1 year ago
After Surgery, Early Engagement Means a Smoother Recovery. Here’s What Makes It Work.
Any workers’ compensation claim requiring surgery is complex. Coordinating care is very much like trying to put together an old jigsaw puzzle. There are many interrelated pieces, and you may discover along the way that some are missing.
Here are just some of the questions care coordinators have to consider:
- Does the injured worker have any comorbid conditions that could complicate healing and recovery?
- Will they need any special equipment at home like a wheelchair or lift system? What size?
- Who will help to take care of them at home? How many caretakers do they need?
- Will they even go home, or would a rehab facility be more appropriate?
- How will they get to outpatient physical therapy?
- Do they have pets at home? Will that be a problem?
- What drug regimen is recommended?
- What is an appropriate timeline for their return to functionality or return to work?
Gathering the information needed to make the best care decisions possible is itself a challenge; executing them is another. Both require a high degree of engagement with multiple stakeholders including the injured worker and his or her family, the lead physician who referred the patient for surgery, the PBM, home care services, and of course the nurse case manager and adjuster.
The earlier that care coordinators engage these parties, the smoother the process goes and the faster the puzzle starts to come together.
“It all comes down to early engagement,” said Kevin Glennon, National Product Leader, Home Health & Complex Care; VP, Clinical Programs, One Call.
“Claims involving surgery require a proactive approach to assisting the nurse case manager and adjuster in coordinating all the equipment needs, care and services for the injured worker. That helps eliminate any delays in the continuum of care and assists in controlling medical spend.”
Here’s what makes an early engagement approach successful in the management of post-surgery workers’ comp care:
1. A primary point of contact
Given the many moving parts of helping an injured worker on the road to recovery, organization and coordination is key. Having a primary point of contact eliminates the likelihood that missed or garbled messages will disrupt the care plan.
At One Call, a Care NavigatorSM fills this role.
“The Care Navigator SM is like a quarterback,” Glennon said. “They work with the adjuster and nurse case manager to gather the details and then coordinate the rest of the players so they’re ready to go as soon as the patient is discharged from the hospital.”
2. Evidence-based care
The equipment and services arranged for a patient are not based on past experience alone. The clinical team follows ODG and ACOEM guidelines for specific injury types and surgeries.
“We build an outline of possible post-op needs based on the clinical criteria that is surgery-specific. We can let the nurse case manager and adjuster know what to expect – here’s what best practices suggest the physician is likely to order upon discharge. Let’s get ahead of the game,” Glennon said.
Of course, every injured worker is different. Psychosocial factors and comorbid conditions may cause a recovery plan to deviate from what guidelines recommend, but these industry standards nonetheless provide a consistent starting point.
3. Early and ongoing communication
Initial communication begins the minute One Call’s internal care team receives notification of an approved surgery.
“We'll be reaching out to the injured worker or the physician right away to obtain any missing information. From that point forward we are always working on the next step, coordinating with medical providers to keep things moving,” Glennon said.
Daily updates are sent to the adjuster or nurse case manager, which is especially useful should any problems arise such as a non-communicative physician’s office or injured worker. “Anytime there is a barrier, there's going to be prolonged communication back to the adjuster or nurse case manager, to make sure everyone knows what’s going on,” Glennon said.
Once a surgery date is confirmed, the Care NavigatorSM begins to identify the equipment and services that will be needed upon discharge. Anticipating and proactively removing the barriers that a patient might face when they leave the acute care hospital is critical.
The Rewards of Early Engagement
The primary benefit of early engagement on complex claims is reduced recovery time, whether the goal is return to work or maximum medical improvement.
One Call launched Surgical PathwaySM, its early engagement program for scheduled surgical claims, as a pilot program in May 2018. Surgical PathwaySM is the latest addition to One Call’s CarePathTM program, which focuses on proactive coordination. Other pathways include Amputation PathwaySM, Wound PathwaySM and Pain PathwaySM.
So far, more than 300 surgical cases have come into the program.
Among these cases, time from authorization of a surgery to the actual surgery date decreased by 44%. Surgeries that are scheduled more than two weeks out decreased by 38%. That means the injured worker spends less time waiting, likely in pain, and can begin rehabilitation sooner.
“On our shoulder cases, we have reduced the time from beginning of therapy to recovery by more than two weeks,” Glennon said. “Overall, surgical cases going through the Surgical PathwaySM program have an 11% shorter duration than similar cases we manage.”
Shorter duration translates into faster recovery and reduced medical spend.
“Utilizing the average maximum TTD rate by state, we're showing nearly $2,000 in savings per case in indemnity benefit alone,” Glennon said.
The most important outcome, however, is the well-being of the injured worker.
Reduced fear and anxiety for the injured worker is a critical benefit. Mental distress can interfere with physical recovery, but when injured workers feel supported, understand their care plan and have everything they need to follow it, they recover faster, regain functionality and get back to work sooner.
This article was produced by the R&I Brand Studio, a unit of the advertising department of Risk & Insurance, in collaboration with One Call. The editorial staff of Risk & Insurance had no role in its preparation. The R&I article can also be found on Risk & Insurance.