Professional Documents
Culture Documents
Case Management
Case Management
RMI 4596
management department that actively coordinates the care of members who incur
or are expected to incur unusually high medical care costs from complex courses of
treatment resulting from injury or illness (Beam). However, how effective is this
process? Is it worth the high cost to employers? The issue may be part of a
Ultimately, there are two goals of Case Management; to reduce lost work time
and reduce disability costs. There are many factors that contribute to getting the
workforce. Between the declining economy, escalating costs of health care, and
attention to human and civil rights, it is getting harder for employers to manage
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employees with disabilities. Employers are seeking new means to maintain the
The legislative and constitutional framework plays a significant part in the costs
employers will face when it comes to occupational and non-occupational injury and
illness. While America does not have a highly regulated employment policy towards
The Americans with Disabilities Act (ADA) is a major civil rights legislation that
prevents discrimination on the basis of disability in all employment practices for both
public and private employers. The ADA does not establish quotas or mandatory
requires that employers with 15 or more employees provide qualified individuals with
disabilities and equal opportunity to benefit from the full range of employment-related
recruitment, hiring, promotions, training, pay, social activities, and other employment
employee must also take responsibility to request an accommodation from their employer
that will allow the individual to perform his or her job better.
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the employee’s illness or disability as occupational or non-occupational illness or
disability. Private insurance companies and state workers’ compensation boards are the
primary administrators of workplace injury benefits and services. Separate health care
and social security benefits are available for workers who become injured or disabled
outside of work. Generally, workers who are injured on the job, who are covered under
and insurance policy and workers’ compensation, receive more benefits and services than
Many employers assume that only social programs are responsible for the care of
persons with disabilities once those workers are unable to perform at work. As a result,
causing a lack of incentive on both the employer and employee side of job retention and
have developed more creative disability management programs intended to assist these
workers with disabilities that utilize services, people, and programs that are designed to
minimize the financial and social impact of disability to workers, employers, and society.
has proven to be an effective way to reduce disability costs and getting workers back into
Early intervention and monitoring of workers’ injuries is a vital part of the return-
to-work process. Monitoring should be supportive to the worker, ensuring that he/she has
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assist the return-to-work process. This helps to give the worker assurance that the
strategies, specifically return-to-work plans for workers. Most plans offer trained case
managers to help patients during a time of illness or disability (Mincer). Case managers
are part of the disability management team who function as a liaison between employers,
labor representatives, injured workers, community health care providers, and others
(Shrey). They coordinate rehabilitation plans and return-to-work transition programs for
workers.
Providing injured workers with case managers can be one of the largest cost savers
for employers (Mincer). Case managers are trained to recognize problems and gaps in
their client’s treatment. They ensure patients are receiving the right treatment and tests
and that they are following normal recovery time. By seeing that the patients get the
necessary exams and avoid any unnecessary treatment, the case manager plays an active
roll in reducing the patient’s hospital stay, the use of community services, and the cost of
treatment.
Another important role the case manger plays is the fact that they are in constant
contact with the patient. They are also able to make sure the person is taking their
the patient is doing what they can to get better and return-to-work. If out-of-pocket costs
are the patient’s concern, the manager could potentially find alternative medications or
refer the patient to generic brands. The case manager can also get the patient assistance
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manager involved in a case is cost effective for an employer and has proven to be
between the worksite and the external community, including medical services and
rehabilitation providers. The disability management team ensures that the steps from
injury to work are clearly defined for the both the worker and the employer. The team
must establish communication lines, explain the program’s objectives to the injured
worker, develop and implement the return to work plan with the injured worker and
others, and monitor the worker’s progress and coordinate additional services or
Ergonomics involves fitting the job to the worker and is designed to reduce the risk of
injury. It ensures that the job duties required for a position are within the physical
capabilities of the worker, thus reducing injury. This approach can be used proactively to
reduce injury, or as a method to accommodate workers who recently return from medical
leave who may not be able to return to their previous position. The role of ergonomics in
this situation is to not only to make job accommodations, but it involves determining
training programs to enhance their capabilities, designing work and schedules during the
transition from being occupationally disabled to a full return-to-work status, and finally
through transitional work options. Transitional work is considered any task or job that a
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worker who has functional restrictions can perform safely, for pay, and without risk of
further injury. The job duties include tasks that are modified, over time, to accommodate
the injured worker during the physical recovery period. With assistance from a case
manager, an employee can get a full evaluation of their functional abilities and an
analysis of job tasks help determine the types of jobs they can perform. The transitional
work plan assigns periodic modifications in the worker’s job task assignments, as the
worker’s capacity to work is increased. The worker is thus accommodated and is given
an opportunity to transition back to work. The worker receives a paycheck and “lost
be challenged. Studies have proved that when comparing case management services to
standard care, case management has proved effective in overall satisfaction of care.
Patients receiving case management services typically spend fewer days in the hospital
and develop fewer needs for care. Case management services have not been proven to
Determining how much to invest in disability and case management services is not
easily determined. It is hard for an employer to calculate the total cost of injury they face
when a worker goes on disability. It can be determined though, that overall the costs of
disability management interventions are worth taking. Studies that offered (1) early
contact with the worker by the workplace, (2) work accommodation offers, (3) contact
between health care providers and the workplace, (4) ergonomics in the work site, and (5)
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Interventions with work/ vocational rehabilitation showed a strong return on investment
as well.
While a number of high quality studies have been performed on the topic, it still
cannot be proven that investing in disability management will always be worth the cost.
The strongest study adjusted costs and consequences for inflation and time preference. It
greater insight into the health consequences of the intervention, not just a monetary
down into the three forms in which the service can be provided: Full Service, Broker
Case Management, and Hybrid. Full Service provides all of the clinical and support
services to the client from a specialized team. Brokerage provides very little direct
service to patients, instead services are provided to the client from various
participants in the health system. In a hybrid program, some services are provided
and some services are brokered. Studies have proven that full service approaches
are the most effective, providing the consumer with a well-trained staff and use of
costs for the employer. It seems to be time to abandon the other models of case
While financial outcomes and productivity issues may be the primary interest of
many firms, the value of human capital seems to be forgotten. The value of good health
to workers and the value of health associated with the ability to better perform other
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social roles should not be looked over (Tompa).
Today, employers are forced to adjust their health care plans to accommodate for
the increased number of older individuals in the workplace. Increased life expectancy,
aging baby boomers, improved medical care, and an emphasis on fitness and healthy
lifestyles has led to a high number of older workers in the workforce. The frequency of
work limitations, occupational disability, and total disability is greater for workers over
55 than for any other work group (Shrey). Older workers who become injured or
disabled also have a longer recovery time, leading to longer periods of work disruption
the foundation in providing effective case management services. Case management has
proven effective in decreasing hospital stays, reducing symptoms, and overall satisfaction
from the patient. It is still undetermined that case management will always yield a good
return on investment, but the satisfaction and care it provides to the employee is an