A new white paper demonstrates the value nurse case management adds to workers’ compensation claims resolution. Using injury data, patient characteristics, diagnosis, medical treatment and claimant behavior characteristics to evaluate 42,000 claims, Helmsman Management Services, a subsidiary of Liberty Mutual Insurance, found that claims that involved nurses had:
- 18 percent lower future medical costs
- 26 percent lower overall claim costs
- 15 percent faster claims resolution
The report titled, The N Factor: How Nurses Add Value to Workers Compensation Claims, found that medical and total loss dollars showed double-digit percentage reductions with injured workers returning to work sooner. Additional benefits of using nurses included increased cost savings and productivity as well as improvements in morale.
A nurse wasn’t recommended on all claims however. Claims involving no co-morbidities and employees that had positive relationships with their employers would not likely benefit from nurse case management.
Helmsman created a model to notify claims adjusters of those cases where nurses will have the most impact. The model leverages 25 to 30 data sets within their claims system and alerts adjusters when a claim may benefit from a nurse’s involvement.
The model looked at characteristics such as:
- Body part;
- Claimant’s motivation to return to work;
- Bill payments for comorbid conditions;
- Above-average use of narcotics.
Excellent communication skills, empathy and collaboration are the qualities of an effective nurse case manager.
Source: Liberty Mutual Insurance/Helmsman Management Services
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