By Delphia Frisch, Executive VP/COO, Genex Services, a division of Enlyte
This week marks a special time for workers’ comp. It’s when we take a moment to celebrate the true heroes of our industry: case managers. Each year, these professionals are charged with ensuring thousands of American employees who sustain an injury on the job receive the care and resources they need to reach their highest level of functioning.
Unfortunately, the life-changing role these professionals play often goes unnoticed, mainly because these dedicated experts are a humble group, often viewing these accomplishments as “part of the job.”
So, in honor of National Case Management Week (Oct. 9-15), I think it’s appropriate we shine a much-deserved spotlight on the thousands of professionals who help keep America’s workforce humming along by ensuring injured employees get the best care they need to return to work.
To best exemplify the difference case managers make in workers’ comp, I decided to share four case studies from the recently announced Heart of Case Management Awards. Now in its 7th year, this national contest highlights the accomplishments of 2,000 Genex Services case managers who serve in various areas of the profession including field, telephonic, catastrophic and disability management case management. I hope these cases give you a true indication of why case management is so vital to the success of workers’ compensation as well as disability insurance as the effective role of case management often crosses insurance lines.
Field Case Management – Mary Meagan Campbell Pittman, MSN, RN, CCM
A police officer was hospitalized in the ICU with shortness of breath secondary to a COVID diagnosis. He required ICU care for several weeks including mechanical ventilation and intubation to protect his airway leading to eventual tracheostomy and gastrostomy tube placement. He also endured two near-cardiac arrest incidents, from which he recovered.
The adjuster referred the case to case management, specifically requesting Mary Meagan Campbell-Pittman due to her excellent reputation and ICU nursing background. Pittman quickly assessed the officer’s status and facilitated communication between the hospital staff, adjuster and family, which had been disrupted at the time due to the facility’s COVID precautions.
The man gradually improved and, after two-and-a-half months in the ICU, was weaned off the ventilator and discharged to an inpatient rehabilitation facility. Despite his condition, the officer was determined to return to duty and quickly progressed to outpatient therapy.
However, another complication emerged when the officer reported severe shoulder pain. Pittman referred him to an orthopedic specialist, who diagnosed the officer with brachial plexus caused by prolonged restraint use to prevent him from removing his IVs while in ICU care.
After undergoing extensive research and making numerous phone calls, Pittman found an orthopedic specialist who recommended a rehabilitation program that would avoid surgery, allow the officer to rehabilitate faster and reduce claim costs. The officer was eventually able to return to modified duty with a goal of full-duty release expected after continued work conditioning.
Telephonic Case Management – Christine Heil, RN, CCM
A 45-year-old manager of an auto repair company was assisting an employee when a vehicle he was standing near fell off a lift and onto his foot, creating an open fracture of his large right toe with bone puncturing skin. The injured employee was treated at his local hospital emergency department and followed up with treatment at an urgent care center. As days progressed, the toe turned black and the man was informed by the urgent care physician that gangrene had set in and his toe would need to be amputated.
This is when Christine Heil, a telephonic case manager, was called onto the case. Realizing such a procedure would permanently affect the employee’s gait and activities of daily living, but aware that delaying the procedure could be dangerous, Heil instructed the man to visit a more specialized facility 35 minutes away with a dedicated wound care center so his foot could be diagnosed properly. There, a physician deduced the black appearance was not gangrene but substantial bruising.
Instead of amputation, the man underwent toe debridement and hyperbaric treatment. Heil continued managing the case, ensuring the injured employee received adequate treatments and wound care from orthopedic specialists, helping him recover from his injury. The result, a complete return to work within six weeks from the onset of Heil taking the case. Her actions helped save the employee’s toe and prevent a claim from spiraling out of control.
Catastrophic Case Management – Kellie Harrell, RN, BSN, CCM
Unlike her colleagues, Kellie Harrell’s award-winning case did not center around one injured employee, but several in responding to a mass casualty incident. A factory was destroyed by a natural disaster with over 100 employees in the building. The devastating event resulted in eight fatalities as rescue crews continued to free dozens of employees from debris.
To handle the number of injured, employees were taken to five hospitals in the area. Harrell received survivors at three hospitals working with up to 10 injured employees at a time. She continued communication with the branch to ensure the adjuster and employer received up-to-date information regarding their employees, while supporting family members through the crisis. She worked weekends, sometimes putting in as much as 16 hours a day to ensure continuity of care. The injured employees she managed sustained various degrees of injury from burns to crush injuries.
To complicate matters, all of Harrell’s claimants had been diagnosed with rhabdomyolysis, a serious medical condition brought on by lying under heavy debris for several hours. The condition can often become fatal or lead to permanent disability. Underlying conditions also posed problems for some of the injured, such as cardiac disorders and diabetes.
Harrell continued to work with hospital staff and specialists, coordinating discharge, home health needs, and future follow up with providers. She continued to provide field case management by coordinating and attending visits with specialists to establish and complete treatment plans.
As her claimants’ physical injuries improved, they were faced with another dauting challenge, overcoming anxiety, depression and post-traumatic stress in returning to work. To help them cope, Harrell recommended support groups and identified those individuals who would benefit from additional mental health services and coping mechanisms. Through her monumental efforts, Harrell enabled most of the employees in her caseload to return full duty ahead of schedule, resulting in significant cost savings and, most importantly, resumption of functional ability.
Disability Case Management – Nicole Kunde, CCM
A 54-year-old mechanic experienced respiratory distress due to worsening COVID symptoms. The man was admitted to his local hospital for supplemental oxygen therapy. Case manager Nicole Kunde was assigned to the case where she coordinated home health treatment to support continuance of care including ventilator assistance.
During one of the visits, the home health nurse indicated the man’s blood pressure had spiked to significantly high levels. Through ongoing communication, the employee felt comfortable with Kunde and disclosed his medical history of cardiac arrest with subsequent stent placement. Armed with this knowledge and realizing his health status was not positively progressing, Kunde made appropriate referral to both cardiology and pulmonology specialists.
While awaiting these appointments, the employee’s health took a turn for the worse resulting in repeat hospitalization. Labs and diagnostic testing revealed a new diagnosis of stage 3 lung cancer. Recognizing the seriousness of the situation, Kunde promptly referred it to Social Security Disability Insurance (SSDI), confident the case would be approved as a compassionate allowance condition.
The SSDI was approved, and this quick action avoided overpayment of short-term disability benefits as the SSDI applied as an offset to the wage replacement benefit. Kunde utilized resources to benchmark estimated length of disability to include comorbidities and worked collaboratively with the employee to establish goals. Both the employee and his spouse have been very appreciative of services provided pertaining to additional income, supplemental resources, and coordination of long-term benefits in case there are any further setbacks.
These cases are shining examples of the impact case management has our industry, but they also represent the commitment all of us have in workers’ comp: improving lives for the better.
About Delphia Frisch
Delphia Frisch is Executive Vice President/Chief Operating Officer at Genex Services, a division of Enlyte, where she is responsible for field branch sales and operations personnel, as well as delivery of all company service lines across the broad spectrum of Genex’s managed care services.
About Genex Services
Genex Services provides best-in-class clinical solutions that enable customers to transform their bottom lines while enhancing the lives of injured and disabled workers. Genex, a clinical management leader throughout North America, serves the top underwriters of workers’ compensation, automobile, disability insurance, third-party administrators and a significant number of Fortune 500 employers. In addition, Genex clinical services are enhanced by intelligent systems and 360-degree data analysis. Its clinical expertise consistently drives superior results related to medical, wage loss, and productivity costs associated with claims in the workers’ compensation, disability, automobile, and health care systems. Genex, Mitchell, and Coventry have combined their joint industry expertise and advanced technology solutions into one organization, Enlyte, to simplify and optimize property, casualty, and disability claims processes and services.
Disclosure:
Enlyte is a WorkCompWire ad partner.
This is NOT a paid placement.