Companies Manage Lower Costs Using Case Management

Article excerpt

Employers and insurers know that the cost of getting an injured employee back to work relates directly to the amount of time it takes.

The minute an injury occurs, an invisible time clock starts clicking off dollars for the company and the worker. If quality of life could be measured, that too would be keeping a downward pace with the time. Studies have shown that, if employees are off work for three months or more, the likelihood of ever getting them back is 50 percent or less.

Injuries set off a chain of events that aren't always conducive to an employee's timely return. Usually, the employee will see a physician for treatment, then will either return to work, be placed on restriction, or be sent home, possibly with a prescription for pain medication, instructions for self-care and physical therapy. Unfortunately, sometimes an employee gets lost in the shuffle, sitting at home waiting for further instructions and growing anxious about the future, while the employer wonders when that person will return. Lack of communication can result in delays in treatment, poorly planned treatment or unnecessary procedures, and inappropriate charges to insurance companies. The variable factor that can change that scenario is case management. Serving as a liaison among the employee and other family members, the employer, the workers' compensation insurance carrier, health care providers, and possibly others, the medical case manager will do everything possible to improve the quality of health to the worker while controlling the cost and monitoring outcomes. Case management has become more accepted among employers, physicians and insurance companies, with the prevalence of managed care. More and more companies realize that having an individual whose sole purpose is to monitor those injured workers' care and to expedite their return to work will translate into ultimate savings. A good case manager looks at all aspects of each case. An effective case management process will include these steps: * Case Identification -- For case management to be effective, early identification is critical. By collaborating with the worker, the employer, and the health care provider, the case manager enhances the return to work process with cost effectiveness and quality of care. * Assessment -- The goal of assessment is to identify the worker's physical and functional status, as well as resource and service needs. Experience and judgment play a large part in the evaluation of the amount of case management needed. …