Case management has been a vital component of workers’ compensation for years. Returning injured workers to the job in a meaningful capacity means that case managers often must perform a dual role as advocate for both the injured employee and the employer.

Though the case management service has, in recent years, felt the pressures of making good on its return on investment, it has also proven time and again its worth.

Now more than ever, case management has become an essential contributor as the entire industry faces the continuing effects of the novel coronavirus, or COVID-19, pandemic.

“COVID has already had a large impact on case management,” said Marijo Storment, CEO of Paradigm Complex Care Solutions. “As we see confirmed cases rising in many states, we know it will continue to have an impact on the entire workers’ compensation space.”

The good news is that case managers have been more than ready to help.

“We’ve asked ourselves, ‘What does case management during this pandemic look like? What does the workers’ compensation space need from case management in the future, post pandemic?’” Storment said.

This question about the future is key: In what ways has the pandemic already challenged the sector and what will the solutions look like in the months to come?

Fast-Tracking Innovation

If anything, Storment said, the COVID-19 pandemic has further sparked a desire for innovation in the case management profession.

“At Paradigm, we’ve been steering toward more innovation for months,” she said.

“The pandemic, while it’s had its challenges, gave us a silver lining: We could accelerate our innovation initiatives to meet the new needs of our customers.”

Marijo Storment, CEO, Paradigm Complex Care Solutions

COVID-19 forced many to work from home as shelter-in-place orders started to come into play mid-March. This posed an interesting dilemma for a profession that does most of its operations face-to-face. How would a case manager stay in touch with injured workers who would not be allowed to visit a physician or physical therapist due to social distancing mandates?

One answer: Telehealth.

According to the American Hospital Association (AHA), only 35% of hospitals in the U.S. had some form of telehealth services 10 years ago. Today, the AHA reports nearly 76% of hospitals have implemented a computerized telehealth system.

Now that the pandemic has come into the mix, many in the industry believe this number will continue to grow.

“Prior to the pandemic, we were already researching alternative opportunities to include more technology in the case management offering,” said Storment.

“Adoption of tele-technology, while it has been around for years, has been slow, not just in the workers’ compensation space, but also in group health. COVID-19 enabled us to really dive into the benefits of tele quickly.”

Forrester Research, a company that sets its sights on developing strategies for organizations in what it calls the “age of the customer,” projects that the adoption of telemedicine has shifted into hyper-drive now that COVID-19 is at play, reporting that virtual health care interactions are on pace to top one billion by the end of 2020. An astonishing contrast to the 36 million interactions the research company predicted pre-pandemic.

Telemedicine providers such as Teladoc have also reported spikes in video requests to more than 15,000 per day since the onset of COVID-19.

What Storment and others in the case management field are noticing is that this increase in tele-services has placed the tele-platform in the hands of every case manager, enabling injured workers or their employers to meet virtually with the team no matter where they are.

“As we integrate tele-technology more into our offering, I think we’ll be able to really dial in on the important appointments in the future, those ones that are critical to the claim,” Storment said. “Instead of being at every check-up, we can remote in. That frees up our time to support the injured worker and focus on the other aspects of their recovery.”

She anticipates case management will adopt a hybrid model of in-person and tele-presence in the future.

Additionally, another benefit Storment has noticed since tele has been growing in case management is the elimination of drive times for services like physical therapy.

“Injured workers used to have to go into a place of physical therapy maybe two, three times a week. That adds up in travel time and travel costs,” explained Storment. “Telerehab, however, lets them stay in their home and still receive the services that they need.”

This has given back valuable time for the worker to focus on home life, recovery and getting back to the job. It also aids in driving down transportation costs for a claim.

A Hybrid Model Is Emerging

While COVID-19 has driven innovation and fast-tracked the adoption of telehealth, that does not mean field case management is at its end, said Storment.

“As long as we have injured workers, field case management has a place and adds value to workers’ compensation,” she said. “Case managers foster relationships built on trust between the provider’s office and the injured worker. That in-person meeting is a vital part of that process and oftentimes can’t be replaced by a technology connection.”

Additionally, because case managers often have a background in the medical profession, they have the unique ability to navigate the world of doctors, physicians, medication and more. They act as a link between comp and health care.

“Every medical community has its own personality,” said Storment. “Case managers can answer questions for both sides — for example, case managers can answer medical questions for injured workers and give guidance on return-to-work requirements for the physicians.”

As case management moves forward and embraces the aftereffects of the pandemic, the goal is to find balance between being out in the field and continuing to adopt tech services.

“Our case managers, who span across the U.S., know their communities. They have been using their strong, community-based relationships to get injured workers access to health care during this time of the COVID pandemic,” Storment said.

“I believe that if we didn’t have that base to work from, the telehealth measures would not have garnered as much success.”

The ideal hybrid model, then, would take into account that not all appointments are critical. That some can be done over the phone or through video chat. But when the need arises for in-person service, the case manager will be there, front and center, while taking proper precautions.

“That’s just one way that case management will evolve.”

Paradigm’s Prime Example

The marriage of tech and in-person case management is well underway for the sector. At Paradigm, for example, the team has already rolled out a service that couples case management and telehealth.

“The Surgical Optimization Program aims to couple our case management services with technology to optimize the injured worker around surgical events,” Storment explained.

The program was also accelerated due to COVID-19, and while the results are still coming in, the team sees promise.

“Having surgical delays can prolong disability duration, and therefore the claim. We’re making sure these patients are healthy before surgery, really optimizing their well-being, to see better outcomes.”

Tackling Challenges as They Come

While the pandemic has certainly brought forth opportunities by accelerating innovation in the case management profession, COVID-19 still has its challenges.

“First, we had to overcome the suspension of medical care,” said Storment. “Telehealth really helped with that.”

Now that access to and resumption of nonessential medical care is starting again, case management leaders are applying the lessons learned to prevent this particular challenge from having long-term effects.

“We’ve been able to keep claims moving throughout the pandemic and get the workers the care they needed. Now, providers and facilities are opening, and we’re looking for the right balance between telehealth and field case management.”

Another challenge, she said, has been return-to-work.

“Injured workers who were unable to get into physicians’ offices were not getting released back to work,” she explained.

Telemedicine, while certainly an advantage, sometimes proved a hindrance in clearing injured workers for return-to-work. Physicians were hesitant to release a worker without physically examining them.

“What we found was, telemedicine physicians are not as comfortable today addressing return-to-work as when a doctor who’s really accustomed to seeing workers’ compensation sees a patient in person,” said Storment.

Now that things are opening, however, this is likely to be less of a challenge in the immediate future. But, Storment stressed, it is something that the profession must review and address for the future.

A final challenge is unemployment. Unlike the suspension of medical care or addressing return-to-work, the high rate of unemployment is likely to have a longer-lasting impact on case management.

“Over 45 million jobless claims have been filed so far,” said Storment. “The unemployment rate is at a very high level. And so, we anticipate that the need for vocational case management services will definitely increase, and we’re prepared for it.”

While there are a wide array of unanticipated challenges that have developed in the case management field, Storment said the Paradigm Complex Care Solutions team is confident that they have the resources, experience and expertise to continue to meet them.

By successfully joining high-tech solutions with high-touch service, case managers can continue to help injured workers and their organizations get the care they need. &