Case Management Guide: Field vs. Telephonic

Case management, as defined by the Case Management Society of America, is “a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy… to promote quality, cost-effective outcomes.” It bridges the gap between injured employees, providers, employers, and adjusters through aligned communication and goal-oriented care. It comes in two main forms: Field Case Management (FCM) and Telephonic Case Management (TCM).

Today, most claims teams use both FCM and TCM as complementary tools. While field case management establishes trust, telephonic case management offers efficiency and reach. The key is knowing when to use each to boost recovery, reduce costs, and foster trust.

What is Field Case Management?

Field case management is the in-person model most people picture when they think of case management. In this approach, a case manager physically meets with the injured employee, attends medical appointments, and may conduct workplace or home assessments to better understand barriers to recovery.

The benefits include:

• Firsthand observation: Being onsite provides context that can’t be captured in records alone, whether it’s evaluating a workstation setup, identifying environmental risks at home, or clarifying treatment details with the provider.
• Building rapport: Meeting face-to-face helps establish trust and provides emotional support, which research shows can improve adherence to treatment and engagement in return-to-work plans. According to the Case Management Society of America, collaborative, trust-driven interventions are strongly correlated with better health outcomes and cost savings.

For complex, catastrophic, or emotionally charged claims, this personalized support can be a critical success factor. In fact, the National Council on Compensation Insurance (NCCI) notes that complex claims, though representing less than 5% of total claims, account for more than 80% of total claim costs, underscoring why direct, field-based intervention is often warranted.

Challenges include:

• Higher cost: Travel, time on the road, and logistics make FCM more resource intensive.
• Limited scalability: One manager can only cover so many cases in person, especially over wide geographies.

FCM remains a high impact but specialized tool. It’s most effective when complexity, severity, or psychosocial barriers demand that extra layer of support.

What is Telephonic Case Management?

Telephonic case management uses phone and increasingly, secure video platforms to manage claims remotely. Case managers guide recovery through proactive communication, care coordination, and clinical oversight, all without the travel and logistics that field visits require.

The benefits include:

• Cost-effective and scalable: Telephonic programs allow one nurse to handle more cases, without travel time or mileage expenses.
• Geographically unrestricted access: Case managers can engage injured workers across state lines or continue oversight if the employee relocates during recovery.
• Improved accessibility and convenience: Workers can connect from home, avoiding transportation hurdles or long clinic waits.
• Frequent communication cadence: Regular check-ins, often quicker and more flexible than field visits, help identify complications early and keep recovery on track.

Challenges include:

• Less personal connection: Without face-to-face interaction, it can be harder to build the same rapport or detect subtle psychosocial barriers.
• Limited visibility: Case managers can’t directly assess the home environment, workplace setup, or non-verbal cues that may signal recovery issues.

In practice, TCM delivers speed, reach, and efficiency, making it an essential tool for straightforward claims and early intervention, even if it can’t fully replace the personal touch of field management.

When Does Field Case Management Work Best?

Field case management delivers the most impact in high-severity or high-barrier claims, where the stakes are higher and nuanced, in-person intervention can prevent costs from spiraling.

Consider these scenarios:

• Catastrophic or complex injuries: Multi-trauma, spinal cord, or brain injuries often demand on-site judgment and collaboration with specialized providers.
• Multiple providers or conflicting treatment plans: A field case manager can serve as the central coordinator, ensuring doctors, therapists, and the injured worker are aligned on treatment goals.
• Psychosocial or cultural barriers: Meeting face-to-face helps address language gaps, trust issues, or motivational hurdles that can derail recovery if left unaddressed.
• Employer collaboration or job-duty analysis: Determining readiness for modified duty or workplace accommodations often requires direct, on-site observation.

These are precisely the types of cases where FCM can reduce friction, speed recovery, and minimize the risk of long-term disability.

Example:

Consider an injured worker with multiple orthopedic injuries and language barriers who is at risk of prolonged disability. A field case manager can bridge communication between providers, coordinate therapy schedules, and work directly with the employer to identify safe light-duty tasks, resulting in a successful return to work months earlier than projected.

When Does Telephonic Case Management Work Best?

Telephonic case management is especially effective in straightforward or lower severity claims where efficiency, early engagement, and consistent oversight are the top priorities.

Consider these scenarios:

• Straightforward injuries: Sprains, strains, or simple fractures with clear recovery paths can often be managed effectively by phone.
• Early intervention: A quick telephonic touchpoint at the start of a claim helps set expectations, align treatment, and prevent unnecessary escalation.
• Medically stable and engaged workers: When the injured employee is cooperative and progressing as expected, TCM provides the steady reinforcement needed to stay on track.
• Frequent, light-touch updates: Regular, short conversations make it easier to detect potential delays before they become complications.
• Cost-conscious environments: According to the American Journal of Managed Care, telephonic approaches deliver substantial cost savings, often reducing nursing time requirements by 30-40% compared to FCM, while maintaining quality outcomes.

Example:

Consider a worker with a rotator cuff tear. The worker was referred to telephonic case management within days. The nurse case manager quickly coordinated the specialist visit, confirmed the treatment plan, and checked in weekly. When medication side effects arose, the issue was caught on a call and resolved, avoiding an ER visit. The worker finished therapy on schedule and returned to full duty in 12 weeks, saving time and medical costs.

Hybrid Approach

While field case management and telephonic case management each have unique strengths, the reality is that most successful programs use a hybrid model. This approach leverages the scalability of telephonic engagement with the personalized impact of in-person intervention, utilizing each at the right moment in a claim’s lifecycle.

A strong hybrid approach includes these steps:

1. Start with TCM for broad coverage and early intervention. Telephonic outreach allows claims teams to engage workers quickly after injury, set expectations, and spot early red flags.
2. Escalate to FCM when higher touch is needed. Triggers may include complex medical needs, psychosocial barriers, conflicting treatment plans, or stalled recovery timelines.

A hybrid approach balances efficiency and precision. By starting every claim with telephonic oversight, teams maximize scalability and cost savings. But by escalating the right cases into FCM, they deliver the human touch and clinical depth needed to resolve the most challenging claims.

Get stronger results with the right case management strategy. Talk to us today. 

Check out our sources:

American Journal of Managed Care. “Telephonic Case Management: A Cost-Effective Approach to Coordinated Care.” AJMC, vol. 26, no. 12, 2020, https://www.ajmc.com/. 

Case Management Society of America (CMSA). Standards of Practice for Case Management. CMSA, 2022, https://cmsa.org/standards/.

National Council on Compensation Insurance (NCCI). The Impact of Complex Claims on Workers Compensation. NCCI, 2020, https://www.ncci.com/SecureDocuments/QEB/QEBComplexClaims.pdf.