial calculation

Calculating the ROI hypothesis

Estimate of
cost impact

Hypothesis
of clinical
impact
Research
question

Estimate of
service
impact

Estimate of
actuarial
impact

Estimating research impact

Estimate of
cost impact

Hypothesis
of clinical
impact
Research
question

Estimate of
service
impact

Estimate of
actuarial
impact

Neurotrauma Strategy
$20 million investment in research for clients who have
incurred a brain or spinal cord injury to:
Improve client outcomes
Improve client experience
Maintain scheme viability

Key criteria
Need to inform policy and practice
Probability of impact of meaningful changes within 5 years
Reward return on investment for client health and outcomes and/or cost
savings

Capacity ability of NT research sector to do the work

Research areas ranked against key

criteria
Criterion
Activity

Investment
Need

Prob. Impact

Reward

Capacity

Priority 1. Models of life-time care

Very high

High

High

Low

35%

Priority 2. Improving Rehabilitation

& Disability management

High

Mod

High

High

35%

Priority 3. Bench to bedside

Low

Low

Very high

High

15%

Priority 4. Capacity Building

Mod

Mod

Mod

High

15%

Secondary complications of Spinal Cord

Injury (SCI) bowel function
Spinal cord severance causes loss of conscious
control of bowel and bladder so that bowel cannot be
emptied voluntarily at convenient time
People with SCI live with this condition for 50-60 years.
A survey by Widerstrom-Noga (1999) showed 85.6%
people with SCI reported problems with bowel control
When asked: if one problem could be solved what
would it be the most common answer was bladder and
bowel problems (ranked as most important by 34% of
people with SCI)

Research proposal
To restore bowel control following SCI, thus:

significantly reducing attendant care requirements of people with SCI;

and reducing their eventual need for surgery;

treating the symptoms of bowel incontinence so their quality of life and

ability to participate in society is greatly improved.

By:
Completing animal proof of principle experiments for use of Capromorelin
(a colokinetic drug);
Conduct a RCT of use of Capromorelin in humans with SCI and matched
non-injured controls
Conduct a repeat dose study using Capromorelin
Prepare and promulgate guidelines for diagnosis, treatment and
maintenance care for bowel problems arising from SCI

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Bowel management

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Clinicians estimate effect in people with SCI (up

to 10 years post-injury) as:

40% paraplegics will reduce care need by 1

hr/day

40% quadriplegics will reduce care needs by

hr/day

20% no reduction of care needs

The research impact questions

Does a blinded RCT

demonstrate the
efficacy of
Capromorelin usage?

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Does usage reduce

care needs by 1
hr/day for 40%
paraplegics; hr/day
for 40%
quadriplegics; no
effect on 20% people
with SCI?

Does the reduced

care needs translate
to reduced service
purchase of
attendant care by 1
hr or hr per visit ?

Behaviours of Concern (BoC)

Traumatic brain injury (TBI) can result in behaviours such as
aggression, agitation, sexual inappropriateness and lack of initiation
These behaviours result in social isolation, relationship breakdown and
dislocation from accommodation creating a significant burden for the
person with TBI and their families and carers
BoC represents the greatest source of stress to caregivers of people
with TBI (Ponsford and Schonburger 2010)
Behavioural strategies to manage BoC are multi faceted and must be
individualised. Knowledge of active ingredients of such strategies, and
skills and expertise to implement them, is poor.
Clients with BoC are excessively reliant on attendant care just in case
and this is increasing over time
Pool of clients with BoC supported by TAC estimated at approximately
600 clients

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Research proposal
To audit files of TAC clients with BoC to document nature of
BoC; pre- and post-injury trajectory
Qualitative study to capture lived experience of BoC for
those with BoC by comparison with those who have had
BoC but resolved without need for attendant care
What has contributed to the BoC
What has made them worse
What has made them better
What are the specific strategies and modifications including family
interactions, activities of daily living, the environment, social interactions,
therapeutic or pharmacological interventions

To identify active ingredients of positive BoC

management for trialling.
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Research Impact questions

Is there evidence
that they reduce
just in case
attendant care
usage?
What are the active
ingredients of
positive behaviour
intervention and
support?

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Does the reduced

care needs translate
to reduced service
purchase of
attendant care and
if so by how much?

Process for assessing ROI

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Work with TAC Business Intelligence to test the clinical and/or

service impacts of proposed research with

Claims staff

Business Intelligence analysts

Actuaries

TAC Scheme an actuarial perspective

Branch

Liability
30 June 2013
($m)

Independence
Recovery
Resolution

$ 5,592
$ 748
$ 1,963
$ 8,302

Claims Handling
Tax Credits
Prudential Margin

$ 799
($ 394)
$ 871

Total

$ 9,578

Total Scheme liability (ie, value of all future payments to current

claims) amounts to nearly $10 billion.
Liability figures feed directly into Scheme financial statements,
and results/performance measures including Actuarial release.

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Results
Bowel ROI

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Around 150 Spinal Team clients receive 1:1

attendant care

Equates to reduction of 90 hours of attendant

care per day across branch

Taking clients less than 10 years after their

accident:

Calculates to ~$0.6m p.a. reduction in costs

Liability impact of ~$25 million savings

Results - BoC
Total liability for Attendant
Care > $4 billion
Around $400 million of
this liability is directly
related to Behaviours of
Concern
10% reduction in care
directly associated with
BoC would have a liability
impact in the order of $40
million

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UNDERSTANDING
ACTUARIAL IMPACT
HELPS TO MEASURE
THE VALUE OF
RESEARCH

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Thank you
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