WorkCompWire
Full article on: workcompwire.com
Too often, navigating the workers’ compensation system after a workplace injury is an isolating and fragmented experience that results in patient dissatisfaction, disengagement, and a prolonged recovery process.
Successful recovery and return to work require more than just the best care available. Equally important—and often overlooked—is the need for seamless interdisciplinary communication between all parties involved in the case. This includes the injured worker and their family, the employer, claims professional, providers, and case manager. Even in the best circumstances, communication breakdowns can impact outcomes and increase the risk of cost overruns.
A recent panel at the WCI 2023 Conference brought together representatives from Paradigm and across the workers’ compensation industry to examine the importance of communication in helping injured workers achieve the best possible outcomes—including the unique role that each participant in a case plays to ensure effective collaboration:
Case Managers
Case managers are central to facilitating ongoing and transparent communication between all parties during the recovery journey. Throughout the course of the claim, they interface with and serve as a liaison between the injured worker, claims examiner, employer, providers, and attorney, when necessary.
Early and frequent communication is critical to helping injured workers reach recovery milestones and return to a meaningful quality of life. In the course of duty, case managers are responsible for providing critical information to set up the case for success and keep it on track. This includes:
- Educating the injured worker and their family on the recovery process and what to expect, enabling them to actively participate in the recovery
- Coordinating treatment and all provider visits to ensure the right care is received at the right time
- Monitoring and updating all parties on the injured worker’s progress, and any barriers to recovery that need to be addressed
- Facilitating a timely and medically appropriate return to work
Throughout the entire course of treatment, it is incumbent on the case manager to serve as an advocate for the injured worker. In doing so, the case manager must collaborate closely with the rest of the recovery team—understanding and delivering the information they need to achieve a successful outcome.
Claims Professionals
Claims professionals, including adjusters and examiners, play a critical role in ensuring the injured worker understands what to expect in the claims management process. For any workplace injury case, the adjuster is involved in making authorization decisions, including those related to medical care and benefits payments, making it imperative that they receive real-time, accurate progress updates that will allow them to successfully negotiate timely treatment approvals and payment determinations.
Case managers work closely with the adjuster from the outset to understand the details of the case, discuss any specific case-related concerns, and determine goals for recovery. Throughout the process, they provide timely updates to the adjuster on any significant changes in status, and communicate providers’ treatment recommendations for authorization to keep the case moving forward.
Employers
When an employee is injured, the employer is very often the first point of contact. Employer communication regarding concern for employee well-being and a commitment to aligning the right resources for optimal recovery and return to work sets the stage for success. Through transparent communication, employers can help ensure that the recovery team has a holistic understanding of the injured worker they are helping, contributing to the best possible outcomes.
Employers can also contribute to the recovery process early on by communicating information about dynamics with the injured worker that could impact the case. This may include candid but objective reports around job satisfaction, previous injuries, or recent job changes. While these types of details may not be directly related to the injury, they can alter the mechanics of the case and potentially affect the outcome.
During the course of a claim, employers have vital information and resources. For example, an updated and detailed job description is extremely important for coordinating and negotiating a medically safe and appropriate return to work at the earliest opportunity possible. Any information that the employer provides can help case managers and providers create and direct an effective care plan.
Providers
By diagnosing the injury, administering treatment, and approving the release to return to work, providers are central to the recovery journey. If there is an important development, or an unforeseen setback, the treating physician will know about it early and can share that vital information with the other team members.
One of the most important points of communication for providers is direct patient interaction. Like any patient, injured workers who feel supported and who trust their provider will be more engaged with treatment and more likely to achieve recovery goals. For providers, an interaction style built on empathy, patient education, and person-centered care is fundamental and can positively impact the case as a whole.
Communicating with providers is another area where the case manager plays a key role. They partner closely throughout the life of the file to coordinate return to work within the appropriate job parameters—interacting with the provider, understanding the treatment plan, and transmitting recommendations as quickly as possible back to the adjuster to help ensure the right treatment occurs at the right time. Case managers are also instrumental in ensuring the provider has all the relevant information to help inform the best course of treatment for the injured employee. If there are questions about the care that’s being recommended, case managers are perfectly positioned to get the necessary answers for the employer or payer.
Building Better Communication and Trust Through Injured Worker Advocacy
Consistent and effective communication is necessary from all parties to deliver a positive outcome for workplace injuries, and case managers are uniquely equipped to be a conduit for open communication. Communication can have as much of an impact on the outcome as the treatment administered, and properly trained case managers can ensure that necessary information gets to the right people when it’s needed. Case managers should also be able to proactively identify potential obstacles to communication early on and take corrective action.
Using communication methods that promote patient engagement, including education and advocacy, case managers can help injured workers be more involved with their medical decision-making and ensure timely care delivery—while building trust along the way. When a case manager has these skills, the impact on outcomes is tangible. In one real-world example, through attention to detail and proactive communication, a Paradigm case manager helped identify a missed diagnosis of compartment syndrome in an injured worker. After recognizing severe symptoms, the case manager acted quickly to coordinate a referral to a new provider, who made the proper diagnosis and delivered prompt treatment, saving the patient from an amputation.
Paradigm’s approach to equipping case managers to communicate proactively and effectively begins on day one, with a comprehensive training and onboarding program. Our case managers are trained exhaustively in areas including motivational interviewing, to engage injured workers and their families in communication, overcoming conflict, and strategies for facing ethical challenges.
To learn more about how Paradigm drives outcomes through nationwide quality case management, visit paradigmcorp.com/case-management-solutions.
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