The Future of
By David Volz
This is the second and concluding installment in a two-part series on case management in catastrophic care. Part one ran in the Feb. 22 edition.
Case Management in its various forms
has become more critical, especially when it involves high-cost care, according to Jane Galvin, managed care policy director for the Health Insurance Association of America. She has seen many employers or self-insured groups contract directly with firms that specialize in managing a specific type of disease. Galvin said that hospitals have always had forms of case management and usually tracked the progress of very sick patients even after going home. Often they supervised occupational and physical therapy outpatient programs.
Management programs have proven their ability to reduce costs and improve the quality of care provided to patients suffering from severe illnesses or injuries. A strong case management program allows a managed care firm to effectively track the results of a patient's progress through a treatment sequence.
Corporations like Honeywell Inc, based in Minneapolis, have established strong internal case management programs. A fairly large employer with 2,600 workers in its corporate offices complex and research centers, Honeywell saves an average of $200,000 annually because of its strong case management program, according to Jean Bey, health services manager for the corporation.
Honeywell has health care advisors on staff to determine the type of assistance people need, especially if a case costs more than $25,000 or involves a long-term problem such as a stroke or spinal cord injury or anything that requires a long hospital stay. The health services advisor works with the carrier's case manager, with employee consent, to determine the best plan of care. Often this advisor coordinates the care between the carrier's case manager, the provider and sometimes an occupational-medicine nurse. Throughout the patient's care, the case is reviewed to ensure that proper procedures are being followed and that treatment is being delivered in a cost-effective manner.
If necessary, changes are made in the individual's program, according to Bey. After a person has been treated and it has been determined that a return to work is possible, the case manager will work with the appropriate supervisors to make the reasonable accommodations needed by the employee.
Even if Honeywell employees are outside the Minneapolis area, they are still cared for by the company's case managers.
"We had a situation where a person hurt his leg in an accident," Bey said. "The accident occurred on the East Coast, but the employee's friend called one of our health service advisors in Minneapolis. Our internal nurse case manager got the primary doctor here talking to the attending physician on the East Coast. Once the patient was stabilized, our health service team arranged for his transport back to Minneapolis and determined the best place for his recovery. We are trying to ensure quality of care as well as saving money."
Andy Cmiel, president of Self-Insurance Marketing Service, based in Laguna Hills, CA, said case management is an industry in flux and will come to define a much wider range of services in the future. He has found that in today's case management scene, a quality organization will have three elements: prevention, traditional medical cost containment and disability management.
Good case management means good prevention and good follow-up should there be a catastrophic illness or injury, according to Cindy Funderburk, R.N., a certified case manager and the district manager for the Nashville office of Eckman/Freeman and Associates. The Louisville firm specializes in cost containment and rehabilitation. She encourages companies to set up strong safety and wellness programs and said that organizations should have an attitude throughout the firm that good health is important.
"Some companies have very developed programs and even provide time off so that employees can have their health care needs met before serious problems develop," Funderburk said. "They also have incentive programs in place for workers who demonstrate a willingness to work toward better health. They might have a counseling program in place to ensure that a pregnant mother avoids drugs to prevent a neonatal problem. Unfortunately, there are some companies that only want to save money on claims and are only able to react to a catastrophic incident."
When such an incident does occur, Funderburk takes a proactive approach to managing the recovery of a client. She tries to find the highest quality of care that is available to ensure the best recovery. If a person has suffered a severe head injury and cannot return to a normal life, she will educate the family about the patient's new condition, work with the patient during the rehabilitation process, help the family work with the patient and find new activities for the individual upon release. If a return to work is not possible, the patient would be encouraged to become involved in a volunteer program to gain a sense of contributing to society.
For something less severe, such as a back injury, Funderburk would seek to prevent a worsening of the condition, which could lead to a back fusion. The patient would be encouraged to partake of therapy programs for the back and participate in safety and wellness programs upon returning to work. Funderburk would work with the employer to ensure the workplace environment was as safe as possible and could accommodate the returning patient.
Anyone evaluating a group health plan should ask how it approaches dealing with people who have chronic illnesses or are at risk for this. Does it have a strong case management program in place? The employer needs to drill down to how the health plan finds the people at risk and intervenes on their behalf. A self-insured plan should not create barriers for people with chronic illnesses, said Kevin Heine of Prudential Health Care, based in Roseland, NJ. *
David Volz is a freelance writer from Plantation, FL