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White Paper
Unlocking the Impact of Effective Medical Case Management
White Paper Summary
Research shows that effective case management, when applied early, optimizes functional outcomes, improves recovery times, and reduces claim costs, ultimately benefiting employers, insurers, and injured workers. Still, companies often attempt to contain the cost of medical case management services by restricting case management activity to specific micro-tasks or by restricting the scope of the case manager’s involvement in treatment, rehabilitation, and/or return-to-work processes. This cost-based approach often limits the benefits of medical case management and discounts the significant savings it can deliver.
As evidenced by industry data as well as Rising’s own performance results, proactive case management addresses common issues like delays in care, unnecessary treatments, and psychosocial risk factors, which can hinder return to work and increase costs. For example, a study by Liberty Mutual/Helmsman showed that nurse involvement resulted in 26% lower overall costs and 15% faster claim resolutions. Rising’s own medical case management program demonstrated 33% shorter claim durations and 27% lower medical costs.
Additionally, delays in return to work can lead to high indirect costs, such as lost production, temporary employees and training/retraining, which can be upwards of four to five times direct claim costs. Medical case management, when properly implemented, consistently generates savings results that more than offset the cost of these services. The key to consistently realizing positive return on investment is to engage a medical case management approach that has both a clinical focus and organizational accountability, including consistent evaluation of case management outcomes and the value added, sound savings calculation methodologies, and ongoing quality assurance and best practice coaching on the files assigned to a clinical team.
To learn more about Rising Medical Solutions, please visit their website.
