In a tough economy, employers require effective and innovative ways to improve workers’ compensation results. Many program managers are updating their approach and leveraging early intervention such as prompt reporting, nurse triage, proactive claims management, and integrated return-to-work (RTW) coordination to improve performance. These strategies are designed to manage work-related injuries right from the start and bring about best possible outcomes.
Improving the Reporting Process
A common challenge for many employers is the delay that often occurs in reporting outcomes. This triggers a chain reaction of setbacks in managing medical, claims, and RTW outcomes. In this scenario, a program becomes reactive and ineffectual in bringing about optimal results. Early intervention is designed to initiate a proactive and coordinated response at the earliest, most critical point at which organizations can impact quality care, costs, and outcomes.
The first component of early intervention is timely reporting of injuries. Although it is well understood that immediate injury reporting leads to improved costs and outcomes, there are many barriers to achieving this best practice. As a result, employers can experience as much as a five- to ten-day delay in receiving injury reports.
To address this challenge, many employers are leveraging a nurse call center, which acts as an injury hotline. This provides a major innovation over the traditional role of nurses in workers’ compensation. Typically, nurses served as medical case managers, coordinating care for only the most severe injuries. Today, triage nurses are getting involved much sooner — basically on the day of injury — to collect injury information and set employees on the right course of treatment.
To report an injury, an employee or supervisor calls the hotline immediately following an accident. The call center gathers all the necessary injury information and sends an injury report to all appropriate stakeholders, including the supervisor, physician, claims adjuster, HR manager, and RTW coordinator. These individuals are then able to initiate their respective roles in the claims process, which goes a long way toward proactive management and optimal outcomes.
Quality Medical Care
Another key factor in workers’ compensation success is ensuring that every injury receives the care and treatment appropriate to medical severity.
With an injury hotline, employers are able to leverage a nurse’s medical expertise to assess injuries over the phone. Using treatment protocols and sophisticated algorithms, the triage nurses systematically identify the appropriate level of care. In severe cases, they will advise an emergency room visit. For less urgent injuries, they may recommend that a patient go to an occupational clinic; for minor injuries, nurses may provide simple first-aid or self-care guidelines.
After speaking with a nurse, many injured employees do not require or request additional medical services. As a result, 30 to 40 percent of all calls result in report-only or first-aid injuries and do not become compensable workers’ compensation claims. In addition, many employers reduce unnecessary emergency room visits by as much as 300 percent.
Pre-Injury Foundation for Success
Employers should be prepared to promptly initiate and seamlessly coordinate activity among the different stakeholders. To lay this foundation for success, organizations must plan for the following preliminary steps:
Training & Promotion: To ensure optimal adoption of an early intervention program, supervisors and employees need training and education. With today’s technological advances, there are many convenient options, such as online self-paced learning, education via teleconference, and web-based training. Distributing and posting promotional material — such as posters, wallet cards, and stickers — also help to remind supervisors and employers of early intervention strategies.
RTW Programs: A key challenge in workers’ compensation is the lack of a RTW culture. Many employers have an all-or-nothing attitude, classifying injured employees as either “off duty” or released to “full duty.” Employers must train supervisors and employees on the goals of RTW and promote the idea of using temporary work assignments to accommodate injuries and work restrictions. Employers should maintain databases of pre-defined modified duty assignments.
Quality Providers: To ensure quality care, employers must invest time in identifying a list of quality physicians, occupational clinics, and medical facilities within a reasonable radius of worksites. This list may then be integrated into the injury hotline’s medical referral process, allowing employers to leverage the best, most cost-effective facilities in their areas.
Post-Injury Program Improvements
Workers’ compensation success also requires post-injury analysis. By leveraging information systems, programs can generate performance reports that help to identify and target areas for improvement. Regular report cards and benchmarks give employers valuable insights for safety and injury prevention programs. For example, safety managers can analyze data to identify frequent types of injuries, which can then be addressed with initiatives to minimize future incidents. Technology also enables RTW programs to monitor employees’ work status to see who has returned and in what capacity (modified or full duty). Programs also can track the number of lost-time claims and total lost days to set goals for RTW improvements.
Injury Triage as Backbone to Future Success
Ultimately, workers’ compensation losses negatively impact an employer’s bottom line, so containing costs is critical. An injury hotline serves as the backbone to an early intervention strategy, offering medical expertise and injury triage to set claims on the right course from the start. Even before injuries occur, employers must deliver training and promotional material that can help build a strong foundation for success. In order to deliver consistent, ongoing value, an employer must leverage technology and data to enable continued program improvements. Overall, an early intervention approach enables employers to facilitate proactive injury management, quality care, and early RTW outcomes.
Paul Binsfeld is CEO of Company Nurse, a firm specializing in injury management for workers’ compensation. He may be reached at email@example.com. Company information is available at www.companynurse.com.