THE CURRENT STATUS QUO
Current case management is not interventional. It is passive or reactive to circumstances and does not direct the trajectory of most claims. Case management is viewed as an expense on a claim file not a driver of patient care, outcomes or cost reduction.
In actuality, certain parties may have a personal and/or financial interest to keep the case active regardless of litigation risk, lost time, or procedures performed.
THE AEGIS DIFFERENCE
We immediately implement steps to actively engage all parties in the process. This begins with educating each individual involved as to their specific responsibilities and clarifying the impact of those responsibilities on costs and outcomes.
We then focus the parties on the goal of return to work. We instruct medical providers on the patient background and physical job requirements that are often not provided and may impact patient treatment plan. Where applicable, we ensure physicians are aware of light-duty work requirements.
We weigh in on proposed treatment plans, compare them to standardized protocols and interject in the process in a timely manner to assess if not challenge treatment plan efficacy. We network with local healthcare providers who consistently provide exceptional results. It is about making parties accountable.
BACKGROUND ON THE OTHER PLAYERS
The medical provider works from the information they are provided. Lack of detail impacts their design of treatment and return to work plan. They will have no sensitivity towards getting the employee back to work unless those parameters are provided to them and in a timely manner.
The employee is often not engaged or not as cooperative as the process requires. This may be because they do not understand the process, their responsibilities or how that impacts their own health. Then there are those who enjoy not working. This may be a small percentage, but it is the main source of an employer's costs.
The employer is often the only party with concerns over claim costs, patient outcomes, and duration of the claim. However, the employer often does not know the value and impact they can provide to achieve their own goals.
Employers need to have a solid understanding of their responsibilities & sensitivity to timelines. They also need to know the tools they have to drive the claim, when to utilize them, and how they could otherwise assist.
GETTING STARTED
We begin with a case history review and assessment.
In addition to providing a baseline measurement of outcomes prior to working with us, it will help us identify what protocols, education and training could be implemented before our case management services begin.
This has a very significant impact on our ability to succeed in engaging the parties and effecting a proactive case management plan.
THE INJURY MANAGEMENT PROCESS
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Consultation with employer & insurance provider at the time of injury
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Discovery & Due Diligence: Initial screening & Medical Record Review.
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Evidence Based Medical Management Protocols
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Monitor & Evaluate