WSIB Specialty Programs
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1 WSIB Specialty Programs Strategy & Procurement Information for Providers July 2017
2 Content Purpose Background WSIB s Current State Specialty Programs Current and Future Request for Proposal (RFP) Descriptions RFP Process Next Steps
3 Purpose Provide l context for WSIB s current state and strategic direction related to the Specialty Programs Provide l an overview and prepare the hospitals and psychiatric facilities for the anticipated procurement for Specialty Programs l Encourage innovation and partnerships from potential interested hospitals l WSIB will conduct a fair, open, and transparent procurement process to select qualified hospitals and psychiatric facilities to meet current and future business needs
4 Background l WSIB is today one of North America s largest insurance organizations, providing workplace injury insurance for over 5 million workers and over 300,000 employers. l We receive over 200,000 new claims each year, of which we invest heavily in early expert medical care to assist injured workers in their recovery and safe return to work. l WSIB is the bridge to helping workers recover and return to work by supporting early diagnosis and treatment, evidenced based care, support for the primary care provider, ensuring quality management and promoting innovation in the services purchased on behalf of injured/ill workers. l Our investment in health care relies on strong partnerships with the medical community and leveraging knowledge and expertise of health care professionals. l We have and will continue to work with high quality providers in supporting injured/ill workers in their recovery and return to work. l In recent years, working together with Ontario s health care professionals and providers, significant improvements have been made in outcomes for injured/ill workers and we know we can do even more.
5 Things have Changed a lot since 2009.
6 What are Specialty Programs? For workers with more complex injuries and illnesses, WSIB contracts with hospitals across the province to deliver Specialty Clinic programs. They provide: l Early, specialized assessment and treatment for workers who have complex injuries and illnesses l Multi-disciplinary teams of specialists and health professionals who are experts in their specific fields, who deliver care through public or private hospitals and/or psychiatric facilities l Clinical evaluations and recommendations to inform case management to support the worker s recovery and return to work l Services in a manner that respects the worker s dignity, including their cultural, linguistic, and gender needs, and ensures a high level of worker understanding, participation and satisfaction
7 What are we Looking for in the Future? In addition to the current delivery model, WSIB is seeking to enhance the Specialty Programs by: Focussing l on continuous improvement and innovation, incorporating leading technology l Adopting solutions and strategies to better serve workers in northern Ontario, in rural areas, and across the province l Seeking enhanced, innovative models of care through partnerships or networking Piloting l Proofs of Concept and, where successful, implementing new approaches at the program level l Increasing integration with community providers to improve workers function, recovery, and RTW outcomes
8 Specialty Program Referrals Summary 2011 to 2016 Timely, quality care through WSIB Specialty Programs maximizes outcomes and better supports workers and their families l Workers come from across the province l Innovative solutions to care may provide more opportunities for workers in the northern and rural communities Data prepared by: Corporate Business Information & Analytics, Strategy and Analytics Cluster
9 Getting Ready for the Specialty Programs Request for Proposal l WSIB plans to issue a Request for Proposal (RFP) to seek qualified hospitals and psychiatric facilities to deliver specialized services for workers in Ontario l Hospitals and psychiatric facilities can bid on one, some, or all of the Specialty Programs in the upcoming RFP l More details will be provided in the RFP
10 Specialty Programs l Assessment and treatment for workers with upper and/or lower extremity amputations by physician specialists and other health professionals l Prescription, measurement, fitting, fabrication and modification of prosthetics by prosthetists l Orthopaedic shoe services for workers who require the prescription, measurement, fitting, fabrication and modification of a custom orthopaedic shoe as the result of foot trauma by pedorthists l Providers may bid on one or both streams l Assessment and treatment for workers with complex spinal injuries that require surgical consultation and who may require spinal surgery by orthopaedic surgeons, neurosurgeons, physicians and other health professionals l Program will include provision of, as required, assessment and treatment for workers exhibiting unusual level of pain which impacts their daily life by physician specialists, physicians and other health professionals l Assessment and treatment for workers with complex burn injuries by plastic surgeons and other health professionals l Assessment and treatment of workers with acquired brain injuries by physical medicine & rehabilitation physicians, neurologists, psychiatrists, and other health care professionals l Assessment, clarification of diagnosis, and treatment for workers with significant psychological and/or emotional distress from a workplace injury, illness or a traumatic event by psychiatrists, psychologists, and other health professionals l Assessment and treatment for workers with substance management issues l Assessment for workers with illnesses arising from workplace exposures by physician specialists in occupational disease and other health professionals l Four separate streams: general occupational diseases, dermatology, respirology and Hand Arm Vibration Syndrome (HAVS). l Providers may bid on any or all of the four streams l Assessment and treatment for workers with work-related lower limb injuries by orthopaedic surgeons and other health professionals l Prospective providers must service foot/ankle and hip/knee injuries l Program will also provide, as required, assessment and treatment for workers exhibiting unusual level of pain which impacts their daily life by physician specialists, physicians and other health professionals l Surgical services will be included in this program l Assessment and treatment program for workers with work-related injuries of the upper limbs by orthopaedic surgeons, hand or plastic surgeons and other health professionals l Program will also provide, as required, assessment and treatment for workers exhibiting unusual level of pain which impacts their daily life by physician specialists, physicians and other health professionals l Prospective providers must be able to provide services for shoulder/ elbow and hand/wrist/glove l Surgical services will be included in this program Please note that the Surgical Program, the Medication & Substance Management Program, and the Function & Pain Program have been incorporated into other relevant Specialty Programs.
11 RFP Process STAGE 1 Mandatory Requirements l All potential Specialty Program providers must be a public or private hospital or psychiatric facility l Personal information must reside on servers/ devices located in Canada l Only providers that comply with the mandatory business requirements in the RFP document will proceed to Stage 2 for further evaluation. STAGE 2 Privacy & Information Technology Requirements l To support patient privacy and information security, providers will be required to provide details about the information technology (IT) infrastructure* within their hospital/facility. l Providers that meet a specific threshold set out in the RFP document will proceed to Stage 4. We strongly recommend that you engage your IT department to ensure your proposal is sufficiently detailed to meet these mandatory requirements. STAGE 3 Written Responses to Rated Requirements l Provider proposals will be evaluated and scored on the basis of the criteria set out in the RFP document l Providers that meet a specific threshold set out in the RFP document will proceed to Stage 3. We recommend that your health professionals curriculum vitae are up-to-date and ready for submission. STAGE 4 Oral Proposal and Presentations l Providers will be invited to an in-person session to present their Specialty Program proposals for which they have been pre-qualified l Providers that meet a specific threshold set out in the RFP document will be invited to proceed to the contract stage of the RFP process
12 Next Steps l RFP will be posted in late summer 2017 on Biddingo: l Questions can be submitted through the RFP process l In the near future, WSIB will also be posting an RFP to procure services for a revitalized Regional Evaluation Centre (REC) Program, to provide comprehensive assessment services for workers with occupational injuries and illnesses.»» A revitalized REC model will promote earlier access to assessment and triaging by claim complexity with linkages to Specialty Programs.
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