You see them rarely, if at all, but they have a big impact on injured workers’ satisfaction and policyholder retention. They are the nurses and physician assistants on Pinnacol’s medical case management (MCM) team. And their impact is about to grow bigger.
The MCM team revamped its structure and focus in 2017 to return more injured employees to work even sooner and healthier, reduce claim costs, and enhance both worker and policyholder satisfaction. If a pilot last year is any indication, the new structure is spot on.
For injured workers with low-back claims in 2017, the realigned MCM team accelerated the return to maximum medical improvement (MMI) to just 97 days. During 2014 through 2016, employees achieved MMI in 136 to 145 days. When Jon Scott, Pinnacol’s vice president of agency relations, safety and wellness, learned of the pilot results, he grew excited about the possibilities.
“The low-back claims pilot delivered really impressive results,” said Scott. “It is a win-win-win for the worker, policyholder and agent. Shorter injury duration means a healthier employee with a better quality of life, lower claim costs, a better experience modification factor for the agent’s client and even a potential dividend increase for the policyholder — all of which help retain business at renewal.”
A sharpened focus on early intervention
Alyson Nowlen, Pinnacol’s director of MCM, led the realignment of the team’s 30 employees. Under the new structure, a group of early-intervention nurses proactively manage “young claims,” which are those less than a year old. We have sharpened our focus on ongoing communication, patient education and help with scheduling appointments, follow-up exams, and compliance with treatment plans. All the while, our nurses continue to stress a caring, empathetic approach to each worker’s recovery.
A group of complex case management nurses works to resolve claims that are at least one year old. These cases involve employees who experience prolonged, more complicated recoveries. A third group of nurses supports catastrophic claims, while a fourth focuses on utilization review and a fifth is tasked with triaging based on injury severity. Last, a field case manager meets with injured workers, physicians and policyholders. This individual helps patients through hiccups in communication, treatment and recovery.
“As the specialization and skill set of our team grow and improve, we aim to resolve more claims during the early intervention phase,” Nowlen said. “Likewise, over the coming years, we expect fewer injured workers will experience delayed recoveries.”
Disability duration declines with the use of evidence-based treatment guidelines from the Colorado Division of Workers’ Compensation and MCG Health, a global healthcare advisory firm. Our MCM team now uses the firm’s Official Disability Guidelines’ predicted-duration calculator to frame consultations with clinicians about treatment and tracking of MMI.
“This is all very promising,” said Scott. “When claims close faster and workers return to task healthy and happy, there’s a real opportunity for the agent, Pinnacol and the employer to cultivate a caring culture of helping employees injured on the job.”