Provider Pulse
March 08, 2019

Care coordination team ready at a moment’s notice

When a serious accident occurs, the outcome could be life threatening or result in permanent disability. Recognizing the immediate need for multiple services and care coordination to manage the medical conditions that involve multiple bodily functions and often, permanent impairment, Pinnacol recently assembled a team of external case managers (ECMs).

Through Pinnacol’s case management program, ECMs take responsibility for coordinating care for injured workers in catastrophic and complex cases from the very beginning of the injury. And while there are third-party ECM firms in Colorado and across the country, Pinnacol’s team offers distinct advantages.

“ECM firms generally carry a huge caseload, but Pinnacol gives each case a lot of time and attention,” noted Medical Director of Ascent Medical Consultants Brian Mathwich, M.D.  

Pinnacol’s team offers two additional advantages over third-party ECM firms:

  1. Strong working relationships based on Pinnacol’s more than 100 years of collaboration with providers and service to employer policyholders. Our provider relationships help ensure coordinated care by multiple physicians and facilities. Our employer relationships ease the return to work by those injured workers who can.
  2. A 360-degree view of the continuum of care. As Colorado’s largest workers’ compensation insurer, we review the medical records of all the physicians and facilities that provide care to a recovering worker. 

“Pinnacol’s ECM team gives me a complete view of the patient’s care, so I can quarterback the recovery plan and work toward the best possible health outcomes,” Dr. Mathwich said.

Enabling providers to focus solely on patient care

Dr. Mathwich works mainly with Pinnacol’s Susan Grigsby. Here’s a look at our five ECM team members:

“Our ECM team brings some 50 years of combined experience in managing complex claims,” said Christine Sims, Pinnacol’s director of Medical Case Management. “Their experience and relationships provide the glue for these cases that often involve so many providers.”

Our team attends medical appointments, coordinates provider visits, facilitates discharges and home care, arranges transportation, supports the clinicians who plan and provide treatment, and ensures timely, accurate communications to providers, employers, injured workers and their families.

“These professionals have a warm, highly effective way of improving communications, allaying concerns and facilitating the greatest level of collaboration,” Sims said. “Our ECM team manages the administrative complexity so the physician or facility can focus solely on providing the very best care.”

If you have a case that would benefit from an ECM or if you’d like to learn more, contact Harry White at harry.white@pinnacol.com or 303.361.4435.

Download this flier to learn more about Pinnacol’s Catastrophic Case Management Program. 
 

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