By Tom Ryan, Managing Director and Market Research Leader for Marsh’s Workers’ Compensation Center of Excellence
Two decades ago, claims administrators began to adopt nurse case management techniques that had been successfully used in group health as a way to control increasing workers’ compensation costs. These techniques have since evolved into an extensive range of options available to employers and insurers to help deliver the right care to injured workers and expedite their return to work. Given their choices, it’s important that employers understand how each option works and how they can help them reduce expenses and improve claims outcomes.
Telephonic, Onsite, and Field Nurse Case Management
From what was once a simple, per-hour charge, telephonic nurse case management services have grown into an array of customizable options based on timeframe, clinical specialty, desired outcomes, and other variables. And now predictive modeling and vendors’ proprietary business rules are helping employers make better decisions about when and how to use nurse case management in individual claims. Pricing for telephonic nurse case management is flexible; it can be available on an hourly basis or for a flat rate for engagements ranging from as little as 15 days to more than 60 days. If necessary, employers can request nurses with specific or specialized health care expertise.
For work-related injuries or illnesses that require additional attention, onsite or field nurse case management can provide “face to face” care and intervention. Some complex claims may be candidates for referring a field nurse case manager to travel and meet with injured employees and treating medical providers. Employers, claim administrators, and carriers may request a number of visits or a specific task or full assignment when making the onsite nurse referral. The onsite presence provides added insight with a holistic approach that includes medical care, planning, and any behavioral or psychosocial issues that may need to be addressed.
Although there are clearly benefits to employers and their injured workers, it remains difficult for vendors to quantify cost savings from telephone and field nurse case management. Some vendors have developed savings methodologies that calculate cost avoidance based on reductions in temporary total disability (TTD) days. Employers continue to request more quantifiable consistent savings methodologies, but no industry standard is currently available.
Nurse triage includes a variety of early intervention services that provide employees with prompt medical attention for work-related injuries and illnesses that are not serious or life threatening. In a nurse triage model, a registered nurse (available 24 hours a day) uses nationally recognized triage clinical algorithms to guide an injured employee through his or her options. Injured employees will also be directed to preferred providers for any required medical care. Nurse triage is typically available for a one-time charge per call, with follow up calls as required, but flexible pricing options are also available.
An emerging technique in case management is telemedicine, through which medical providers can remotely treat patients by using technology, ranging from emails and phone calls to virtual medical examinations. Occupational health providers and payers are exploring telemedicine as a potential opportunity to realize cost savings and improve medical outcomes. Key benefits of telemedicine include:
- Providing prompt diagnosis and treatment of minor injuries or illnesses.
- Delivering high-quality, specialized care to remote employee populations, including those who are offshore or located in rural areas.
- Helping employers evaluate remote injured workers who may be candidates for transitional temporary modified duty.
Telephonic, field, and onsite nurse case management and nurse triage are available through most third-party administrators, workers’ compensation insurers, and managed care providers, and the market for telemedicine is likely to continue to expand in the coming years as workers’ compensation buyers continue to look for ways to secure the best care for injured employees and lower costs. Employers should talk to their insurance brokers and claims advisors about the benefits of each option and how they can be successfully applied to deliver cost savings and drive better outcomes in workers’ compensation.
About Tom Ryan
Thomas Ryan is a managing director and the Market Research Leader for Marsh’s Workers’ Compensation Center of Excellence. In this role, Tom oversees research and distribution of content on emerging issues, tracks federal and state regulatory changes and prevailing market conditions, and other topics related to the workers’ compensation environment. He also consults with clients and provides information and recommendations using Marsh’s holistic MPACT Workers’ Compensation strategy.
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