Early Intervention: A Catalyst for Case Management Success

From the moment a worker reports an injury and files a claim, the countdown begins. The actions taken by the employer in the next 24 hours will determine the trajectory of the case and, in no uncertain terms, whether the employee will return to work in a timely manner or at all.

In a recent webinar, CorVel’s managed care experts shared in-depth insights on how companies can enhance workers’ compensation outcomes through effective case management following a workplace injury. Let’s explore the takeaways of that session to discover why early intervention is the industry standard for case management success.

What is Early Intervention Case Management?

Early intervention in case management is defined as a proactive, comprehensive approach to managing a workplace injury or illness. This approach turns the often-slow-moving claims process on its head by rapidly deploying coordinated resources immediately after an injury is reported to assess, implement, coordinate, monitor, and evaluate options to meet an individual’s care needs for a safe, efficient recovery and return to work.

Core Principles of Early Intervention Case Management

1. Timeliness: With labor shortages and rising industry demands impacting provider availability, quickly routing patients to care (contacting physicians, setting appointments, coordinating services among specialists, etc.) prevents both treatment delays and medical overtreatment.
2. Proactive Approach: Establishing proactive protocols, such as employee wellness programs and on-site and/or virtual clinics, sets the foundation for addressing risks of injury before they escalate and, when incidents occur, initiates the claims process in real-time.
3. Comprehensive Care: Adopting a holistic approach to care acknowledges the influence of physical, psychological, and social health on an individual’s overall well-being and drives patient-centered care. This whole-person approach also recognizes how comorbidities impact care effectiveness.
4. Coordination: In addition to nurse advocates, members of an injured worker’s clinical team may involve several parties dispersed across care networks, such as a primary care physician, specialist, and physical therapist. Remaining aligned on treatment plans requires open communication channels between all stakeholders.
5. Goal Setting: Setting measurable, achievable milestones for worker recovery is critical to informing treatment plans and ensuring that return to work is a realistic and attainable goal. Maintaining flexibility in goal setting also helps adapt plans to patient progress.
6. Individualized Programs: Customizing medical action plans where appropriate accounts for workers’ unique circumstances, such as transportation access challenges or cultural considerations. This level of personalization empowers patients to follow treatment regimens effectively and be active participants in their recovery.
7. Continuous Evaluation: At the program level, regular review provides opportunities for case teams to identify process shortcomings, implement necessary adjustments, and integrate strategies to prevent future workplace injury.

Best Practices for Early Intervention Programs

1. Identify Cases for Early Intervention: Not all workplace injuries require an early intervention case manager. With CorVel’s Care Advocacy model, companies have the power to customize early intervention criteria depending on variables, such as the type and severity of injury. These criteria establish rules that route relevant claims directly to nurse care advocates within 24 hours of the initial report.
2. Build an Effective Team: Driving a claim to closure relies on careful coordination from a web of stakeholders. Assembling a team with clearly defined roles ensures that medical action plans are carried out efficiently and equips injured workers with a support system dedicated to their wellbeing.
3. Develop Customized Protocols: Workers’ compensation laws are continuously evolving to account for the labor force’s new physical and emotional needs. For example, in the past few years, states like Alaska, Arizona, and Oklahoma have established presumptions of compensability for psychological injuries, setting a new precedent for mental-to-mental injury claims. In addition to customizing programs to fit a company’s unique culture, strategies must also account for legal requirements that vary by state.
4. Leverage Tech to Maximize Efficiency: Advanced technologies, including AI and machine learning, are rapidly transforming claims processing, streamlining review, and automating manual tasks for increased efficiency. With CorVel’s Care^MC Edge® platform, case managers have best-in-class tools at their disposal to communicate real-time updates, assess risk, and optimize resource allocation for effective programs.
5. Implement Quality Assurance Measures: Missteps in the first 30 days of a claim are key drivers of longer claims cycles, increased risk of litigation, and delayed care for injured workers. Setting quality standards and integrating checkpoints helps mitigate these risks while providing objective criteria to assess program performance. Applying quality measures is also key to remaining in compliance with state or federal requirements, such as Medicare Set-Aside agreements.
6. Collect and Analyze Data: Claims data provides key insights to inform program refinement. For example, trend data on the frequency and severity of various injuries can help companies pinpoint workplace risk factors and develop initiatives to improve employee safety. Likewise, patient data provides key insights to power cost containment through more effective healthcare utilization. Ultimately, leveraging historical data enables companies to learn from past cases for program improvements.

While the strategies and components of every early intervention program will vary based on a company’s unique needs, trust is at the core of all programs. As experience shows, companies that build a culture of transparency retain employees who are more empowered to report their injuries and remain communicative throughout the claims process.

At CorVel, we understand that the first 30 days following an injury are crucial in determining overall outcomes. To date, we have achieved a 14% reduction in overall claim costs, a 16% reduction in average lost workdays (compared to predictions), and a 14% reduction in attorney involvement in claims for our valued partners through the implementation of our Care Advocacy program. Through CorVel’s early intervention strategies, we are committed to providing an additional level of care to support injured workers’ treatment, recovery, and, ultimately, their return to work during this critical timeframe.