prospects for harnessing private sector capabilities to improve employment for ssdi beneficiaries...
Post on 21-Dec-2015
214 views
TRANSCRIPT
Prospects for Harnessing Private Sector Capabilities to Improve
Employment for SSDI Beneficiaries
February 21, 2007
SSDI: Challenges and Opportunities
Winthrop CashdollarExecutive Director for Disability
InsuranceAmerica’s Health Insurance Plans
Overview
The SSDI program is under increasingly severe strain.
Demographic and fiscal trends will swamp the program – insolvency looms.
Current efforts to change SSDI program policy and administration are not likely to bring sufficient or timely relief.
Circumstances may allow a scenario under which the private disability insurance industry can partner with SSA to improve SSDI outcomes
Declines in Household Incomes of Working-Age People with Disabilities
Median Household Income for Men Ages 21 to 64 by Work Limitation Status
2002 Dollars. Based on Current Population Survey.www.disabilitystatistics.org
$20,000
$30,000
$40,000
$50,000
$60,000
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
Med
ian
Ho
useh
old
In
co
me
Without WorkLimitations
With WorkLimitations
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
Per
cen
tag
e E
mp
loyed
Without WorkLimitations
With WorkLimitations
Exodus of People with Disabilities from Employment …
Based on Current Population Survey. Employment defined as more than 52 hours worked in previous year. www.disabilitystatistics.org
Employment Rate of Men Ages 21 to 64, by Work Limitation Status
… onto Public Programs
Source: Social Security Advisory Board, The Social Security Definition of Disability, October 2003.
% Change in SSDI Beneficiariesper 1,000 Insured, 1990-2002
0%
10%
20%
30%
40%
50%
60%
70%
Allages
20-24 25-39 30-34 35-39 40-44 45-49 50-54 55-59 60-64
Aging of the Baby Boomers
Data from: http://www.census.gov/ipc/www/idbpyr.html
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Age
Po
pu
lati
on
Co
un
t
2010
50 to 64
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Age
Po
pu
lati
on
Co
un
t
2020
50 to 64
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Age
Po
pu
lati
on
Co
un
t
1990
50 to 64
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
Age
Po
pu
lati
on
Co
un
t
2000
50 to 64
Age and Disability
The boomers are now 45 to 60 years old.
A recent study* estimates that:– 20% of adults in their 50s have a work
limitation– Another 34% experience a work
limitation in the next 10 years
Richard W. Johnson, Gordon B.T. Mermin, and Cori E. Uccello, Urban Institute, “When the Nest Egg Cracks” December 2005.
Ticket-to-Work
Objective: Create competitive market of employment service providers motivated to help SSDI and SSI beneficiaries earn enough to exit the programs
– Tickets are performance based vouchers– State VR agencies must compete with private providers
Results:– National rollout started in 2002, finished in 2004– In earliest states, participation rate is approaching 2%– Many administrative problems– Private providers have not found a successful business
model– SSA is about to implement new regulations that will likely
increase provider interest– But will they increase beneficiary interest?
SSA Demonstrations
Accelerated Benefits
Mental Health Treatment Study
HIV/Auto-immune Impairments Demonstration
Benefit Offset National Demonstration– Replaces the benefit cliff at SGA with a gradual
decline– Offers an “early intervention” to qualified applicants– Provides employment support & health benefit
package– Enrollment starts in late 2007 (?)
Private-Public Partnership
Application of private insurer core competencies and tools
Move SSDI program administration and risk management further and faster in the necessary direction
No need to increase government bureaucracies/recreate capabilities already present in the private sector
Test private-public partnership approaches more expeditiously
Options to Re-Orient and Strengthen SSDI
Improved Sharing of Disability Claim Information
Fee for Service Early Intervention and RTW
Private Administration of Public Disability Benefits
Improved Sharing of Disability Claim InformationMedical information/documentation provided by a treating physician
Documentation of definitive medical evidence in cases of presumptive diagnoses (e.g. diagnoses by Board Certified physicians)
Results of any Independent Medical Examinations (IMEs) performed to support private disability claim adjudication
Results of any Functional Capacity Examinations (FCEs) performed to support private disability claim adjudication
Information regarding actual return-to-work of SSDI applicant or beneficiary
Fee for Service Early Intervention and RTWEarly evaluation of medical/functional status of new SSDI applicant: Comprehensive rehabilitation/return-to-work plan for SSDI applicant/beneficiaryRehabilitation/return-to-work management for SSDI applicant/claimantOutreach, planning, and follow-up with employers to implement and support SSDI beneficiary return-to-work.Periodic review/reassessment of SSDI beneficiary medical/functional statusFraud investigation/documentation regarding SSDI applicant/beneficiary
Private Administration of Public Disability BenefitsDemonstration of competition between private and public sectors in administration of public disability benefit
Workers would have a choice between traditional SSA administration of SSDI benefit and administration by a private disability insurer
Private insurer participants reimbursed/rewarded for risk management and RTW
Private Administration of Public Disability Benefits - continuedPrivate insurer participants required to pay SSDI benefits following SSDI rules and adjudication decision
Benefits paid from the Trust Fund
Performance incentives for continuation of employment, RTW, impact on Trust Fund
Structure could encourage integrated management of private and public disability benefits
Privacy and Interoperability
Suitable arrangements to authorize sharing of claimant/applicant information
Security of claimant/applicant information
Guarantees against unintended/inappropriate uses of claimant/applicant information
Private-Public interoperability
