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© 2019 Professional Dynamics, Inc

The Effectiveness of Early Intervention

by a Nurse Case Manager in Workers’ Compensation

 

 

Controlling workers’ compensation costs is a challenge every employer faces. A large portion of these costs are directly attributed to medical costs and time away from work due to work related injury or illness. In partnership with a public entity in California, Professional Dynamics implemented a program designed to address both challenges by utilizing Nurse Case Management that begins at the first notice of injury.

 

Background

 

Professional Dynamics, Inc. (“PDI”) is a Managed Care firm located in Northern California, with 37 years of experience in the workers’ compensation industry. PDI’s client is a City in Northern California with 2100 covered employees. The City is unique in that they employ a single, unified Department of Public Safety where employees are trained to perform the roles of firefighter, police officer, and EMT.

 

Problem Statement

 

The City reports a high number of days away from work due to work related injury or illness. This time away from work is not solely due to recovery time from the injury or illness, it is also compounded by delays in the injured worker’s medical treatment, late reporting of injuries/incidents, and barriers to returning the injured worker back to their employment. Such barriers include inability to obtain a proper list of work restrictions/abilities from the medical provider, uncooperative injured workers, or the employer’s inability to match the employee with a position within their medical restrictions and abilities.

 

In the year prior to the implementation of the new program, the City recorded 4,183 lost days of which 3,607 were in the Department of Public Safety.

 

Solution

 

PDI assigned a dedicated Nurse Case Manager to the City and injured workers were given a toll-free number to utilize whenever they experienced a work-related injury or incident. This number connects the injured worker with PDI’s team of Registered Triage Nurses who utilize Schmidt/Thompson medical guidelines to triage the caller’s symptoms. The triage nurse directs the caller to the City’s preferred medical providers and reports the injury to the employer and to the dedicated Nurse Case Manager.

 

The dedicated Nurse Case Manager begins work on the case within one business day of the report of injury. The Nurse Case Manager’s routine intervention includes:

  • Discussions with the employer to identify barriers and/or red flags

  • Follow up with the injured worker to ensure they have sought treatment from the appropriate medical provider and answer questions regarding medical treatment

  • Communication with the medical provider to discuss any barriers to return to work and to pre-injury status

  • Authorize treatment as applicable, the same day treatment requests are received from the provider

  • Coordinate a release to return to work from the medical provider and transitional employment accommodations with the employer, when applicable

 

Outcome

 

The Nurse Advice Line injury reporting process reduced the time between injury and reporting allowing the dedicated Nurse Case Manager the opportunity to begin facilitating treatment and return to work at the beginning stage of the claim. The Nurse Case Manager worked closely with the injured worker to ensure their accountability with attending appointments, but also assisted with scheduling follow-up appointments, and specialist and therapy appointments, avoiding unnecessary delays in treatment. The Nurse also authorized appropriate treatment immediately and coordinated with the medical provider and employer to return employees back to work sooner than projected, with modified employment accommodations where applicable. The resulting cost savings were seen immediately:

 

  • After the first year of the program, the City saw a 56% reduction in days away from work, including a 61% reduction in days away from work for the Department of Public.

  • After 3 years, the average medical cost per claim was down 53%, from $5,526 per claim to $2,571, and the number of total disability cases were reduced 20%.

  • After five years of the program, the days away from work were reduced an average of 62% from the year prior to program implementation, 68% for the Department of Public Safety.

 

Additionally, the City saw a substantial positive impact on employee morale and understanding of the workers’ compensation process. The employees provided feedback that discussed their trust in the dedicated Nurse Case Manager, and how the Nurse’s involvement made them feel at ease about the process. Over 5 years, the City saw an 81% reduction in litigated claims.

 

Conclusion

 

The work performed by the dedicated Nurse Case Manager shaped the future of the claim not only reducing medical dollars and days away from work, but also providing the injured worker with an advocate for their medical concerns. This advocacy contributed to a substantial improvement in injured worker cooperation with the medical treatment plan, resulting in faster recovery times and earlier return to work. The Nurse Case Manager also established solid relationships with the medical providers, gaining cooperation from the physicians in releasing employees to modified duty.

 

This program demonstrated the importance of early intervention of a workers’ compensation injury and how this intervention has a direct impact on medical dollars and days away from work. The program also demonstrated the substantial influence a dedicated case manager has on relationships with providers, injured workers, and the overall outcome of the claim.