Telephonic case management transforms care during the pandemic

Helping injured employees return to work safely and appropriately takes a network of experienced professionals and protocols that allow for nuanced care. Unfortunately, the pandemic has complicated these protocols for each person invested in workers’ rehabilitation. For Medlogix, telephonic case management has been an ideal solution.

“Our goal is to minimize lost time,” said Cindy Pirozzi, Senior Vice President of Managed Care at Medlogix. “We want to see that an injured employee gets the prompt, ongoing, and quality assessment and treatment they need to get back to work.”

Major Players

The team of professionals that will take the employee from injury through return-to-work needs to work seamlessly together to assess and adjust procedures and care each step of the way. The significant roles are employee, employer, care provider, adjuster, and the nurse case manager. 

The injured party, or the employee, is the patient who suffered injury or illness on the job. The injured worker’s employer has goals to support their employee in their treatment plan to return to work. The care provider team comprises medical professionals who actively assess and document patient needs and progress throughout diagnosis, recovery, and rehabilitation.

An adjuster’s role is to make compensability determinations, set reserves and handle the financial payment aspects of the claim. Finally, the nurse case manager assists the injured worker by directing and guiding them through the process.

Added Strain

Each of the roles above has experienced the ongoing pandemic differently, but all have been impacted. Labor shortages put insurmountable pressure on injured workers to recover quickly. The constant ebb-and-flow of positive COVID-19 cases means every employer is juggling employee health and safety along with the demands of their business.

It is no secret that care providers are also burdened beyond capacity, as the coronavirus demands such a high proportion of time and emotional energy. These stressors can make it challenging to connect and communicate with patients. Adjusters and nurses, in particular, are facing unprecedented stress. Though they can often work remotely, they are experiencing an exceptional caseload volume while also striving to give each case the attention it deserves. In addition, scheduling in-person provider visits and diagnostics in a timely manner has become immensely challenging during the pandemic.

On the Case

The nurse case manager has two prominent roles: 

• To help identify appropriate providers and services throughout care
• To ensure timely and cost-effective resources are used to obtain optimum value for all parties. 

They serve as a conductor of sorts, and they follow and review each step to ensure proper care is administered. To improve outcomes, they also consider alternatives in the patient’s treatment plan. 

“Essentially, the case manager is the maestro,” Pirozzi said. “You’ve got the strings, brass, percussion, and then the woodwinds section comes in, and they’re orchestrating it all. They are the ones with their eyes and ears on all of it.”  The workers’ compensation system can be confusing for an injured worker, and the case manager takes the confusion away.

The case manager interviews the patient to assess the injury mechanism, and the injury itself, listens for inconsistencies, and follows up on any additional complaints that might not have been included in the initial review. They then make sure that the injured worker is matched with the appropriate service providers and review each case step to determine what care needs to continue or pivot to ensure forward motion on behalf of all parties.

Pandemic Pivot

Pandemic public health protocols and other pandemic-associated barriers during peak case counts across the country made access to providers a challenge for patients. Successful return-to-work strategies take time, attention, perspective, and nuance to achieve. Telephonic nurse case management has been a sound solution for Medlogix to connect and provide quality healthcare providers for the injured workers.

Nurse case managers maintain consistent contact with the injured party to ensure preauthorization, coordinate appointments, and follow up as needed with care providers involved. This type of case manager is trained explicitly in interpersonal communication and other skill areas that allow for over-the-phone exchange to be seamless, thorough, and efficient. Telemedicine appointments have also been a useful tool and are scheduled when needed. 

“It is key to have someone on each case from the get-go as soon the injury occurs,” Pirozzi said. “Especially during the pandemic when access has been a challenge with changing public health protocols, we could still have our case managers on the phone with the patient and care providers same day or within 24 hours, and they are working remotely with a phone and computer.”

Prolonged care

When it comes to managing claims with prolonged or questionable treatments, a telephonic case manager can be an invaluable resource. Not only are they able to be persistent with continuous follow-up, but they can make sure the claimant is receiving the care they need.

“If the injured workers are in a treatment program for an extensive period, objective improvement needs to be documented,” Pirozzi said. “The case manager works closely with the employer to obtain the employee’s job description with essential job tasks, so the treating provider can evaluate the worker to determine if they are capable to go back to their previous job or work in a modified or transitional duty position based on their functional abilities.”  If the functional abilities are not clear, then the nurse case manager may recommend a Functional Capacity Evaluation (FCE), which will define, objectively, the injured worker’s functional capabilities. 

Telephonic nurse case management is a cost-effective and efficient solution for over-seeing workers’ compensation cases from incident to resolution, whether for acute or persistent injuries. Read more about Medlogix’s robust worker’s comp services at medlogix.com/workers-comp.