Also to blame is the NCM process itself. In spite of professional certification for NCM, the process is poorly defined for those outside the nursing profession. Moreover, and more importantly, NCM has difficulty measuring and reporting proof of value.
Granted, the NCM is a trained professional who reacts to events and conditions in the claim based on a medical knowledge base. But when the product is unstructured, variables in delivery cannot be measured or appreciated.
When the conditions in claims that lead to intervention by NCM are computerized and standardized, the outcomes or effects can be measured. Apples can legitimately be compared to apples, but not to oranges and tennis balls. Similar conditions in claims are noted and approached the same way every time, so the results can be validly measured.
Industry research and corporate wisdom
Industry research and corporate or professional wisdom regarding risky situations can supply the standardized indicators for referral to NCM. American Airlines uses the standard that all lost time claims should be referred to NCM. But there are many, sometimes more subtle indicators of risk and cost in claims that can be identified early through computerized monitoring and referred for NCM intervention.
Another example of developing standard indicators for referral is based on industry research that shows certain comorbidities, such as diabetes can increase claim duration and cost. These claims should also be referred to NCM for oversight. Yet another example is steering away from inappropriate medical providers who can profoundly increase costs.
Computer-intensified medical management
As a long-ago nurse and a longer-time medical systems designer and developer, I believe the solution lies in appropriate computerized system design. To be effective, the components are those described above. The elements need to be simple to implement, easy to use, and consistently applied. Only then can NCM offer proof of value.