Case studies of treatment provider approaches > Abilita Program delivery models

Background

The Abilita® Program is Australia’s foundational structured Biopsychosocial Rehabilitation program introduced to Workers Compensation schemes in 2008. Developers of this program recognised the important role in recovery for people with injury to understand the relationship between and influence of bio-psycho-social interactions. This led to development of the Abilita Rehabilitation Index for Musculoskeletal Injury (ARI.MSI), Restore Coaching Program and Abilita Consultant Assessment and Coaching training courses.

Biopsychosocial Domains

Abilita software categorises and measures questionnaire responses into domains of core biopsychosocial influence. For the ARI.MSI questionnaire these are Pain, Function, Emotions, Coping, Confidence, Work Perceptions and Occupational Factors. These are presented in a chart in Initial and Impact Assessment reports (see Fig.2 Individual’s pre post coaching results).

From this chart, Case Managers understand referral requirements; participants take ownership of responses and gain insight and motivation to engage in a self-management skills coaching program; and Consultants prepare a coaching plan based on domain ratings plus the additional psychosocial Profile Report.

Screening tools

Developed according to the Important Elements of screening tool (p.27)

•AB5 – predicts psychosocial risk rating using 5 questions drawn from ARI.MSI domains

•AB7 – predicts psychosocial risk rating using 7 questions from ARI.PI (Psychological Injury)

Assessment questionnaires

These are comprehensive questionnaires to identify and measure all relevant psychosocial barriers for each condition cohort, informing domain charts and providing psychosocial profile.

•ARI.MSI for physical injury, 61 questions including full OMPSQ and PSEQ.

•ARI.PI for psychological injury, 72 questions including full DASS21, additional work perception questions and a brief trauma screen.

•Abilita Health Survey (AHS) for persistent health conditions, 36 questions.

Delivery Models

1.Abilita License

Abilita licenses are held by insurers, employers and health and rehabilitation providers. This model has supported structured Biopsychosocial Rehabilitation services for over 6,000 Australian, New Zealand, Malaysian and South African people with compensable personal injury. Predominantly, Workplace Rehabilitation Providers have utilised Abilita assessment, coaching and training within their service delivery for claimants referred to them by an insurer or employer.

2.Claims Management System

Abilita psychosocial screening and assessment tools have now been embedded in a claims management system for Life, Accident and Health Insurance, making these tools available to an Insurer using FINEOS Claims. FINEOS delivers the capabilities of a core claims system to operationalise the Abilita® psychosocial toolkit at scale with workflow, digital, business rules logic, algorithm execution, data management and reporting. This model brings the triggering of an Abilita Assessment under the control of the insurer, using automated business logic to determine cases for triage screening with at-risk claimants offered an Abilita Assessment. Assessment results provide Case Manager guidance for referrals to an appropriate Provider for Psychosocial Matched Care.

Quality Assurance

Biopsychosocial knowledge – Abilita provides role-specific credentialed training for Case Managers, Assessment and Coaching Consultants, and System Managers.

Claimant engagement is managed through protocols to ensure language to introduce triage and assessment questionnaires is reassuring to claimants building their trust and confidence in the benefits of participation to their recovery.

Adherence to Abilita Program structure is achieved through training and inbuilt processes in both models.

Matched-Care coaching content is clearly informed by the Initial and Profile Reports providing ARI, OMPSQ, PSEQ, DASS21 results, domain ratings scores, and psychosocial profile detail. Abilita Coaching training offers biopsychosocial coaching content for 16 topics.

Provider Accountability is measured by post-coaching Impact and Review Assessment results including shifts in domain and instrument scores, and claimant evaluation.

Evaluation of the program in Model 2 is achieved through extensive digital data available to monitor processes such as screening rates, provider engagement, timeframe adherence and to track psychosocial, work capacity and cost outcomes.

Workplace Rehabilitation Provider Outcomes

Recent analysis of Abilita outcomes data [17] from 8 Abilita licensees who are Australian and New Zealand Workplace Rehabilitation Providers, includes both long term (with entrenched psychosocial barriers) and early intervention cases.

Participant engagement: satisfaction with the program 94%

Enhanced recovery: Referral within 6 weeks of injury

Reduction in psychosocial risk factors for physical injury 45%

Reduction in psychosocial risk factors for psychological injury 29%

Enhanced recovery: All cases (average 36 weeks before referral)

Reduction in psychosocial risk factors for physical injury 27%

Reduction in psychosocial risk factors for psychological injury 18%

Continued Improvements:

Cases with additional improvement several months post coaching

Physical injury 64%

Psychological injury 67%

Increased work capacity at completion of coaching

Physical injury 83%

Psychological injury 76%

Potential savings [17] calculated from average costs for Sprain & Strain claim $200,000 pp.

Research and Development

Extensive clinical and literature research has supported development of Abilita resources

Research evidence for the program is available at Benefits of a Structured Biopsychosocial Approach to Workplace Rehabilitation for Musculoskeletal Injury (latrobe.edu.au)5