I read an article on the Risk & Insurance web site and it made me question if carriers, TPA’s and employers know where to get the best bang for their buck when it comes to work comp case management. Huge case management conglomerates may not be the best choice. Payers are looking for spirited nurse case managers who will be patient motivators and advocates, not slaves to process.
Large insurers and other companies providing case management services may have good practices, guidelines, protocols and client handling instructions but some workers’ comp observers express concern that today’s case managers spend their workday adhering to those processes, rather than critically evaluating claims and applying their medical expertise to improve outcomes.
Judie Tsanopoulos, director of workers’ comp and loss control at St. Joseph Health System: “I don’t need to pay for you to scribe. I need a critical thinker and a decision-maker and to challenge what is happening in the exam room.” “That is what I want to pay for and I want them to take their technical skills and clinical skills and utilize them.”
Field case management nurses are now far less likely to engage in critical practices such as questioning a doctor’s treatment decisions when necessary, said Sherri Hickey, a director for Safety National. Instead they focus on following protocols and processes, such as making sure patients find their way to a contracted medical provider network. She doesn’t see as many nurses with the “more aggressive, challenging attitude” she believes is necessary.
Case managers who have worked for huge case management conglomerates will tell you that the smaller more case and claimant oriented companies are delivering great outcomes, savings and claimant support. We have the time, the resources and the drive because we are not drowning in outdated processes and corporate baggage. We can be more aggressive and focused which drives us and supports a challenging attitude. Done right, nurse case management can have a huge impact on resolving claims.
References: Article – Slaves to Process, Roberto Ceniceros Senior Editor at Risk & Insurance®