The Case for Early Intervention

In workers' comp, a patient-focused, early intervention claims management model has demonstrated many key improvements over traditional case management.

Doctor with a stethoscope around his neck with his arms crossed

When it comes to workers’ compensation, the undisputed common quest of insurers and claims managers is to ensure that workers – especially those with serious injuries – receive the most appropriate care for a faster, more optimal recovery. When injured workers are at risk for temporary or permanent disability, there is an additional concern. Without vigilance, their condition can worsen, and they may be unable to return to work. Longer recovery periods can be costly. When employees are permanently disabled, the financial drain of replacement and disability compensation can be exorbitant.

Current research shows that a more patient-focused and supportive approach to injured employees can improve health outcomes and spending. A well-trained, multidisciplinary team offering immediate assistance and patient advocacy allows injured employees to get quality care and compassion when they need it. Companies that have implemented a patient-focused, early intervention claims management model report many key improvements over traditional case management, including: 

  • A faster return to work delivers more cost savings and more productive employees. Collaboration between employers and case managers resulted in a 50% decrease in the number of injured workers on one firm’s Total Temporary Disability (TTD) report, leading to a faster return to work and lower medical costs.  
  • Lower usage of potentially dangerous prescription drugs. In one instance, narcotics usage dropped from 18% to just 3.7% of claims.
  • Cost savings. One company saw case management costs go down $11,000 in one year and savings go up $1.5 million. It also experienced a 39% reduction in average costs paid per claim and a 37% reduction in the total costs incurred year over year. 

In addition to improved outcomes, lower costs and a faster return to work, relationships between the employer and the injured worker are reinforced in this model. By using nurse case managers to coordinate care, the patient and family are freed from the worry of navigating a complex healthcare system on their own. This advocacy assures them that the care plan is always moving forward. The additional coordination, concern and empathy during the recovery process reassures injured workers that their employers are looking out for their well-being. By transforming the sometimes adversarial relationships between employer and employee that can occur when cases are not monitored, the model makes litigation less likely. For example, one CorVel customer reported a 41% drop in litigated claims when case management services were used. 

See also: Claims and Effective Risk Management

Here are the components of a patient-centered approach that works to achieve these positive outcomes: 

  • Early intervention and communication. The initial interaction is conducted by an advocacy nurse who can quickly assess the injury. The early intervention directs the patient to the right care providers, at the right time, for optimal care. The stage is set for the creation of a personalized treatment program.
  • Close assessment. A dedicated team of nurses and coordinators work closely with adjusters, providers and employees to ensure an effective and timely return to work and maximum medical improvement.
  • Advocacy and information sharing. Using a single database that includes claims and care information streamlines claims management. This shared information improves the accuracy of the initial claims report, links all partners and data and can dramatically enhance care efficiencies.
  • Technology. Fully implementing a patient-centered model requires different process flows. Innovative technology and communication tools result in better tracking temporary total disability (TTD) claims. Automated alerts can help inform case managers of emerging problems so that they can be quickly rectified to keep the care plan on track.
  • Follow-up. Regular follow-up by nurse case managers and the support team helps ensure that appointments are kept, that team members are expediting care and that the appropriate specialists and ancillary benefit services are brought in as needed. This follow-through also ensures that the patient and family know, understand and participate in the care plan.
  • Screening. A myriad of complications can hurt an injured worker’s recovery. From depression to drug addiction to family issues, nurse case managers also screen for potential mental health and social determinants of health concerns. By identifying problems that may affect recovery, nurse case managers can identify and procure the appropriate resources to support injured workers in their journey to get well.

Early interventions can reduce claims costs, speed recovery and avoid disability while also building trust between workers and employers and minimizing the risk of litigation. By embracing the vision of a patient-focused approach, employers and claims managers create a claims management process that is not only cost-effective but ensures improved care for injured employees.

Karen Thomas

Profile picture for user KarenThomas

Karen Thomas

Karen Thomas, RN, MSN, CCM, vice president, clinical solutions, is a visionary for developing new care models to heal injured workers and restore function.

Thomas has 34 years of clinical experience with a focus on case management and technology solutions in various settings. She has taught nursing and case management at the university level, creating curriculum to propel case management into clinical practice. Thomas oversees CorVel's case management services, including early intervention nursing, utilization review, case management, return to work coordination, disability management and life care planning. Thomas and her nursing team are currently developing various solutions using artificial intelligence, machine learning, clinical codification and patient applications to improve medical and claim outcomes for injured workers, employers and payors.

Read More