Streamlining Patient Care – A Telephonic Case Management Model
Managing Care Early with Better Healthcare Outcomes
In this brave new world of technology, healthcare and its supporting systems have naturally begun to evolve into a cohesive process that enhances the interactions between medical professionals and their patients. In this article, we will explore new specific tools and methodologies that can strengthen communication between caregivers and patients, without costly visits and outdated (and often slow) processes.
Workplace injuries today can either undermine employees’ relationships with their company or reinforce the bridge between the company’s mission and the injured employee’s recovery experience. In the past, cumbersome and litigious medical delivery processes wreaked havoc on companies’ administrative overhead, financial resources, and injured employees’ well-being. The resulting conflicts often fractured the trust between employees and employers.
Injury Management Organization (IMO), a Texas based company, takes this problem seriously. As a unique managed care company, our role is to partner with our clients to ensure a smooth, efficient, and effective managed care process – for the injured and those who manage them. As one of the first in our industry to embrace the E-Intelemed model, we provide full support, processes and consultation to current and prospective clients who want to improve the care their injured employees receive.
Our model reflects our belief that managers should not be advising injured employees on medical care, nor should employees have to jump through numerous hoops to be treated for their injuries. Employers and employees can and should have timely and effective access to the resources they need.
This is where IMO comes in. We take an advocacy position with our clients’ employees, reducing the time it takes to get appropriate care by utilizing active, knowledgeable and professional nursing staff and medical partners in the communities where the clients do business. The mission is to get employees back to, or stay at work safely, quickly, and compassionately. The benefit to the client partners is shortened recovery time and early back-to-work for the employee.
“Early Intervention Telemedicine”
To speed up recovery and, therefore, continue productivity in the workplace, IMO developed and leveraged a Telephonic Case Management/Early Intervention Model, now known as E-Intelemed. While the Telephonic Case Management (TCM) model can be tailored to match the client’s needs, IMO has also developed and implemented a full spectrum of proven models for its clients. For example, a Nurse - 24/7 early intervention approach for immediate after-hours care, a Telemedicine coordination referral at the onset of the injury, and an Early TCM model that integrates an evidence-based guideline check with the treating provider.
E-Intelemed Saves City of Houston $7 Million
A successful example of an E-Intelemed - Telephonic Case Management Model with the City of Houston (COH) where an early intervention case management model was developed to ensure that employees could return to work within the Maximum/Optimum return-to-work dates based on the evidence-based guidelines, the Medical Disability Advisor Guidelines.
Vice President of Client Services, Donna Ramsey reports that the COH model began with an assigned task force team who quickly identified that a referral would be made to a telephonic case manager at the 21st day of lost time, based on the receipt of medical documentation. The telephonic case manager would then review the documentation and contact the medical treating provider and the injured employee. Once completed, the telephonic case manager would send both entities a Return-to-Work letter that would inform the provider and the employee of the optimum return to work dates, based on the nature of the injury per the Medical Disability Guidelines.
“The success of the Telephonic Case Management Model was proactive, creative and gave great customer service to our injured employees and accountability to the providers treating our employees.”
Betsy Ramos, CPM
Workers’ Compensation Division Manager for City of Houston
To further improve the efficiencies, the telephonic case manager would maintain regular communication with the injured employee, reminding them of upcoming appointments, facilitating preauthorization and scheduling events. Additional support would also include the medical providers, transitional duty, and other accommodations.
In addressing return to work, the telephonic case manager would continue these efforts and work with the claims adjuster until a full duty release is given. If any red flags were identified along the way, the telephonic case manager would alert the claims adjuster and make necessary recommendations, including, but not limited to, assignment to a field case manager or other return-to-work support.
This model saved the City of Houston more than $7 million dollars during the last three fiscal periods and is projected to save over $3 million for the current fiscal year.
This case study is just one example of how a tailored Telephonic Case Management Model can speed the evolution of patient care toward improved outcomes and reduced costs.
The bottom line? When leveraging our Early Intervention Case Management Services, our client partners regularly find that employees are out of work for a shorter time and are more satisfied with the process, there is a speedier response from the caregiver, medical and administrative costs are lower for the client and employees are more satisfied with the overall care experience. The cost reduction and avoidance can easily exceed up to 70% of cost containment savings.
As medical costs increase and fear of return to work continues to rise, early intervention and medical care efficiencies become even more vital. IMO is here to actively leverage the Telephonic Case Management models, uniquely design the best client fit, ensure high levels of service delivery, provide support and ensure quality medical care that lead to safe and productive stay-at-work outcomes.
Primary Benefits of IMO E-Intelemed
- Early connectivity and timely consultation with a medical professional – diagnosis, medical guidance, and pharmaceutical prescriptions. This may include conducting the First Report of Injury coordination with the early intervention approach.
- Early intervention for non-emergency injuries leading to faster recovery time, sooner return to work, and reduced costs.
- The TCM model coordinates Urgent Care Referral, Emergency Room Referral, may provide professional first aid advice or coordinate a referral to the telemedicine provider panel.
- Coordination of Telemedicine care when appropriate, from providers who are just a phone call away, some offering services 24 hours, 7 days a week, thus reducing employees’ time away from work. The “Telemed Connect” model provides access to medical professionals who are credentialed and contracted to provide telemedicine services via any device that has a web cam and internet connection: e.g. smart phone, laptop, desktop, I-Pad or tablet.
- An early intervention Telephonic Case Management model catering to all types of employers and all types of injuries in a network and non-network environment.