CM3: How Nurse Case Managers Add Value to Workers’ Compensation Claims
Workers Comp claims a nurse case manager and add value. Mary O’Donoghue, Vice President, Medical Services Helmsman Management Services
Stephanie Perilli, Senior Director, Medical & Health Management The Home Depot
November 12, 2015 8:30 a.m. – 9:45 a.m
Nurse Case Managers (NCM) have long been a recommended WC claims management technique as recommended by J&L often. The right case managers can reduce the cost of claims greatly.
This is a chart that shows the value of a nurse case manager as a claim lengthens by comparing the claim costs with and without a nurse case manager.
There are instances where a NCM may not provide value such as an injured employee with no comorbidities and a great relationship with the employee<<I thought that was a great point of emphasis.
An employer-based study compared shoulder surgery claims with nurses to similar claims from 31 other companies that did not have a nurse assigned. Claims with a nurse assigned had 57% fewer disability days. From my experience, this is a valid %.
Home Depot uses nurses in these instances:
- Unique intervention based on assessed needs of our population
- Targeted case management strategy beyond catastrophic cases
- Clear and concise integration of all medical resources
That was a nice summary list.
Home Depot calculated they are experiencing a 12% reduction in claim payouts when an NCM is on the file.
This was a good presentation on Nurse Case Managers. I have even seen larger reductions in claim values when a nurse is involved on the file. The key is to know when and whether or not to assign a NCM.
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