Another example of a problem is extended medical treatment past a designated point for low back strain. The alert is sent to the claims adjuster whose procedure is to engage a medical case manager to investigate. The investigation procedure is standardized.
Examples of how this works are unlimited, but the important thing is that intervention procedures are analyzed in advance and clearly stated so the actions are consistent across the organization and going forward, regardless of who actually carries out the intervention. Obviously, details of actions may be variable, but the general course should be followed.
The plight of medical case management has long been that results could not be measured. Consequently, medical case management as a strategy has been undervalued.
Karen Wolfe is the founder and President of MedMetrics®, LLC, a Workers’ Compensation medical analytics and technology services company. MedMetrics offers online apps that super-charge medical management by linking analytics to operations, thereby making them actionable. email@example.com