Here’s the one-year anniversary of the September 2010 amendments to the Statutory Auto Benefits Schedule. It seems appropriate to reflect on the impact of these changes on the Ontario Auto Insurance Industry. Today, we will be examining the effects of the Minor Injury Guideline. Viivi Riis is a Senior Health Analyst at the Insurance Bureau of Canada. We spoke to her in order to get the perspective of the Ontario Insurers. Riis was kind enough for us to get her perspective on the MIG’s impact.
A Brief History of the SABS Changes
In an effort to reduce the complexity and increasing costs of auto insurance, the Financial Services Commission of Ontario (FSCO), developed the September 2010 changes. The Auto Insurance Industry has been losing significant money with no signs of improvement. A downward spiral appears to be inevitable without any dramatic intervention. The SABS is not like television shows which can be resolved in 60 minutes. It requires much more effort and dedication from all parties to find a cure.
If you are wondering what caused the entire mess, David Gambrill (Editor of Canadian Underwriter Magazine) summarized the Auto Insurance Industry’s past situation by saying: “Ontario’s Auto Insurance Industry was ill t]he system is too complicated, nobody understands the paperwork, there is too many health professionals, assessments for minor injuries; most of the insurance money is propping the system (including cottage industry for assessment), rather than going towards the claimants. The system disproportionately caters for minor injury claimants. etc.” (Canadian Underwriter. Ontario’s Ailing Auto Industry. 2009, 05, 01. The FSCO faced multiple challenges with these issues and had to find logical and efficient solutions. It is not an easy task considering the many businesses that interact with Ontario’s insurance industry. There aren’t any easy answers.
The Superintendent of Financial Services submitted a report to Minister of Finance in March 2009 with 39 recommendations for reforming the SABS. You can access the report on FSCO’s website. All the key stakeholders were able to express their concerns during the consultation phase. The report contained 39 recommendations.
The SABS changes went into effect on September 1, 2010, after the recommendations were accepted. Many in the Auto Insurance Industry hoped that the changes would be a complete sweep and instantly fix the problems. However, one year later, it appears that the FSCO’s strategy has been more transformative. It will take longer to see the full impact of streamlining the model, reducing coverage, and adding caps.
The MIG: Future and Present
The MIG replaces the PAF Guideline. It was created in consultation with healthcare professionals, legal representatives, and insurance industry stakeholders. The FSCO states that the MIG is not an end-all solution to auto industry woes. It should be considered an interim measure and that the Neck Pain Task Force, other experts, and others will replace it in the future. (FSCO Bulletin 10/10).
Next is the Minor Injury Treatment Protocol. The FSCO stated that the Minor Injury Treatment Protocol (MITP) is “an initiative to create a treatment protocol that treats minor injuries that reflects current scientific and medical literature.” The project was initiated in 2010 and will be completed by 2014. FSCO will be provided with an evidence-based treatment plan, clinical prediction rules to identify patients who are at high risk of becoming chronic and a marketing strategy to educate the public and providers about the new protocol.
FSCO shared additional information about the MITP within its “Auto Insurance e–Newsletter (May 2011, edition): The MITP will help insurers and providers treat minor injuries resulting in automobile accidents. It will also include clinical prediction rules that can be used to identify patients at greater risk of developing chronic pain or disability. It will also focus on treatment outcomes, and provide milestones for health care providers that can be used to track progress. FSCO will use the MITP in order to eventually develop a Guideline. This will be issued by Superintendent. A plan will be developed for education and marketing the new protocol as part of the MITP project. The MIG in its current state appears to be with us at least until 2014.
Today’s MIG
To accompany the SABS changes, the FSCO developed the Minor Injury Guideline (MIG). The MIG is a solid guideline for minor injuries. The MIG is an excellent example of both the overall intent of the changes as well as the challenges that it presents: The MIG demands a fundamental shift in how insurers, doctors and partners approach their cases.
Instead of a complete overhaul, small steps like the introduction of MIG can be crucial to transform the system and address the problem areas that are prone to inefficient and wasteful processes. The MIG, in its current capacity should remove some barriers to early treatment for minor injuries and promote treatments and therapies that encourage Claimants to return to work quickly and to their normal routines. Riis stated that the MIG’s long-term goal is to provide the kind of care that has been proven effective in medical literature. We expect to see a decrease in disability among the WAD/sprain population. The Claimant, the insurer, and the provider all want a happy outcome.
Does the MIG Help to Improve the Situation?
Although the IBC is currently conducting surveys about MIG utilization and associated costs, the results won’t be available until the autumn. We don’t know the results of the surveys but we can examine a key component of the MIG which reflects the intent to change the SABS.
The MIG is a primary focus on the early detection and management of psychosocial risk factors. If treatment options are focused only on the injury, and not how it affects the Claimant’s whole life, proactive therapies and interventions don’t get applied in the time necessary to prevent other problems from becoming barriers to recovery. Viivi Riis, the IBC, and others have discovered that there are many barriers in Ontario to returning to work, many of them unrelated to the injury. The focus of treatment was on the injury and did not consider psycho-social factors such as fear avoidance or catastrophizing behaviors that could lead to prolonged disabilities. Riis believes that the MIG can be applied to prevent this problem. However, it’s not the insurer’s role to identify such risks. Riis also believes that health businesses should talk to their insurance partners about how they can help the Claimant with these issues. The Insurance Industry will save money by working closely with the Claimant to gather information about their lives and address their needs. This will allow them to keep their costs down and prevent the Claimant from being unable engage in their normal routine. Riis says that “early disability (and return-to-work) management is possible within the MIG, which I believe there is room to innovate by health care companies in this regard.”
It is not enough to completely change the SABS. It is important to change how providers and insurers work with it. The MIG now requires that insurers, insurance partners and health care providers focus on all elements that could affect the Claimant’s return-to work options. Riis believes that the evidence from the past year will prove that it is more difficult to achieve the desired outcome (successful returns to function), than to spend vocation interventions on patients that don’t work. It will be easier to give the Claimant the best possible care if the emphasis isn’t on giving the Claimant as many options as possible, but rather to help them return to their normal function.
Paradigm Shift: Focus On Function
It is difficult to make meaningful changes in business practices every day, but it becomes more challenging when trying to overhaul an entire system. The presentation was titled “Minor Injuries Guideline- What’s the Deal?” Viivi Riis stated that acceptance of the SABS recommendations changes required a paradigm shift. This is also evident in the administration and management of the MIG. Here, health care providers will need to shift their focus away from maximum medical recovery to be able to manage strains and sprains properly.
For example, Riis and the IBC have found that when it comes to the treatment of strains and sprains the “evidence…overwhelmingly suggests that a return to usual activities and advice in that regard is beneficial to health outcomes… (t)here is new evidence on how to manage sprain, strain and WAD injuries and acute pain. This evidence raises some questions about the traditional physical treatments that are still used. According to my members, early treatment is still focused on physical treatment. Disability management happens after MIG resources are exhausted or after physical treatment approaches have failed. Many Claimants who have suffered sprains and strain injuries are still being advised by their health care providers to abstain from certain activities, or even completely. There is no explanation for why this advice is required.
The MIG eliminates the ability for the treatment provider and Claimant to have an open relationship. Providers need to be involved in case management and look at the entire treatment model, not just the injury. It seems that the key message is to focus on function, early return to work and normal daily routines rather than maximum medical recovery.
These changes were only in place for one year. Viiivi Riis stated that it was impossible to determine if they are having the intended effect. Insurers report various experiences.” However, once the MIG and spirit of the SABS are adopted by the Insurance Industry, and all other health care providers, we will see an evolution in innovation.