Post-Pandemic Case Management: What’s Changed, What Remains the Same, and How to Prepare for What’s Next

Workers’ compensation and case management are inextricable from the other. Medical management professionals involved in helping an employee travel the road to recovery and return safely to work hold two different—but not discrete—responsibilities: First, to the affected employee, and second to the patient’s employer.

Case managers have the vision to see who and what kind of information and resources are necessary to contribute to an employee’s rehabilitation plan. They also have the talent to know which resources will best support the employee’s return to work.

The modern workers’ compensation treatment management model (closely tied to the coordinated care model) serves employees not simply from the isolated physical diagnosis but from a broader, holistic approach to ultimately enable the employee to return to work in optimal condition.

Having one point of contact for each of the stakeholders in the treatment and recovery streamlines the process and boosts quality. That centralized tracking helps ensure exceptional care, avoid redundancies and omissions, and keeps the treatment care plan moving forward smoothly and effectively. It also ensures that information is relayed responsibly to the claims adjuster and the patient’s employer, to advocate for any requisite workers’ compensation or return-to-work plans.

What's Changed

It feels like everything in 2020 changed in an instant – even within case management, there were some significant innovations that took place rather quickly.

One upgrade to the industry that the pandemic pushed to the forefront was the increased reliance on technology to keep operations moving along. Quarantines and concerns around viral spread prevented many people from feeling comfortable visiting on-site medical facilities, and case managers were unable to meet with injured workers in-person to evaluate their individual claims. As with many others in all industries, workers’ compensation professionals inevitably found ways to expedite advancements that would have happened naturally over time

What about pain: Understand pain and options for managing pain within workers’ compensation claims

Each year millions of claims are submitted by workers who may have suffered a work-related injury or illness. The Bureau of Labor Statistics reported 2.8 million nonfatal workplace injuries and illnesses reported by private injury employers in 2019 alone. Of that figure, 888,220 nonfatal injuries and illnesses caused a private industry worker to miss at least one day of work, with 80% of injuries or illness being sprains, strains, tears, soreness, bruises, contusions, cuts, lacerations, punctures, and fractures – all, very likely, causing some degree of pain[i]. Ten to twenty percent of individuals who enter the workers’ compensation system due to physical trauma develop chronic pain from either the severity of the initial injury or the injury’s progression. [ii] Chronic pain, one of the most common reasons adults seek medical care, has been linked to restrictions in mobility and daily activities, dependence on opioids, anxiety, and depression, and poor perceived health or reduced quality of life.[iii]  This month’s INSIGHTS article explores pain, including pain management options, and how they may be used during an individual’s workers’ compensation rehabilitation.

The experience of pain from one individual to another is entirely unique. As one may imagine, pain is subjective and intertwined with two complementary aspects: a feeling of pain in a particular part of the body, and the other, an attempt to relieve or terminate the pain[iv].  Determining the best options for treating a worker’s pain is guided by understanding the source and history of the pain, the intensity, the duration, aggravating and relieving conditions, and the structures, or parts of the body, involved in causing the pain. Pain management is aimed at identifying the source of the problem and defining the optimal plan of treatment[v].

Options for pain management include:

  • Interventional procedures
  • Medication management
  • Physical therapy or chiropractic therapy
  • Psychological counseling and support
  • Alternative therapies
  • Referral to pain management specialists[vi]

Interventional pain procedures

Interventional pain management aims to relieve, reduce, or manage pain and improve a patient’s overall quality of life through minimally invasive techniques specifically designed to diagnose and treat painful conditions. As nurse case managers, facilitation of timely testing and ensuring the completion of treatments and procedures helps develop a clear picture of how the individual’s pain is being managed and its effectiveness in relieving or reducing the underlying pain.  The nurse case manager’s assessment skills are crucial in detailing pre-and post-procedure status, documentation of symptoms, the anticipated impact in everyday life, and the longevity of response.  This knowledge helps the health care provider determine the treatment’s long-term effectiveness and the resulting pain relief.

References: 

[i] Brown, Jeff – BLS. (2016). Employer-Reported Workplace Injuries and Illnesses — 2015. https://www.bls.gov/news.release/pdf/osh.pdf

[ii] MPR. (2015, September 10). Prescribing Pain Medications for Workers’ Compensation Patients – MPR. MPR. https://www.empr.com/home/mpr-first-report/painweek-2015/prescribing-pain-medications-for-workers-compensation-patients/

[iii] Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., Kerns, R., Von Korff, M., Porter, L., & Helmick, C. (2018). Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR. Morbidity and Mortality Weekly Report67(36), 1001–1006. https://doi.org/10.15585/mmwr.mm6736a2

[iv] Institute of Medicine (US) Committee on Pain, Disability, and Chronic Illness Behavior, Osterweis, M., Kleinman, A., & Mechanic, D. (2020). The Anatomy and Physiology of Pain. Nih.Gov; National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK219252/#:~:text=At%20least%20four%20physiological%20mechanisms,primarily%20central%20nervous%20system%20mechanisms.

[v] Standiford Helm II, MD. (2016, September 6). Pain Management. MedicineNet; MedicineNet. https://www.medicinenet.com/pain_management/article.htm#how_is_pain_treatment_guided

[vi] DO, T. (2019). Interventional Pain Management: A Comprehensive Approach to Chronic Pain. SpineUniverse. https://www.spineuniverse.com/treatments/pain-management/interventional-pain-management-comprehensive-approach-chronic-pain

case management during coronavirus

Caring in the midst of a crisis: Re-examining workers’ compensation case management during COVID-19

In the wake of COVID-19 healthcare professionals worldwide are experiencing drastic changes in how they work and care for their patients – changes which not only impact hospital and acute care professionals,  but changes with rippling impacts to health care providers in varying fields including nurse case management. Whether facing a global pandemic, or an equally significant crisis, the ability to adapt is critical for patient recovery and care. After more than a month of shelter-in-place protocols, MLCC takes a moment to re-examine workers’ compensation nurse case management and how we’re ensuring our patients continue to receive the attention and care they need for recovery.

As workers’ compensation, or field nurse case managers, our primary role is not direct care. Instead we are commissioned to assess, plan, facilitate, coordinate care, evaluate and advocate options and services to meet an individual’s and family’s comprehensive health needs.[i] During a crisis, our mission does not change yet, how we deliver and manage our cases just might. Within workers’ compensation, we’re often treating individuals with emergent injuries or illnesses, and elective treatments may not appear critical in the face of those directly affected by the crisis. However, our goals remain focused on the improvement and healing of our patients, and here’s how we’re doing it:

1. Finding alternative methods of treatment

Our patients and the care they need is our priority. When customary modes of treatment are not available, nurse case managers must find alternative solutions such as replacing in-office provider visits with telehealth visits and video appointments. Physicians, physical and occupational therapist are still able to provide orders, update treatment plans, provide treatment, and more through video conferencing features of telehealth software platforms.

2. Finding alternative care providers and alternative methods of care delivery

As nurse case managers within workers’ compensation, finding alternative care providers and alternative methods of care delivery is something we do every day in practice.  When one door is closed there is always another that is open. At MLCC, once regional shelter-in-place and stay at home orders were executed we immediately developed an evolving list of providers that were open and confirmed the level of services they had available. If certain caregivers were closed and unavailable, alternative treatment sites and treatment providers were identified.

telehealth in workers' compensation case management

For our existing patients, we immediately reassessed diagnosis and whether any new complications or risk for complications were identified while continuing treatments put in place by their care providers through video appointments and telehealth conference calls.

When new patients were referred, with new or evolving injuries/illnesses, physicians were identified, and visits facilitated as needed. As with all patient visits during this time of crisis, appointments were completed in person with appropriate personal protective equipment (PPE) or through telehealth platforms and video conferencing until the pandemic is under control.

3. Exploring varying options for testing

During times of crisis usual and customary standards of care and case management may not be available. In the Northeast region we found that provider offices may be closed for patients, but open for specific services, or even transformed into COVID-19 testing centers. As case managers we rely on our relationships with our providers and are consistently exploring the varying options available to our patients.

Let’s consider an example case where a patient who has been diagnosed with a fracture and needs an evaluation of the injury. The evaluation has been delayed due to the shutdown of offices but can no longer be postponed. Even though the physician’s office is closed, their x-ray office may be open, and their treating physician is requesting an x-ray.

However, amid the current crisis the x-ray department is now a known COVID-19 evaluation and treatment center. That patient, who is severely compromised, may be put at risk in that center. An alternate site would be found, orders facilitated, and the treatment scheduled by the nurse case manager to decrease risk of the patient contracting COVID-19.

Having the ability to continue managing our cases and securing varying options is the responsibility of the nurse and by doing so decreases the anxiety the patient may have around their treatments and care.

4. Connecting patients with the appropriate resources

As health care professionals, our focus always includes the prevention of further complications, or contamination in the case of COVID-19, of patients and their families while getting them resources and services they need for recovery. In the wake of the current pandemic this includes nurses wearing appropriate PPE’s and taking precautions during patient visits, at therapy appointments, or out in the community.

personal protective equipment

It also means connecting our patients with protective equipment, masks and gloves, when attending appointments in their physician’s or provider’s office. Continuing to educate and provide supplies goes a long way in minimizing risk of possible contamination.

Back to life, back to work: highlighting an invaluable profession during National Case Management Week

National-Case-Management

In the face of serious illness or injury, the idea of ever reclaiming a productive life can feel impossible. Fortunately, there is a set of compassionate professionals whose very role is to help turn that idea around—and make it a healthy and attainable goal.

It’s National Case Management Week (October 7–13), a time to join organizations everywhere in recognizing medical case managers and their invaluable impact. Here at Medical and Life Care Consulting (MLCC), we’ve made “back to life, back to work” a motto of sorts, as helping individuals return to optimal, active living is what we do every day.

“When the unexpected happens, it can be devastating and hard to see the light at the end of the tunnel,” said our president, Cynthia Bourbeau, who founded MLCC in 2001. “Our job is to work with patients, families, health-care providers and employers to develop a plan to reach that brighter place. Our case management professionals bring extensive training, expertise and sensitivity to every situation we encounter. Together, we lay out the smoothest path possible, in terms of the patient’s physical, emotional and social well-being, as well as financial and logistical considerations.”

Because research has shown that patients who stay active recover from their injuries more quickly and with fewer complications, we offer innovative stay-in-work programming as a component of our comprehensive employment-centered services. This allows for job modifications or light-duty job specifications for an individual when possible and indicated.

“We work with patients’ employers to develop customized plans,” Bourbeau said. “When individuals can stay on the job while still protecting their health and safety, it’s often the ideal scenario.”

Beyond our services within the employment realm, which also include workers’ compensation, short-term disability and long-term disability case management, our professionals provide major medical case management services within the community. In these cases, we work directly with patients and families as they navigate the challenges of catastrophic illness or injury, delivering services at a patient’s home or during acute hospitalization.

MLCC is proud of the role that we—and our fellow medical case managers nationwide—play in keeping individuals “in the game.” Learn more about our services, staff and story today. When the goal is getting back to life and work, we’re ready for the job.