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To Be Effective, Case Management Solutions Must Deliver Both Options and Quality
By building trust and partnerships during what is often a very challenging time, case managers are central to guiding injured patients back to health and meaningful work.
Accomplishing this in today’s work and health care environments requires case managers, and case management companies, to be better equipped and trained than ever before.
“There is almost an overwhelming range of workplace injuries and paths to wellness, so many employers today have a workforce that is spread across the entire country,” said Shannon Ford, Senior Vice President, Case Management Solutions for Paradigm. “To meet this reality, case management in workers’ compensation needs to be able to achieve a comprehensive range of services, while still staying highly focused on individual needs.” And when injuries become more challenging and complex, that’s when high-quality, people-focused, and expansive case management can be a real difference-maker in achieving positive outcomes.
Why Options Are More Important than Ever for Case Management
Work-related injuries require case management solutions for a wide range of situations and circumstances, including coordination between multiple providers, patient history of previous injuries, multiple and complex injuries, and psychosocial or behavioral health concerns. “The higher the stakes of a case, the greater the need for resources and experience to address those challenges,” said Brenda Calia, Vice President, Case Management Delivery for Paradigm. “In the current environment, case managers must be equipped with the skills and resources to consistently achieve measurably improved outcomes for all types of cases, including the most complex and difficult injuries,” she said.
Added Ford, “A one-size-fits-all approach to case management does not work. Person-centric and outcome-focused results require case management solutions that provide expansive options and the highest commitment to quality.”
Achieving cost-effective results that return injured workers back to their families and communities means dedicated solutions for any need. “To meet the variety and complexity of claim and injury types, comprehensive case management should provide a diversity of solutions that can be custom-tailored for any eventuality,” explained Calia. Above all, it’s about having the ability to guide injured workers through the entire recovery and return-to-work process. “Clients need access to a bigger set of tools. In addition to traditional telephonic case management, some cases may benefit from field case management. In other situations, working with a nurse triage service can assess the required level of care right at the injury site,” she said.
“Achieving a positive outcome in workers’ compensation is about returning injured workers to productive activity,” stressed Ford. “Case management should be able to meet this key part of the journey through vocational services and transitional return-to-work programs.”
Another critical element is the ability to provide nationwide coverage. “Workforces are larger, and more spread out than ever before. Clients need to know that injured workers will receive quality case management and guidance, no matter where they are located,” explained Calia.
Defining a Higher Level of Quality in Case Management
Of course, any set of options in case management must be able to achieve the objective it is designed to accomplish, which is why assuring quality is just as important. “Excellence in case management needs to come from an established track record for achieving unparalleled outcomes on a long-term basis,” said Calia. According to both leaders, quality needs to be measured by time, consistency, and human-centric collaboration in the following ways:
- Long-term quality: In the case management sector, organizations should carefully develop service options to build long-term, high-functioning relationships with clients and partners. Proven results over an extended period of time attest to an effective methodology, demonstrating the power of a deep library of case data.
- Consistent quality: From driving attendance at critical appointments to refining medical treatment guidelines, case managers should be laser-focused on achieving specific results every day. As just one example, vocational programs should be constantly measuring return-to-work rates and making necessary adjustments for continuing improvement.
- Collaborative quality: As standard-setters for patient-centered care, case managers need to be able to work with anyone to do what is right for the injured worker. The most important guiding principle is being human-centered and putting people first. To do this, case management services need to collaborate closely with clients, becoming an extended part of their team.
“Building long-term, consistent, and collaborative client relationships requires the relentless pursuit to understand, meet, and exceed expectations,” said Ford. “It’s ultimately about a deep commitment and understanding that everyone is there to truly improve the lives of the injured workers we mutually serve.”
Combining Options and Quality for Clients and Injured Workers
Paradigm Case Management Solutions was built to deliver the range of essential services that modern cases need, combined with the unparalleled commitment to quality that has set Paradigm apart in catastrophic care management for decades. “We offer flexibility through a wide range of services that can fit nearly any need and deliver the level of quality that has distinguished Paradigm in the marketplace for more than 30 years,” explained Calia.
Paradigm’s case management options include:
- Field Case Management: Certain cases, particularly those that involve highly complex injuries, require case managers to provide in-person assessment and support. The Field Case Management unit at Paradigm consists of more than 800 skilled case managers serving on the front lines to ensure positive clinical and return to work outcomes. This commitment to compassionate service, in tandem with an expert-guided, data-driven approach, has translated to a 93% success rate in obtaining a medical release to return to work and an over 5:1 return on investment (ROI) for field case management files.
- Telephonic Case Management: Virtual and telephonic services have become more important than ever to health care in recent years, and there is every indication that the trend will only continue. No matter what the situation, if a case can be better served over the phone, telephonic case managers must be equipped to provide the same level of care and support as case managers in the field. Paradigm’s Telephonic team provides nationwide coverage, licensure, and experience in every jurisdiction. The result is a 93% release to return to work rate for telephonic referrals.
- 24/7 Nurse Triage Service: Around-the-clock Nurse Triage Services enable nursing intervention within moments of a workplace injury to ensure proper care. In a single encounter, highly trained case managers can transition injured workers from triage to the most appropriate setting for care. This streamlined approach is carefully designed to reduce unnecessary ER visits and recordable injuries, resulting in 78% of the calls managed by this service remaining non-OSHA recordable.
- Vocational Services and Transitional Return to Work: Paradigm’s team of vocational specialists and established network of work sites can quickly place injured workers in positions that strictly align with their restrictions. Transitional Return to Work focuses on an employee’s abilities, rather than their injuries, while maintaining the employee’s self-esteem, sense of productivity, and routine. By keeping the focus squarely on the injured worker and achieving a positive outcome, 89% of these cases close with a medical return-to-work release.
Care is at the core of the Paradigm approach. Paradigm’s expansive options, along with nationwide coverage and unparalleled commitment to quality, help to ensure the best possible outcomes for everyone involved in the process.
Learn about Paradigm Case Management Solutions.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with Paradigm. The editorial staff of Risk & Insurance had no role in its preparation.