Success Story: Minnesota Certified Managed Care

A Firefighter’s Journey to Navigating Workers’ Comp and Return to Duty

Managed Care

In February 2022, a dedicated firefighter paramedic injured their right bicep while assisting a patient. Despite the discomfort, the firefighter’s strong commitment to serving others led them to delay seeking treatment for a month. However, the muscle strain showed no signs of improvement, signaling the need for expert guidance in navigating the complexities of workers’ compensation and managed care.

Intervention by CorVel’s Managed Care Program

CorVel’s certified managed care program provided invaluable support. Leveraging CorVel’s expertise, the firefighter bypassed the primary care provider stage and promptly secured an appointment with an orthopedic specialist at Summit Orthopedic. An MRI revealed bicep tendinopathy, and a PRP (Platelet-Rich Plasma) injection was initially suggested as a treatment option.

However, the nurse case manager, proficient in the Minnesota Treatment Parameters, reviewed the suggested PRP injection and determined it was inappropriate for treating this type of injury. The Minnesota Treatment Parameters, designed to ensure the most appropriate and effective care, did not recommend PRP injections for bicep tendinopathy. Consequently, the nurse case manager deemed the PRP injection medically unnecessary. This decision was subsequently validated through a second-level peer review in May 2022, further supporting the nurse case manager’s assessment.

The nurse case manager collaborated with the provider to explore alternative treatment options that would adhere to the guidelines while still providing the firefighter with the needed care. Through this partnership, an occupational therapy program was recommended and certified for 12 visits.

Successful Outcome and Significant Savings

Due to the nurse case manager’s diligent efforts and the support of CorVel’s managed care program, the firefighter received the necessary treatment without any lost time, allowing a healthy return to work. The nurse case manager’s success in navigating the complexities of the Minnesota Treatment Parameters and certified managed care network and their ability to find alternative treatment options resulted in significant savings for the employer, totaling an impressive $14,668. This included $5,990 in medical and utilization management savings and $8,678 in indemnity savings, equivalent to 63 days.

The Value of CorVel’s Managed Care Program

This case is a testament to the value of CorVel’s certified managed care program and the dedicated professionals who work tirelessly to ensure injured workers receive appropriate and effective care while minimizing employer costs. By partnering with CorVel, employers can rest assured that their employees will be supported throughout their recovery journey,  ultimately leading to better outcomes for all involved.