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At the Heart of Case Management

I have done presentations on The Benefits of Case Management to carriers, peers, and other health care professionals.  Sometimes it sounds dry and philosophical to list benefits: access to care, best practice recovery, lowered cost expenditures. But who is the one that benefits?  In our practice, is it the injured worker? the employer? the insurance carrier? From the Case Management Society of America, "It is the philosophy of case management that when health care is appropriately and efficiently provided, all parties benefit." Allow me to demonstrate for you the heart of case management from two of our case managers this week.

One of our CM Team has a patient that was "swimming" amidst a work injury and numerous mis-diagnoses and was fearful this CM's job was to just "write him off." Our RN worked to find a physician that would clarify his diagnoses, even collaborating between his group health carrier and Work Comp carrier.  At the conclusion of an evaluation this week, this case manager stated, "He thanked me profusely at the conclusion of his exam and started to cry." She had not written him off - by far, but had been his greatest advocate, while facilitating prompt treatment and shortening claim resolution time.  

One of our NorthEast Arkansas territory case managers has worked for several weeks now with a catastrophic injury patient.  He has progressed now to where he is allowed weight-bearing status on his orthopedic injury - that was a big milestone.  At his physician visit this week, our CM presented him with a new pair of overalls.  He had been distraught since his overalls were cut off of him in the ER, worried about the cost of a new pair for returning to work.  This is not something WC carriers typically pay for.  This injured worker was brought to tears; "he cried, and I cried" she reported. She had seen past the formalities of the case management role, to the heart of her patient. After all the hospital, rehab, therapy, there was a light at the end of the tunnel, and this case manager will be there to smooth his journey and be a steward of his benefits.

This is what it's all about!
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