Claims professionals are no stranger to catastrophe and disruption. It's imperative that the claims process continues to expand its risk strategies in spite of hurdles, starting with fostering relationships and utilizing technology.
The first few days after a workplace injury are critical for several reasons.
First and foremost, the worker is dealing with a life-changing event. They’re often being introduced to the workers’ compensation system for the very first time. Meanwhile, unanswered questions about their health and length of recovery coupled with fears about their financial stability can cause stress and negatively impact claims outcomes.
Conversely, the employer hopes the worker will be taken care of while they monitor the claim to avoid any adverse outcomes or litigation downstream. For the employer as well as the worker, the earlier the claim is managed, the better the end result will usually be.
“Most people have no knowledge of the workers’ compensation process,” said Karen Thomas, Director of Case Management Innovation, CorVel. As a registered nurse tasked with overseeing clinical services at the company, Thomas has seen the benefits of early intervention in workers’ compensation claims.
That’s why she’s enthused about CorVel’s expanded emphasis on the value of nurses in producing good claims outcomes.
“Nurses really understand what it takes to recover,” she said.
“Sometimes there are underlying items to address in the claim that may not be as obvious to a claim adjuster, but a nurse is trained to watch for. These might include the need to call in an interpreter in order for the worker to understand the injury and treatment more clearly, or the need to educate the worker on the use of pain medication or understand the details of their prescribed treatment plan.
“When we can make these early interventions within hours or days of the injury, that’s going to have a long-term, positive effect to drive patient engagement and achieve recovery of that injury,” Thomas said.
At CorVel, getting involved in a claim early on is more than just good practice. CorVel’s Care Advocacy is designed specifically to address claims as quickly as possible to keep things moving while providing the best care for workers in the process.
Here’s why that advocacy-based approach works and what CorVel is doing to keep its program current and effective for partners.
The Care Advocate Program at CorVel has been in existence for more than a decade and provides injured workers with direct access to highly trained nurses with extensive experience in the workers’ compensation space.
In the past year, the CorVel team ramped up its offerings in order to proactively meet the needs of its partners and patients in an ever-changing health care and employment environment. Specifically, by expanding the role nurses play in the first 30 days of a claim, CorVel built a more personal, customized and effective program.
“We’ve really recommitted and made some changes to the program to bolster and provide greater support during that critical first 30 days after injury,” Thomas said.
Care Advocacy is the second point of contact for a nursing professional in CorVel’s model, picking up where the Advocacy 24/7 triage nurse leaves off after the initial report of injury. Injured workers are given access to a Care Advocate within 24 hours of the first report.
The Care Advocate ensures that the injured worker receives a level of care that not only expertly addresses the physical injury, but takes into account biopsychosocial factors that could impede their recovery if not addressed. This patient-centered approach to claims management puts injured workers at ease, increasing satisfaction among employees and facilitating timely return to work.
The Care Advocate nurse diligently reviews the worker’s diagnosis and treatment plan, ensuring they’re engaged with their care and recovery while acting as a patient advocate to the injured workers throughout the length of the claim.
An advocacy program, though, is only as good as the nurses providing the service. CorVel employs nurses with a registered nursing license in the Care Advocate role. To guarantee its partners and patients get the quality care they expect, Care Advocacy core training includes virtual nursing assessments, meeting the unique needs of injured workers and understanding workers’ compensation benefits.
This training equips nurses with the assessment skills needed to document a case, communicate with providers and have assertive conversations with members of the claims team when they see the worker is in need of a service or consult.
For CorVel, the training goes a step further: “Our nurses receive specific patient advocacy training. And then they receive training from our claims team, our pharmacy team, and really any team that feeds into the claims process,” said Thomas.
This gives nurses a full understanding of the tools available to them to drive the best outcomes.
One such tool is the PeerWell app. PeerWell | Musculoskeletal Recovery Solution for Workers’ Compensation Through a partnership with PeerWell, CorVel has implemented an application through which injured workers can access information on recovery from minor musculoskeletal injuries. This app includes safe exercise recommendations, nutrition information, lessons in mindfulness and more — all of which enables the worker to be an active participant in their care and recovery.
“We use a variety of technologies to support the workers, and our nurses are trained to provide them with the information they need to get started.”
Technologies within Care Advocacy are continuously improving as well. Utilized as a backbone for claims, technology has enabled the Care Advocate nurses to capture significant data to build intelligence behind the scenes to the system.
Included in that data is a worker’s medical assessment, which gauges attitudes, beliefs and other personal sentiments that could impede recovery. Capturing such data paves the way for better implementation of predictive analytics in supporting better claim outcomes.
“If a worker is having a negative feeling or sentiment about recovery, the nurses capture that information,” Thomas said. “Then the system can notify our team that the claim might be at risk for taking longer for the injured worker to recover or return to work.”
As part of its recent revamp of the program, CorVel has implemented the CareMC Edge AI platform, which houses the relevant data captured during a claim and drives machine learning within the platform.
“CareMC Edge uses data mining, creating predictive indicators which create actions and alerts for claims specialists and other members of the team so that we can collaborate,” Thomas explained. “It connects the dots and provides real-time communication to everyone who’s a stakeholder in the claim.”
She offered the example of pain management medication. If CorVel’s system identified a morphine equivalent score that is too high for the injury, the pharmacist on the claim would receive an alert. The Care Advocate and claim specialist would also be contacted, and the team could open up a dialogue with the prescribing physician.
“For the safety of the patient, we have this opportunity thanks to the technology at play to re-evaluate pain management for that particular worker.
It’s widely accepted that the first 30 days following an injury are a vital window of opportunity to provide optimal care and avoid an expensive, drawn out, debilitating claim. The CorVel Care Advocate Program has this industry best practice at the core of its mission.
The model is providing winning results, as borne out by the numbers.
“We’ve seen a 49% decrease in the rate of litigated claims. We see that people respond when they feel heard,” said Thomas. Additionally, the Care Advocate Program has recorded a 53% decrease in total temporary disability payments, as well as a 74% decrease in total medical paid.
Payers and patients are applauding the Care Advocate approach. According to Thomas, injured workers feel empowered knowing they have a nurse on their side and not just a claim specialist. The nurse provides vital medical expertise with a workers’ compensation focus and work toward patient engagement throughout the claim.
“CorVel is committed to approaching claims body, mind, soul,” said Thomas.
“Our biopsychosocial model provides nursing support, because as nurses, we’re going to address your care holistically. We’re going to look at the injury, yes, but we’re also going to look at the environmental and social impacts on that person. That’s something that’s very much embedded in Care Advocacy.”
To learn more, visit: https://www.corvel.com/care-advocate.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with CorVel. The editorial staff of Risk & Insurance had no role in its preparation.