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EMPOWERING the CLAIMS MANAGER an Insight Into the Brain of the Nurse Case Manager

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EMPOWERING the CLAIMS MANAGER an Insight Into the Brain of the Nurse Case Manager 5/9/2019 EMPOWERING THE CLAIMS MANAGER An insight into the Brain of the Nurse Case Manager 1 A. CAPTAIN A. LIGHTENING B. NIGHT B. KNIGHT C. THE C. HULK D. ANCIENT D. CENTURION E. SPIDER E. SURFER F. INVISIBLE F. GIRL G. MASTER G. WARRIOR WHAT’S YOUR H. MR. H. MAN I. SILVER I. GHOST SUPERHERO J. DARK J. MASTER K. PROFESSOR K. HORNET L. RADIOACTIVE L. PHANTOM NAME? M. INCREDIBLE M. CRUSADER N. IMPOSSIBLE N. DAREDEVIL O. IRON O. MACHINE P. ROCKET P. AMERICA Q. HUMAN Q. X R. POWER R. DOOM S. GREEN S. FIST T. SUPER T. SHADOW U. WONDER U. PATRIOT LAST NAME LAST INITIAL FIRST NAME INITIAL FIRST V. METAL V. CLAW W. DOCTOR W. TORCH X. MASKEED X. SOLDIER Y. CRIMSON Y. SKULL Z. OMEGA Z. WOMAN 2 NURSEWORKS NORTHWEST We’re an adventurous, outdoorsy, wellness-driven team. TRICIA DENICE RACHEL TONJA 3 1 5/9/2019 GOOD GUY HEALTHCARE 4 BAD GUY HEALTHCARE COST TREATMENT 5 A NATIONAL HEALTHCARE STAT 1% OF ALL U.S. PATIENTS CONSUME 20% OF THE NATION’S HEALTHCARE SPENDING and in that, the estimated 9.6 million patients who qualify for both Medicaid and Medicare (dual eligibility) are expected to cost the government $775 BILLION by 2024. (PwC Health Research Institute (2014). Top health issues of 2015). 6 2 5/9/2019 A WORKER’S COMP STAT BENEFIT PAYMENTS UNDER WC PROGRAMS TOTALED MORE THAN $61.8 BILLION IN 2012, which was a 1.3% increase from the year prior. The medical benefits share was $30.8 billion; The replacement of lost wages was $31 billion. (National Academy of Social Insurance (2014). Workers Compensation: Benefits, coverage, and costs, 2012. 7 A QUOTE FROM OUR DIRECTOR… We’ve seen a big drop in injuries at work in our state since 2012, along with that, we’re doing a better job helping injured workers heal and return to work. JOEL SACKS, DIRECTOR, WA STATE DEPARTMENT OF LABOR & INDUSTRIES 8 BACK TO NATIONAL STUFF… TRAUMATIC OCCUPATIONAL DEATHS AND INJURIES COST THE NATION $192 BILLION ANNUALLY (Centers for disease control and prevention (2015). Traumatic occupational injuries). 9 3 5/9/2019 MORE NATIONAL STATS… WORK-RELATED INJURIES WILL HAVE AN AVERAGE COST THAT IS ABOUT 70% MORE THAN THE SAME INJURY TREATED THROUGH AN INDIVIDUAL’S PRIVATE INSURANCE. 10 Work-related injury ? Utilization of medical claims stay open services MORE THAN FOUR TIMES longer WHY DOUBLE in Workers than non-work Compensation. related claims, ? 11 COSTS TO A CLAIM DIRECT COST INDIRECT COST • HOSPITAL • WAGE REPLACEMENT • SURGERY • ANY SETTLEMENT ASSOCIATED WITH PPD • DIAGNOSTIC TESTING • LOST PRODUCTION • THERAPIES, • TEMPORARY EMPLOYEES • PHARMACEUTICALS, • TRAINING • CLINICAL NURSING SERVICES • RETRAINING • DME • ETC. • ETC. 12 4 5/9/2019 ACCORDING TO THE WORKER’S COMP INSTITUTION: THEREFORE, IF THE AVERAGE COST OF A CLAIM IS APPROXIMATELY $27K, THE REAL COST FOR THE EMPLOYER COULD BE UPWARDS TOWARD $150K! (Utterback, D., & Schnorr, T. (2010). Use of workers’ compensation data for occupational injury and illness prevention.) 13 NURSE CASE MANAGER = HUB 14 PATIENT CENTERED CARE WORKER’S COMPENSATION WAS ONE OF THE EARLIEST PRACTICES FOR NURSE CASE MANAGERS. The use of the NCM is reserved for the cases that are more serious or have complicated issues that require close coordination. 15 5 5/9/2019 THE CASE MANAGEMENT SOCIETY OF AMERICA WHAT IS A CMSA defines a case manager as someone CASE MANAGER? who works within a collaborative process of assessment, planning, facilitation, care coordination, evaluation and advocacy to meet an individual and family’s comprehensive health needs through communication and resources to promote quality, cost-effective outcomes. 16 ASSESSMENT Meet with the Meet with the Meet with the employer / injured worker & healthcare employer their family provider team representative 17 PLANNING FOCUSED, ACTION ORIENTED, MEASURABLE, ATTAINABLE, AND FISCALLY RESPONSIBLE. 18 6 5/9/2019 FACILITATION THE NURSE CASE MANAGER IS RESPONSIBLE FOR MAKING CERTAIN THAT ALL ASPECTS OF THE TREATMENT PLAN, AS AUTHORIZED BY THE CLAIMS MANAGER, ARE IN PLACE. 19 CARE COORDINATION CONTACT ALL INVOLVED TEAM MEMBERS TO ASSURE ALL TASKS ASSIGNED ARE BEING CARRIED OUT. 20 CARE COORDINATION INCLUDES: • ATTENDING PHYSICIAN • INTERPRETATION SERVICES • SPECIALISTS/SURGEON • PHARMACY • PHYSIATRY • WOUND CARE • PSYCH • PT/OT/MT/ST • IMAGING • HOME HEALTH CARE • DURABLE MEDICAL EQUIPMENT • WC/WH • TRANSPORTATION • SIMP 21 7 5/9/2019 EVALUATION • WHAT WAS THE GOAL VERSUS OUTCOME? • DO CHANGES NEED TO BE MADE IN THE TREATMENT PLAN? • ARE THERE ANY GAPS IN CARE THAT HAVE BEEN IDENTIFIED? ? 22 ADVOCACY THE PRIMARY OBJECTIVE OF THE NURSE CASE MANAGEMENT PROCESS IS TO ENSURE APPROPRIATE, HIGH-QUALITY CARE FOR INJURED WORKERS IN A TIMELY AND COST-EFFECTIVE MANNER. 23 COMMISSION FOR CASE MANAGER CERTIFICATION CCMC CONDUCTED A SURVEY THAT SHOWED AS PATIENT CARE BECOMES MORE COMPLEX, AND HEALTHCARE PROVIDER ACCOUNTABILITY INCREASES, THE ROLE OF THE NURSE CASE MANAGER BECOMES MORE IMPORTANT (Commission for Case Manager Certification. (2010). Care coordination: Case managers “connect the dots” in new delivery models. CCMC Issue Brief, 1(2).) 24 8 5/9/2019 I.D. ASSIGN. HIGH RISK INJURED WORKERS: • CONGESTIVE HEART FAILURE (CHF) • CARDIAC CONDITIONS • CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD), • ANY TYPE OF NON-RELATED MAJOR SURGERY • AGE RELATED CONDITIONS (Osteoarthritis, osteoporosis, cardiovascular disease, not to mention pneumonia, cancer, diabetes…) 25 A FEW OTHER INDICATORS TO ASSIGN A NURSE CASE MANAGER: • ANY CATASTROPHIC INJURY, • UNCERTAIN DIAGNOSIS OR CONFLICTING DIAGNOSES, • CASES WITH AMBIGUOUS/QUESTIONABLE/UNUSUAL TREATMENT PLANS, • CASES THAT ARE NOT RESOLVING IN A TIMELY MANNER, • CASES WHERE THE INJURED WORKER IS INJURED FREQUENTLY, • CASES WHERE LONG TERM, NON-CANCER TREATING OPIOIDS ARE STILL BEING PRESCRIBED, • CASES WHERE COMORBID, UNRELATED DIAGNOSES ARE DELAYING THE REHABILITATION OF THE INDUSTRIAL INJURY OR ILLNESS. 26 COMORBID CONDITIONS THAT ARE AFFECTING YOUR CLAIMS OBESITY TOBACCO USE HYPERTENSION DEPRESSION DIABETES OSTEOARTHRITIS 27 9 5/9/2019 NCM CASE ASSIGNMENT 1 2 3 MEET WITH MEET WITH MEET WITH THE THE INJURED THE INJURED EMPLOYER WORKER WORKERS HEALTH CARE TEAM ALL PARTIES ARE HELD ACCOUNTABLE TO STAY FOCUSED ON THE OUTLINED TREATMENT PLAN AND FOLLOW THROUGH. COMMUNICATION IS KEY! 28 ENGAGING THE INJURED WORKER • EDUCATE THE INJURED WORKER RE: DIAGNOSIS, TREATMENT, L&I PROCESSES • COMMUNICATE REGULARLY WITH THE INJURED WORKER • TRANSPARENCY! 29 ENGAGING THE INJURED WORKER By ENGAGING the injured worker, an emotion is invoked that typically results in a desire to participate in their treatment plan. These injured workers are not just satisfied, they become loyal to their provider’s services. “PATIENT ENGAGEMENT IS A CRITICAL CORNERSTONE OF PATIENT SAFETY AND QUALITY” (Nursing Alliance for Quality Care, George Washington University School of Nursing. (2011, December 15) Guiding principles for patient engagement). 30 10 5/9/2019 ENGAGING THE INJURED WORKER LOST IN TRANSLATION Between 40 and 80% A total of 78% of More than 70% of of the information patients leave the adverse events are patients hear during a hospital without caused by a breakdown HCP consultation is lost understanding their in communication almost immediately treatment among caregivers and between caregivers and (Engel, K., Heisler, M., Smith, D., Robinson, C. H., (Williams, M. (2002). The role of health literacy in Forman, J. H., & Ubel, P.A. (2009). Patient patients patient-physician communications. Family comprehension of emergency department care Medicine, 34(5), 383-389). and instructions: Are patients aware of when they do not understand? Annals of Emergency (The Joint Commission, (2016), National patient Medicine, 53(4), 454-461). safety goals). 31 THE TELEPHONE GAME! REPEAT BY WHISPERING INTO YOUR NEIGHBOR’S EAR (ONLY ONCE!) WHAT YOU HEARD FROM YOUR NEIGHBOR. 32 GOOD DAY (chorus) We're gonna have we're gonna have a good day and all my homies gonna ride today and all these mommies look fly today and all we want do is get by today hhheeeyyy we're gonna have a good day and ain't nobody gotta cry today cause ain't nobody gonna die today you can save that trouble for another day hhheeeyyy we're gonna have a good day 33 11 5/9/2019 COMMUNICATION • L&I CATASTROPHIC CLAIMS GAP ANALYSIS: one of the gaps identified was improved communication, care coordination, and planning. • WE ARE EACH PILLARS OF INFORMATION that need to share with one another to determine the most effective treatment plan and allow for best patient outcomes. 34 COMMUNICATION ON A WEEKLY BASIS (MORE OR LESS DEPENDING ON THE ACUITY OF THE CASE), UPDATES ARE RELAYED TO THE CLAIMS MANAGER/EMPLOYER. 35 THE A’S OF NURSE CASE MANAGEMENT ASSESS the needs of the injured worker ADDRESS the barriers to care A ASSIST in the coordination of care ADHERE monitor injured worker treatment compliance 36 12 5/9/2019 ATTENDING SURGEONS TEAMWORK PHYSICIAN EMPLOYER / INJURED CLAIMS WORKER MANAGER (and their family) ANCILLARY SERVICES (VRC, PT/OT/MT/ST, DME, Pharmacy, Home Health, Etc. 37 A FEW OTHER INDICATORS TO ASSIGN A NURSE CASE MANAGER: • ANY CATASTROPHIC INJURY, • UNCERTAIN DIAGNOSIS OR CONFLICTING DIAGNOSES, • CASES WITH AMBIGUOUS/QUESTIONABLE/UNUSUAL TREATMENT PLANS, • CASES THAT ARE NOT RESOLVING IN A TIMELY MANNER, • CASES WHERE THE INJURED WORKER IS INJURED FREQUENTLY, • CASES WHERE COMORBID, UNRELATED DIAGNOSES ARE DELAYING THE REHABILITATION OF THE INDUSTRIAL INJURY OR ILLNESS, • CASES WHERE LONG TERM, NON-CANCER TREATING OPIOIDS ARE STILL BEING PRESCRIBED. 38 CATASTROPHIC CASES CATASTROPHIC CLAIMS ARE UNPREDICTABLE FROM
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