By Kim Radcliffe, SVP of Clinical, One Call
The workers’ compensation industry can learn a thing or two from legendary UCLA basketball coach John Wooden who said, “It’s the little details that are vital. Little things make big things happen.”
I have certainly experienced how the “details” can make all the difference for an injured worker’s health, recovery and quality of life.
This is especially true for injured workers who have suffered from complex injuries: a chronic back wound that heals after switching out the bed; a quadriplegic who’s utilizing a standing wheelchair after being put on a weight loss plan; an amputee who returned to work after adjustments were made to a prosthesis that was causing pain.
Paying attention to the “details” helps to uncover the root cause of any roadblock that is inhibiting progress or future success. Don’t miss the details – incorporate unparalleled oversight and management of each injured worker’s recovery plan.
So what elements comprise unparalleled oversight and management of complex cases?
1) Engage early
It’s a simple but important concept. The earlier you can engage with the injured worker and assess the complexities of the injury, the sooner you’re able to develop a customized plan that makes sense for that particular person. This engagement at onset of injury helps set expectations, thus relieving an injured worker’s anxiety; mitigating psychosocial factors; reducing delays in the continuum of care; and avoiding unnecessary or improper equipment, supplies or services.
2) Adopt a patient-centric mindset
Each injured worker is unique – which means their needs are equally unique. Adopt a patient-centric mindset that looks past the physical aspects of the injury and assesses all biopsychosocial elements at play.
Is the injured worker experiencing pain? Are they battling stress or anxiety? Is their outlook positive? Do they have a strong support system? Are they motivated to return to work?
Answers to questions such as these will help properly address an injured worker’s holistic needs, both short and long-term, thus setting them up for success.
3) Utilize a coordinated, well-communicated approach
As the complexity of a case increases, so does the importance of a coordinated approach. Establish a designated point of contact up-front who can seamlessly coordinate all end-to-end solutions – from physical therapy to more in-depth needs, such as home accessibility. This person’s primary goal is to ease the minds of all stakeholders by providing a seamlessly coordinated, high-touch, informed experience. This enables other partners, such as nurse case managers, to focus their attention on injured worker care vs. oversight and administrative needs.
4) Access clinical excellence
Incorporate a team of multi-disciplinary clinical experts – such as physicians, nurses, prosthetists, occupational and physical therapists – who work together to establish an evidence-based, consultative plan of attack. Each expert provides a unique perspective that when combined, often leads to vital insights regarding care. From there, clinical experts are able to communicate on a peer-to-peer level with other stakeholders, such as the nurse case manager, about next steps. When you’re speaking the same language, you’re able get on the same page a lot quicker and adjust the recovery plan, as needed. Collaboration among clinical experts also ensures the most current and relevant clinical solutions are considered, which helps drive the best possible outcomes.
5) Regularly review an injured worker’s care plan
Last, but certainly not least, is the ability to review an injured worker’s plan at any time. This should be a two-pronged approach:
- Data and analytics should be accessible and utilized throughout an injured worker’s journey to determine the best, most appropriate, timely care possible. This includes assessing their health condition at the onset of injury, such as addressing existing comorbidities that may impede recovery. As an injured worker moves through their recovery, data should function as a red flag alert system, sounding the alarm when care is about to veer from the plan and pinpointing the root cause. Innovative technology allows guidelines and red flags to be systematically and automatically incorporated into care management to ensure a timely response to concerns.
- Conduct regular six-month reviews of a long-term homebound injured worker’s environment, equipment, services and supplies. This review process helps to ensure ongoing functionality, address any changes in health status and needs, and confirm that equipment and devices are in good condition to prevent wounds or injury. Always ask yourself – does the current situation result in the best health and happiness for this individual? If not, it’s time to make some changes.
Paying close attention to the details of an injured worker’s journey demonstrates a commitment beyond returning them to work, or even life. It demonstrates a commitment to their quality of life. In doing so, you will be helping our industry get one step closer to a patient advocacy approach – one step closer to the realization that we’re capable of making a difference in the lives of real people because of our efforts.
About Kim Radcliffe, MHA, PT
Kim has been with One Call for 14 years, starting as VP of Clinical Operations for Align Networks (previously, a division of One Call) in 2006, becoming President of Physical Therapy in July 2014, and currently serving as SVP of Clinical. Kim leads a multi-specialty team of clinical experts to focus on comprehensive, patient-centric and injury-specific clinical oversight to ensure the delivery of quality care and superior outcomes.
Kim is credited with the creation, development and evolution of One Call’s Gold Standard Review program, a clinical oversight program that monitors quality of care, treatment patterns, utilization and appropriateness of care. Kim received her B.S. of Health Science in P.T from the University of Florida in 1997 and her Master of Health Administration from the University of North Florida in 2007. She has more than 20 years of experience in management and leadership within the healthcare industry, with a focus on out-patient, ancillary services. Kim has also co-authored the article: “Evidence based medicine as a strategy for quality improvement” Int J. Public Policy, Vol 5., Nos. 2/3, 2010.
About One Call
As the nation’s leader in specialty network management services for the workers’ compensation industry, we place injured workers at the heart of everything we do. We utilize creative and innovative solutions to timely and efficiently connect injured workers with quality provider networks across a multitude of health care services. Our foundation is built on an unwavering commitment to deliver exceptional service and unparalleled clinical expertise to drive outcomes. For more information and the latest news, visit us at onecallcm.com, LinkedIn (One Call) and Twitter (@onecallcm).
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