CASE STUDY HELPING PEOPLE WITH REDUCED WORK ABILITY RETURN TO THE LABOR MARKET ESTONIA FINLAND GERMANY SWEDEN US OMAN UAE LITHUANIA SERBIA EASE OF DOING BUSINESS TETRIS is an information system commissioned by the Estonian Unemployment Insurance Fund for the purpose of performing fair and accurate work ability assessments and granting disability benefits in accordance with legal and procedural requirements. The Work Ability Reform of 2016 obligated the Fund to take over the bulk of work ability assessment and work ability benefit provision from the Social Insurance Board. With over 100,000 potential clients and tight deadlines, the reform’s success depended on optimized business processes and a versatile information system, which Nortal delivered. The Challenge In 2016, Estonia intended to introduce an extensive work ability reform, which would affect more than 100,000 people receiving disability benefits. The reform set out to achieve four major goals: Foster a more positive attitude in society towards Handle all of the people currently receiving 1 people with reduced work ability, which would 2 disability benefits on an individual basis and also have a positive effect on their self-image. determine their actual eligibility. Help people with reduced work ability to return Increase tax revenue and reduce costs on a 3 to the labor market. 4 national level. What made the task even more challenging was the legal obligation to assess an applicant’s work ability within 30 days and pay the benefits by the 10th of each month. Any delays here would impair the quality of life of the applicant, not to mention the related overdue charges the Fund would have to incur. Knowing this, Nortal began designing a system in 2015 that would tackle the challenges in a comprehensive way. HELPING PEOPLE WITH REDUCED WORK ABILITY EASE OF DOING BUSINESS The Opportunity Studies had shown that a remarkable 69% of employers would be willing to employ people with reduced work ability, which presented an opportunity to bring the two parties together. If executed successfully, not only would it bring countless people out of the fringes, but the state would also benefit by collecting more taxes and paying out fewer disability benefits. The goal of providing an actual personalized assessment played a large part here. Where the old system measured all applicants by the same yardstick – mostly because the individual approach would have entailed impossible paperwork – the new system, with its fast electronic procedures, brought the person back into focus. So now, instead of assessing the percentage of the disability, the system assesses the ability to work. Instead of paying a disability pension, the system provides work ability benefits. Approaching each person individually also served to fulfill another important purpose. During the domestic economic crisis of 2009, the number of people claiming disability benefits grew out of proportion. For the most part, it was caused by lax eligibility testing procedures and the tendency of General Practitioners to grant incapacity certificates too easily. As a result, it was suspected that thousands of people were receiving benefits without a due cause, costing the state millions of euros annually. The old paper-based system, however, provided no feasible way to prove it. By dedicating more time to finding a job that fits the applicant’s profile exactly, TETRIS finds ways to return the person to the labor market that the old system simply couldn’t. The Solution After consulting with the client, Nortal concentrated on the following key activities: PROCESSES Adjust and revamp business processes related to work ability assessment to manage the high volume of applicants and take advantage of electronic services. X-ROAD Use X-Road, the electronic backbone connecting the nation’s registers and databases, to retrieve as much data about the applicant as possible. On the basis of complete and accurate information, medical included, the person’s eligibility for benefits could be more easily determined, and attempts of fraud discovered. PORTAL Build a Web-based portal where medical experts could review the self-assessment forms submitted by applicants, check the information against data retrieved from national registers, and produce a conclusive expert statement on the matter. Nortal sought to optimize those parts of the business processes that were still designed after the old-fashioned, paper-based methods of customer service. For example, consultants needed to manually query each register over X-Road to collect information about the applicant or spend extra time before the first appointment analyzing which services could be legally offered, to avoid costly appeals or service cancellations later. There was also no way to send financial information from the consultant’s desk to the Fund’s accounting system, or a reliable method for keeping up to date with all open cases. As a care provider in all medical fields, Tartu driven solution unifies and simplifies the on the actual diagnosis and treatment. This University Hospital operates a near fully complex diagnostics processes for hospital’s improved the quality of the hospital’s medical digital process both inside the hospital and staff in order to help them provide patients care. Thanks to the Patient Portal, part of also in interacting with its environment. with high-quality medical services even more the new e-service, patients can now access Nearly all exchanges of data, be they med- efficiently. The Hospital Information System their medical data more conveniently and are ical, financial or operational with adminis- created by Nortal significantly reduced the therefore engaged in the process early on. All trators, other care providers and patients is administrative workload of hospital staff, crucial data are also accessible securely on digital. Inside the hospital, a central process- enabling the clinical personnel to focus more mobile devices. HELPING PEOPLE WITH REDUCED WORK ABILITY The Solution To raise data quality to a new level and support against, the registers enables to determine accurately automated decision-making, TETRIS was connected a person’s eligibility to receive disability benefits, to 13 national registers; such as the Employment taking into account their income, insurance coverage, Register, the Commercial Register, and the Health state of health, and more. Conversely, any grounds for Insurance Database. Data collected from, and verified exclusion would have a clear and legitimate reason. TETRIS Education Electronic National Defence Health Insurance Information Health Information Obligation Database System System Register Register of Taxable Criminal Records Persons TETRIS is connected to 13 national registers Database to ensure high-quality data and support automated decision-making. Commercial Prisoners’ Register Register Register of Social Insurance Employment State Pension Population Social Services Information Register Insurance Register Register and Benefits System Since the system heavily relies on the input of and terminated; assessments are automatically medical experts, it was reasonable to build contract priced based on the contract’s parameters; and management features into TETRIS. Now, contracts each contract’s volume and fulfillment can be with doctors are automatically created, renewed, monitored. The Result TETRIS makes the goals of the Work Ability Reform attainable. Officials are freed from needless manual work, more people with disabilities are entering the labor market, and the state collects increasingly more taxes. By 2020, nearly 26,000 people with disabilities have returned to the workforce since the beginning of the reform. Managers of the Fund are delighted to finally have an accurate overview of contracts and financial volumes, helping them to authorize new procurements or remind healthcare providers of contractual due dates. TETRIS brings up-to-date financial information automatically to their fingertips. TETRIS is a valuable tool for managing the entire work assessment process for a number of officials and medical experts: 200 50 100 CASE OFFICIALS PROCEEDINGS MEDICAL EXPERTS OFFICIALS TETRIS seamlessly weaves together all the relevant information: STEP STEP STEP STEP 1 2 3 4 Information submitted by an The applicant’s medical data Medical experts’ professional Decision reached well within applicant retrieved from national registers assessment of the case the 30-day limit Moreover, due to the large number of applicants, rigid deadlines, and the complexity of each case, the automated facilities of TETRIS are crucial in enabling the Fund to make allowance payments on time and in correct amounts, ensuring legal compliance. HELPING PEOPLE WITH REDUCED WORK ABILITY Other key features of TETRIS are: Automatic compensation of costs to the Automatic creation of billing records in the 1 applicant (such as the costs of visiting the 3 Fund’s accounting system; unemployment office or paying for a sign language interpreter); Automatic monitoring of each application’s Joint reception of work ability applications 2 status and the informing of the official of 4 with the Social Insurance Board and sharing outstanding issues such as upcoming due the assessment results (since the Board dates or deficiencies to be remedied; assesses the degree of severity of a disability). Based on data from 10 different registers, the smart solutions of the Fund automatically calculate and process approximately 100,000 work capability allowance and unemployment