Skip to main content
Ethos - Now You Know For Sure

5 Trends Affecting Case Management in 2026

Older claimants, GLP-1 medications, changes in pain treatment, earlier-emerging large claims, and outpatient surgery are reshaping medical case management. These five developments show how case management coordinates care and moves claims forward in 2026.

By Caroline Caranante | Sep 22, 2026 | 3 min. read

5 Trends Affecting Case Management in 2026

What you will find below:

  • Impact of an Older Workforce on Medical Case Management
  • Large Claims are Emerging Sooner
  • The Rise of Topical Pain Medications
  • Impact of GLP-1 Medications on Case Management
  • Outpatient Surgery is Becoming More Common

Medical case management continues to change as the workers’ compensation landscape evolves. An aging workforce, earlier signs of high-severity claims, changing medication use, and changes in where procedures are performed are all affecting how medical care is coordinated. These trends highlight why case managers need to look beyond the immediate injury and consider the factors that can influence treatment, recovery, and return to work.

Impact of an Older Workforce on Medical Case Management

Workers 55 and older are making up a growing share of claims, and their claims tend to cost more.

NCCI’s 2026 data shows that workers 55 and older:

  • Make up 24% of the labor force but 28% of lost-time claims and 34% of lost-time claim costs
  • Have claims with 32% higher severity, meaning a higher average cost per claim

Additionally, NCCI found that workers 65 and over are 10% more likely than the average worker to have a comorbidity, meaning another health condition alongside the injury.

WCRI’s 2025 study of 930,000 claims tied degenerative and comorbid conditions to higher costs and longer temporary disability, and notes they can complicate treatment and recovery.

This shows that case managers need to look beyond the injury. Other conditions, medications, and the pace of recovery all shape a claim. When recovery runs longer than expected, it’s important for case managers to look for the cause.

Large Claims are Emerging Sooner

Some workers’ compensation claims become significantly more expensive than others. NCCI’s January 2026 analysis found that claims reaching $1 million in costs are getting there faster than they did in the past.

In 2003, 27% of claims that eventually reached $1 million did so within about two years of the accident. By 2023, that figure had increased to 59%.

NCCI found that these faster-growing claims are often tied to severe injuries, including motor vehicle accidents and falls from heights, which can require extensive treatment and in-home care.

The trend does not mean there are more large claims overall. Instead, it shows that when a claim does become severe, more of the costs can develop earlier in the life of the claim. Identifying the characteristics of these claims early can help injured workers receive appropriate treatment sooner.

The first weeks of a claim can have a significant impact on what happens next. Early access to medical records and coordination of treatment can help identify the level of care a severe injury may require. For claims involving serious injuries or in-home care, case managers can help coordinate that care and keep treatment moving forward.

The Rise of Topical Pain Medications

Topical creams and gels are becoming a larger part of pain treatment in workers’ compensation. NCCI’s February 2026 analysis found that spending on topical pain medications is growing, and because these medications are generally more expensive, even small increases in use can affect overall costs.

Medication review is a core part of case management, including reviewing whether medications and treatment plans follow established guidelines. As topical pain medications become more common, they are another part of the treatment plan that case managers may need to review. When a recommendation doesn’t fit the guidelines, case managers can seek a second opinion or peer review.

Impact of GLP-1 Medications on Case Management

GLP-1 medications are increasingly used for weight loss. According to Gallup, 11% of U.S. adults currently take a GLP-1 in 2026, up from 3% in 2024.

NCCI notes that the direct impact of obesity on workers’ compensation is limited. Obesity contributes indirectly, through a higher likelihood of injury and slower recovery after injury.

Surgery adds another consideration. The FDA label for Foundayo, a GLP-1 medication, warns about pulmonary aspiration, meaning stomach contents entering the lungs, during general anesthesia or deep sedation. This means a claimant’s GLP-1 use may need to be considered when a procedure is being planned.

Knowing what a claimant is taking is part of medication review. When a claimant on a GLP-1 needs a procedure, several teams have to weigh in. Case managers, who act as a center of communication among providers, help keep them connected.

Outpatient Surgery is Becoming More Common

More procedures are being performed in outpatient settings rather than requiring an inpatient hospital stay. In 2026, CMS began phasing out its inpatient-only list, starting with 285 mostly musculoskeletal procedures, and expanded the procedures that can be performed at ambulatory surgical centers. NCCI notes that the impact on workers’ compensation costs varies by state, depending on how closely state fee schedules follow Medicare payment rules.

Joint replacements are also part of the trend. A January 2026 WCRI study found that shoulder, hip, and knee replacement surgeries are increasing and examined whether those procedures are performed in an inpatient hospital, hospital outpatient setting, or ambulatory surgical center.

When a procedure is performed on an outpatient basis, recovery may begin at home sooner. That can make planning for transportation, home care, follow-up appointments, medications, and return-to-work needs especially important. Case managers can help coordinate those pieces so the transition from surgery to recovery is clear and manageable.

Final Thoughts

The role of medical case management continues to expand as claims become more complex. The value is not just in coordinating care after a problem arises, but in recognizing potential barriers early and helping address them before they create bigger delays. As the workers’ compensation landscape continues to change, that ability to anticipate what comes next will remain an important part of effective case management.

Need a case management partner to coordinate care and keep claims moving? Connect with our team to learn how we can help.

Sources:

Related Articles

Dive deeper into the world of risk management and investigative insights with our curated selection of related articles.