What you will find below:
- Factors Influencing Costs
- The Stages of Case Management
- Return on Investment
Medical case management is one such service that plays a pivotal role in coordinating and optimizing patient care. Medical case management aims to manage the care of a person through the lens of full recovery instead of cost savings. While this might not be the best approach for every injury claim using a nurse case manager can help all parties achieve their goals.
It is a means by which injured workers return to work faster and with better outcomes. What’s the natural bi-product of better medical care and a supportive environment? Reduction of days lost, faster-improved return to work (RTW) rates, and ultimately cost containment.
Factors Influencing Costs
Several factors contribute to the costs associated with medical case management. These can vary based on the complexity of the medical condition, the level of coordination required, and the duration of the case management services. Additionally, geographical location and the specific healthcare providers involved can influence the overall cost.
Case managers charge by the hour with base rates ranging from $75-$140. What is this price difference dependent on?
- Geographical reasons: field case management nurses typically charge per hour plus expenses which includes mileage. For this reason, it’s best to choose a FCM located near your claimant.
- Complexity of case: Catastrophic case management has a price tag commensurate with the complexity of the case. Traumatic body injuries will need more intervention than a minor fracture. The price of a case will also depend if an interpreter or bilingual nurse is required.
- Type of case management: FCM and TCM both provide oversight and coordination of medical care but differ in their approach. A field case manager is the better option if the injury is complicated and requires a more hands-on approach. A telephonic case manager provides case management support over the phone. Learn more about the difference between these services in our FCM vs TCM article.
The Stages of Case Management:
Once a case gets assigned to a case manager it goes through a series of steps before creating a plan and eventually reaching the goal of recovery.
The stages include:
- Intake and referral
- Needs assessment
- Care planning
- Monitoring and follow-up
Intake and Referral:
First, you determine the case would benefit from case management and refer it to an agency that handles medical case management. The appropriate case manager for this type of injury/patient will be assigned and given access to all necessary documentation. The case manager will get in contact with the subject as soon as possible to discuss any recent updates and any immediate needs. Sensitivity and empathy are important in this line of work, otherwise, your patient won’t trust you and make the recovery process that much harder.
The CM will now identify the problems, risks, and challenges of the case. Your case manager will have close contact with you while collaborating in designing a road to recovery for the patient. This typically includes a target RTW date and health goals.
At this point, an action plan with time-specific goals and details about the treatments/services will be established. The plan will always be tailored to the patient’s needs and should never follow a cookie-cutter approach. The case manager must also consider the perspective of interested parties.
Monitoring and Follow-up:
Once all the phases of the case are completed, the case manager can assess the results. They will review the worker’s health condition, necessary continued regimens, and other recovery needs.
The work doesn’t end here, as modifications can be made to the plan based on the progression of the patient. The case manager must maintain communication with the client and patient. This includes explaining post-recovery care, follow-up appointments, and any other medical needs such as transportation or disability equipment. They will also provide you with detailed reports listing out the progress, medications, and anything else that might affect the return to work plan.
Return on Investment:
Cost containment must begin at the beginning of a case if it is going to be effective.
- A good analogy for a medical case manager is that of a travel agent. Without a travel agent, the researching, booking, and coordination of your activities is completely your responsibility which might result in more affordable rates but is trickier.
- Otherwise, without a travel agent or investing hours of research into your vacation, you are in an unfamiliar place and bound to spend far more money figuring out every detail of your trip on your own.
- Now imagine you weren’t planning just a trip for yourself but for you and your family or group of friends. That’s when things can get complicated as everyone has different preferences and budgets.
In 2021 URAC reported 410,404 unique cases that utilized a case manager. Satisfaction ratings were 96% and medical readmission was as low as 6%. Although many experts agree that calculating the ROI for case management is difficult. How do you isolate the exact contribution of a case manager if no two cases are the same?
Intuitively, the skillsets of an FCM or TCM are valuable in medical settings compared to the knowledge a claims adjuster will have about navigating complex injuries. Adjusters have claims management experience but unless they have a background in healthcare, they will lack the expertise of a nurse who has hands-on experience treating patients, reading charts, and monitoring recovery.
As we step into 2024, the landscape of medical case management costs continues to evolve. But the goals stay consistent – help injured workers receive quality care and return to work. Understanding the benefits this service can provide you and your claimant will make your claims load more manageable and cost-efficient. Creating a quality, supportive environment for injured workers will result in the unexpected outcome of cost containment and increased return to work rates. The cost savings of field case management or telephonic case management outperform the price of these services. There are options for every budget, whether that means assigning a lower complexity case to a TCM or utilizing a catastrophic case manager to make your life easier, the knowledge of these professionals surpasses cost.