Savings Analysis - Nonfiction Version

Confession: I always hated calculating savings dollars for case management. I’ve been in work comp case management since 1990, and I always felt guilty – like I was given a free license to make up imaginary scenarios and inflated savings numbers. Outside of negotiated discounts, that’s essentially what is seemed to be – if CM hadn’t been there, the treating MD might have recommended “X” and so I saved $__. Therefore, for years, I didn’t address savings dollars in those terms.

Does case management result in managed care savings? Yes it does! RN Case Managers

· identify pre-existing conditions confused with injuries,

· keep treatment focused on the mechanism of injury, reducing wasted dollars

· address appropriate physical abilities and limitations for work

· propel cases forward, avoiding delays in treatment and approvals

· And communicate, communicate, communicate!

But how are these savings captured on a factual basis and not imagination? Enter evidence-based guidelines. These guidelines contain a dataset of actual claims to capture and categorize virtually any injury diagnosis along with other medical conditions, and the length of time it took for these claimants to return to work, and when the claim to be closed. Utilizing ICD and CPT coding we can plug in all the factors of a claim we are working, and find out real savings dollars. Pretty cool. For the last few years we have been utilizing these evidence-based guidelines to not only identify CM savings, but also to steer expectations of outcomes.

This week I’ve been working on savings reports for customers using evidence-based guidelines to “show them the money.” With evidence based guidelines, we can now plug in all the factors of a claim and produce actual savings numbers. Putting the proof in the pudding, so to speak.

In this age of escalating medical costs, case management can be seen as an added expense to claim management when in actuality, case management is a savings tool.

How much could case management be saving you on your claims?

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