The wise utilization of Medical Case Management services is a critical component of effective early intervention, and a major contributing factor toward a safe and productive return to work. The timely delivery of these services are typically managed by an experienced Case Manager, who may be designated as a Certified Case Manager (CCM), a Certified Occupational Health Nurse (COHN), a Disability Medical Manager (CDMS), or a Certified Rehabilitation Counselor (CRC).
Case-management expertise may be further applied in either Telephonic Case Management (TCM) or Field Case Management (FCM). A question often asked is, “How do we decide if a case requires a TCM or a FCM, and what are the expectations for each?”
Although the approach may differ between the two, both types of case managers connect with the relevant parties of the case — employee, provider, claims administrator, and employer — and share the common goal of navigating the case toward effective medical care and a safe / productive return to work.
The TCM approach is an effective “soft touch” method to case management and is conducted virtually via phone or other communication methods. A TCM may be referred to the injured employee at the onset of an injury and is activated for various reasons including retrieval of medical records, direction or clarity of medical care, and identifying return to work plans. The TCM is utilized on medical-only cases whereas a Field Case Management is utilized when an employee may be facing lost time from work due to the severity or nature of the injury.
The FCM approach is considered a “high touch” method to case management. Similar to telephonic, field case management may include retrieval of medical records or managing the recovery of the care.hHowever, the FCM maintainsface-to-face consultations with the treating provider, and manages (not monitors) the case to confirm that the injured employee is medically recoveringand progressing toward an effective return to work status. In addition, a FCM may also visit the employee’s place of work to help organizea safe transition to modified or full duty that adheres to the treating provider’s treatment and work plan. The FCM will likely be recommended on catastrophic injury cases and is usually assigned at the onset ofsuch an injury to coordinate medical treatment and develop a safe return to work strategy.
Face-to-face availability of FCM improves support for the injured employee. The FCM ensures that the injured employee understands the plan of care, while facilitating more effective communications between all parties. High quality and regular communications between employer, insurance carrier, and medical provider can bring clarity and realistic expectations for the medical treatment plan, recovery timeframe, and return to work strategy.
While both case management servicescan be equally effective in ensuring quality medical care and recovery the hourly rate for a TCM can be as much as $15 less than that of a FCM. When a case warrants an FCM, the industry standard professional rate for the case managementusually includes both telephonic and fieldwork for a more “high touch” case, whereas TCM is handled only virtually or telephonically. In addition, catastrophic case management may warrant a higher hourly rate for professional case management, based on the required criteria and case management objectives.
Overall, case management is a necessary tool to help employees return to work in a manner that is safe and based on evidence-based medical best practices. Despite the cost of case management services, the returns of quality medical care and early return-to-work are well worth the investment. Employers/carriers can conservatively save $50 for every $1 of case management time.
In summary, IMO’s success is based on a solid anchor of case management services, which the organization has been providing for more than 32 years. Connect with IMO to learn more about how we can serve you with our premier anchor service!