Getting the Most Out of Your Case Management Program




One of the most effective tools for assisting your workers’ compensation claims team continues to be intervention by a Nurse Case Manager. Nurses assigned, on targeted cases, can be instrumental in cost containment. They serve as an advocate for the injured worker, assist in ensuring optimal care, and decrease disability days.


Strong, healthy, case management programs that bring value require work on the front end to design a program tailored to specific needs. Program evaluation to determine drivers of cost is essential in building a program that is cost effective and results focused. In addition to use of FCM or TCM services, utilizing specialty case management services may be beneficial to address issues with high pharmacy costs, aged claims, surgical claims or costly pain management programs. Our focus is on RTW and we train our nurses to your specific RTW program so that there are no delays once a work release is in hand.


A carefully planned and well monitored case management program can produce tremendous results. Over a one year period, an EK carrier client experienced the following.

  • Case management fees on closed cases decreased by 35%
  • Open caseload decreased by 30%
  • Annual fees for case management decreased by 26%


What steps were taken to accomplish these great results? We began with a review of all cases assigned to case management, starting with the most recently assigned. Determination was made as to necessity of services, appropriate level of service (FCM vs. TCM), and goal achievement. Cases with no significant benefit resultant of services were closed. For cases that remained open, a case management oversight program was put in place to ensure effective, proactive action plans, goals for the assignments, and appropriate fees for service.


Working closely with our client, Case Management Protocols were developed, followed by training for both claims examiners and nurses. On a regular basis, conference is held with the client to review open cases and select those that require discussion (RoundTable) with the claims examiners. RoundTable meeting are crucial to staying on top of costs, as they assist in keeping your team focused on time-limited, task assignments that are goal driven.


EK Health partners with clients to develop the right and best program to meet their unique needs. For discussion of your case management program, please contact us at 877-861-1595.

 


Joanne Travaline
, Assistant Vice President of Strategic Accounts