Making a Case for Case Mgmt.
I suggest we define the term "case management" broadly. I also suggest we define it as an intervention to support the worker as they cope with their impairment.
When is a person actually doing case management? To find out we need to liberate the act from the career of case management.
A spectrum of acts can qualify as case management. A human resources staffer advising a just-injured employee, or a nurse helping a family prepare for the quadriplegia of an erstwhile breadwinner can properly qualify. In analyzing the science, we have very few reliable studies since only a handful of them have been published since the mid-1990s.
Two studies, looking at case management from opposite extremes of medical severity, used retrospective techniques to compare interventions with control groups constructed after the fact from claims data.
In a 2008 study, Milliman matched 74 catastrophic claims managed by the case management firm Paradigm with claims Milliman found in its own database.
The study found that the Paradigm cases were 36 percent lower in cost and their return-to-work outcomes were better. The study supported Paradigm's assertion that these types of cases are highly sensitive to expert intervention at both the patient and the treating-specialist levels.
Another study, released this spring, uses a similar approach to evaluate instant, and far less medically intense, case management. The study, titled "Multi-Faceted Case Management: Reducing Compensation Costs of Musculoskeletal Work Injuries in Australia," was co-authored by Glenn Pransky of Liberty Mutual's Center for Disability Research.
The research team identified employer claims from incidents in 2002 to 2004 in the Australian state of Victoria. Those claims began during a period in which employers began using an injury management firm called OccCorp. Employers alerted OccCorp 20 minutes after an injury happened, and OccCorp's case managers called the worker at least six times in the first two weeks to listen, encourage and advise, then kept on the claim until its closure.
The researchers matched OccCorp's clients with similar employers and tracked similar claims arising from the same period.The claims for which there was an intervention incurred 35 percent less expense and 58 percent fewer lost days, the researchers found.
To be sure, motivated employers helped the interventions succeed. This is not a bias flaw in the research. Rather, it's up to claims payers to induce their clients to buy into the strategy.
OccCorp employs social workers and physical therapists as case managers. In other settings, the "high-contact" professionals can be even more varied. Insurer Seabright, for example, deploys doctors to call the worker directly right after the injury. Seabright is close to adding allied health professionals to their intervention process.
Empowering this response strategy is a concept called "PIE," or proximity, immediacy and expectancy, to respond to sudden misfortune such as a battle injury.
Here, then, we have two confirmations of the value of case management, and that case management works.
PETER ROUSMANIERE is an expert on the workers' compensation industry. He can be reached at email@example.com.
June 1, 2012
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