Success Story: Minnesota Managed Care Expertise

A Triumph in Recovery with Nurse Case Manager Support

In the bustling world of commerce, where employees are the lifeblood of any thriving enterprise, one worker’s journey to recovery exemplifies the power of effective case management. In February 2021, a dedicated employee suffered a right low back injury while performing a seemingly mundane task—repetitively bending over to clean out a cart. This incident began a challenging yet ultimately successful road to recovery.

Initial Response and Treatment Plan

At the onset of the injury, CorVel’s certified managed care program, supported by a skilled nurse case manager, provided unwavering support. With a keen understanding of the Minnesota Treatment Parameters and a network of trusted providers, the nurse case manager deftly navigated the complexities of the worker’s compensation system. They directed the injured worker to network providers and certified a comprehensive treatment plan that included physical therapy, chiropractic care, a single lumbar sacroiliac joint injection, and a lumbar MRI.

Navigating Treatment Challenges

As the treatment progressed, the nurse case manager encountered a hurdle when dry needling and laser therapy were ordered. However, armed with the knowledge of the Minnesota Treatment Parameters, the nurse case manager recognized that these treatments were not medically necessary. A peer review and dispute process completed in March 2022 confirmed that dry needling and laser therapy did not meet the criteria for medical necessity. The peer review and dispute process were repeated in July 2022, when a second SI joint injection and additional injections were also found not medically necessary. By avoiding these unnecessary treatments, the nurse case manager achieved significant cost savings for the employer.

Ongoing Support and Advocacy

Undeterred by these setbacks, the nurse case manager continued to advocate for the injured worker, authorizing a sacroiliac joint belt for home use and skillfully coordinating a return-to-work program based on the physical therapy restrictions. Thanks to their efforts, the injured worker could keep working with permanent limitations, incurring only 11 days of lost work time. This approach benefited the employee’s well-being and proved cost-effective for the employer by eliminating the need for a Qualified Rehabilitation Consultant (QRC) on the file.

Results and Savings

The results of this case speak volumes about the effectiveness of CorVel’s certified managed care program. Through the expert guidance of the nurse case manager, the employer realized a total savings of $36,599, which included $24,114 in medical and utilization management savings and $12,484 in indemnity savings, equivalent to 152 days.

By partnering with CorVel, employers can ensure that their injured workers receive the most appropriate and efficient care, leading to better outcomes, reduced costs, and a smoother path to recovery. In a world where every dollar counts and every employee matters, CorVel stands ready to help businesses navigate the complexities of worker’s compensation and emerge stronger than ever before.