Case Study: Traumatic Brain Injuries

60% of workers who experience a Traumatic Brain Injury on the job, never return to work.**

 

Catastrophic claims are less than 1% of all workers’ compensation claims but account for over 20% of claims cost. Traumatic Brain Injuries are the most common and costly type accounting  for 20% of reported work-related injuries* of catastrophic claims that employers and carriers face.

Catastrophic Nurse Case Management is an effective and necessary tool for employers and carriers to manage cost and improve outcomes.

Work Comp’ Traumatic Brain Injury Employee Back to Work in 14 Months

Claimant: 45 year old male

Occupation: Hotel Maintenance

Injury: Employee sustained reported injury due to a fall from a ladder

Upon initial admission to the hospital, employee required significant sedation and intubation and placed on ventilator support.

Brain Injury Diagnosis:

Cranial CT scan revealed a non-displaced right parietal /occipital skull fracture with soft tissue swelling, bi- frontal hemorrhagic contusions, swelling in both frontal lobes, and subarachnoid hemorrhage.

A secondary cranial CT scan revealed an increased edema around the contusion in the anterior frontal and temporal lobes, mild decrease of subarachnoid hemorrhage, and no new intracranial hemorrhage. Mild decrease in the overall cerebral edema (swelling) was noted.

Recovery Timeline:

  • The claimant was placed in a drug induced coma and transferred to the ICU for multiple months.
  • Upon recovery he was transferred to a Neuro Unit and received intensive physical therapy.
  • CT brain scan findings listed improving bifrontal contusion, improved bifrontal edema, no new areas of hemorrhage, and mass effect or shift present and normal ventricles in size.
  • The claimant was transferred to an inpatient rehab facility where he received intense multidisciplinary therapies where he made significant cognitive improvements under the rehab program and transitioned to an outpatient program and was placed under the care of a neurologist.
  • After several months of intense treatment modalities and therapies, the claimant reached a maximum medical improvement with 0% impairment rating. Within 14 month of date of injury, he was released from care and able to return to work full duty..

Review Med’s Nurse was assigned to provide nurse case management for the entirety managed the case for the entirety of the claimants 14 months of recovery.

Review Med’s Catastrophic Case Management Impact:

Immediate Response:

Review Med’s Nurse Case Manager was tasked to manage the claim from the initial report of injury. She arrived at the hospital to assist employees and family through in processing. This also allowed the employer to have immediate reporting and assessment of injury prognosis.

The Nurse Case Manager complied with the carrier and employer request to visit the claimant on a daily basis in the acute phase of hospitalization.

Clarity and Understanding:

Nurse was a resource to educate the family regarding the claimant’s injury and the complex treatment recovery process.

The nurse was bilingual and functioned as a translator for the claimant and family members with providers and the carrier representative.

Claimant Advocate:

Expedited the request for a neurology consult and CT head scan.

The case manager met with various on-site case managers in order to maximize the claimant’s inpatient care.

The case manager diligently researched and located a rehab facility to adequately address the claimant’s medical and rehabilitative needs.

She kept the carriers’ in-house nurse case manager and adjuster thoroughly and timely informed regarding the employee’s status and progress.

Identified a billing error by the hospital and facilitated the correction of the error, saving the carrier unnecessary and unrelated treatment cost.

Review Med’s Nurse Case Management was instrumental to the successful positive outcome of this claim. Her involvement to function in multiple capacities and report to multiple agencies was executed attentively, effectively, and in the best interest of the claimant and carrier.

*Source References:

*  Faul M, Xu L, Wald M, Coronado V. Traumatic Brain Injury in the United States: Emergency Department Visits, Hospitalizations and Deaths 2002–2006. Atlanta, Georgia: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2010. For Abstract Click Here

** van Velzen, J. M., van Bennekom, C. A., Edelaar, M. J., Sluiter, J. K. & Frings-Dresen, M. H. (2009). How many people return to work after acquired brain injury?: A systematic review. Brain Injury, 23(6), 473-488 link  http://www.ncbi.nlm.nih.gov/pubmed/19484621 For Abstract Click Here

 

 

Part 1: Linda Meik, Most Loyal Grand Gander

If you are involved in the insurance industry in Texas or active in the Blue Goose, you know Linda Meik. In July at the 110th Grand Nest Convention, Linda will be named the “Most Loyal Grand Gander,” the highest and most prestigious position in the Blue Goose organization. She will be the third women who has achieved this nomination and to hold this position in the organizations century old history. The enthusiasm and dedication she holds for the organization is abundant and inspirational.

As an admiring peer and fellow gander, I am privileged to have had the opportunity to interview this accomplished and humble leader about her involvement with Blue Goose, the industry, and her take on success.

Honorable Order of The Blue Goose, International

Blue Goose was founded in 1906 during the Wisconsin Field Men’s Club annual meeting. Today the organization has 3800 members, who they call “Ganders,” across the United States and Canada. The organizations’ headquarters, or “Home Nest,” is still located in Wisconsin, and has 41 chartered regional chapters, or “ponds.” It is a fraternal organization that was formed for any professional in the insurance industry including, insurance executive, adjusters, auditors, underwriters, brokers, regulators, attorneys, and vendors.

The Texas Pond

Linda started her affiliation with Blue Goose in 1995 when she joined the Texas Pond. Since its’ initial chart in 1907, the Texas pond has faced many ups and downs in growth. When Linda accepted a board position in 1999 as Wielder of the Goose Quill the Texas pond was experiencing a decline in membership, along with several other Southern Region ponds. These ponds considered terminating their charters and even merging some of ponds in the southern territory. Taking on the challenge, she claimed “the south would rise again,” and alongside her board members they worked hard to revive membership and attract new interest. Emphasizing flexibility and focusing on the needs and interests of the local insurance community, membership quickly doubled.

The Grand Nest

In 2005, she decided to join the national leadership ranks at the Grand Nest as Keeper of the Golden Goose Egg. For the past decade she has held many national positions within the Grand Nest and traveled all over the USA growing and building fellowship.

When the Grand Nest was experiencing a decline in membership nationally, she once again was steadfast in her resolution to encourage the importance focusing on the interests of the current market of insurance professionals. Stating she simply felt that “insurance was not dying,” but rather growth and evolution while maintaining their founding purpose was necessary.

It is essential to the organization to preserve their core standards nationally but to also allow each pond to be creative in building a flock that fits their territory and flocks prerogative. Consistently taking inventory of the interest of their ponds the organization is able to thrive and engage their ganders.

It is evident that the key to the Blue Gooses’ survival and success has been its resiliency and willingness to evolve.

In her current role as Grand Supervisor of the Flock, she travels across the nation to work with established ponds on budget management, event coordination, and increase membership.

“Linda Meik has been instrumental in growing Blue Goose as a whole and especially the TN Pond. She is our go-to, whenever we have questions about the organization’s procedures and events. She is a driving force to keep the ponds active and relevant. The TN Pond is grateful for her assistance over the years!”Kathy Johnson, MLG TN Pond

Networking

Blue Gooses’ founding precepts are “character, fellowship, and charity.” And by no surprise these values seem to be the core to Lindas’ philosophy and approach to professional success.

A graduate of Dakota Wesleyan University, Linda built a successful career in the insurance industry spanning over 30 years, amassing a wealth of industry knowledge and a vast network of resources.

She says often people remark, “you know everyone.” Her explanation? “No. I knew who to call. I got out and I met with people face to face. When I needed help, I had that network. People must reach out and [authentically] network, not market themselves, but to meet them. You would be surprised, people are marvelous and want to help. It is one thing to have a lot of [industry] acquaintances, but if you don’t have friendship and trust, you will not make it to the top of the ladder.”

We discussed the impending shift the insurance workforce will face with the immense amount of baby boomers anticipated to retire from the industry. Her outlook on how we are to bridge the gap is by preparing and mentoring professionals just entering the market place, similar to how Blue Goose was able to thrive. “Young professionals can teach and mentor the old, it’s a two way street.” She feels it is imperative for older professionals to impart their experience, guide the new generation, and also be open new applying fresh ideas from the new workforce.

During our conversation a quote from Dorris Roberts struck me, “She doesn’t give in. She does not give up. And she never takes no for an answer.” I have not had the opportunity to know Linda long, but I firmly believe this is her philosophy for success.

I took many lessons from our brief interview. When you find an organization, whether it be for career or social association, it should inspire purpose and drive you. She reminded me as a young professional in pursuit of achievement, you must be persistent and deliberate, but the most important thing is to be your authentic self and build meaningful relationships—and then success will follow.

Thank you Linda for sharing your insight and experience. Congratulations on your upcoming appointment as “Most Loyal Grand Gander.” We look forward to seeing the impact you will continue to inspire in our industry.

 

To find out more about Blue Goose or to find a pond near you, visit the organization here!

 

National Council of Self-Insures 2016 Conference

Our team will be headed to San Antonio for the National Council of Self-Insurers 2016 Annual meeting May 22-25. This year’s conference will be held at the Wyndham San Antonio Riverwalk Hotel in downtown San Antonio Texas. The four day event will feature many exciting open round-table discussions and case study presentations.

One of the most highly anticipated presentations for this year will be, “What Can you learn from the Pros on Medical Treatment and Return to Work.” Led by a panel of some of the top sports risk managers and workers’ compensation professionals in the industry: Therese Baxter, Workers’ Compensation and Liability Manager for the Seattle Mariners & Seattle Seahawks; Daniel Romo, SVP of The Fairly Group; and Dino Stiris, Risk Manager for the Chicago Cubs & Wrigley. The panel will provide insight into handling Workers’ Compensation claims and Return to Work initiatives in the professional sports arena.

Founded in 1946, The National Council of Self-Insurers is an organization of corporate, state association and professional members. Representing approximately 3500 employers, membership is comprised of some of the largest self-insured corporations nationwide, including many fortune 500 organizations. The organization functions as a national education forum and resource for employers, self-insured, and state self-insurer funds. For more information about NCSI or about attending the Annual Conference, visit the here.
Let’s Connect! Interested in coordinating a meeting with one of our team members during the NCIS 2016 Annual conference? Contact us at info@reviewmed.com.

For more conference information visit NCIS.

Find out more about Review Med and our managed care solutions!

Q&A: An Employers’ Perspective: Jan Gatlin, Community Health Systems

An Employers’ Perspective: Jan Gatlin, CHS

J an Gatlin is the Senior Manager of Workers Compensation, Property, and Casualty at Community Health Systems. She is a lifetime Tennessee resident and attended Middle Tennessee State University. After working as a claims team manager at Liberty Mutual for over 30 years, she accepted her current role with CHS in 2008.

Founded in 1985, the Nashville based company is one of the largest hospital organizations in the country, operating 198 hospitals in 29 states. CHS employees over 35,000 employees and 22,000 physicians across the nation.

Jan will be one of six risk management experts sitting on the employer panel during the Mid-South Workers Compensation Associations April meeting.  The organization will feature the “Employers’ Perspective on Workers’ Comp Processes.” We asked the longstanding MSWCA member and veteran claims leader to be featured on our blog and she graciously accepted. Below is a few excerpts from our interview:

How did you find your way to the insurance industry?

I went to work at Liberty Mutual Insurance for the summer and stayed 30 plus years.

Can you tell us about your current role with CHS?

I oversee all WC, Auto and Property claims for CHS.

What do you see as the biggest challenge handling workers’ compensation claims?

We operate in 29 states so each state is different.  Overall, it is probably educating the people that handle workers comp in our facilities to be proactive.

What do you consider your philosophy to risk management?

We need to do everything possible to prevent the injury first and if we can’t we need to take care of our employees.

What kinds of claims does the CHS team typically encounter?​

Literally, every type of claim that you could imagine.

How long have you been involved with Mid-South Workers’ Compensation Association?

Off and on for a number of years.

What do you hope the attendee will take away from this year’s MSWCA Employer Panel?

[Insight into]…different programs that different companies are using and sharing of ideas.

Mid-South Workers’ Compensation Association, a non-profit organization, was formed in 1990 “for the purpose of creating an organization which would focus on the needs of the professionals who handle workers’ compensation claims.”  Tennessee has three MSWCA chapters, in Nashville, Memphis, and Knoxville. For more information about the organization, meeting and membership information, visit the MSWCA website here.

Review Med Attending 2016 Annual RIMS Conference & Exhibition

We are pleased to announce that Review Med will be attending the RIMS 2016 Annual Conference & Exhibition April 10-13 in San Diego. This will be Review Med’s 19th year to attend the industry’s largest annual risk management event.

Our team is excited to once again attend alongside all of the industry’s top experts and we look forward to share our managed care expertise and innovative solutions.

The national RIMS Conference is the premier resource to stay abreast of all the most prevalent national and global industry topics and is the ultimate opportunity to collaborate with other like-minded industry thought leaders and professionals.

This year’s conference will include many new event features:

  • 180 educational sessions
  • Three inspiring TED-style keynotes presentations
  • Members-Only Lounge to relax, recharge your phones/lap tops, and to utilize for networking
  • Professional Development Center: HR professionals will assist attendees with resumes, career questions, and complimentary professional head shots

RIMS At-A-Glance

RIMS, the risk management society™, is a global not-for-profit organization representing more than 3,500 industrial, service, nonprofit, charitable and government entities throughout the world. Founded in 1950, RIMS brings networking, professional development and education opportunities to its membership of more than 11,000 risk management professionals who are located in more than 60 countries. For more information, visit RIMS.org.

Interested in coordinating a meeting with one of our team members during the RIMS’16 conference? Email us at info@reviewmed.com

For more conference information visit RIMS’16.

Find out more about Review Med and our managed care solutions!

 

Why Bundled Programs Aren’t The Only Way

 

Medical costs continue to rise globally with exceptionally high rises in the Work Comp arena. After years of putting new cost containment services into practice to slow the growth of medical costs it appears something is definitely not working.

As the medical costs continue to increase in workers’ compensation, employers and insurance related service providers are searching for the preverbal silver bullet. As the cliché goes, if you keep doing the same thing expect the same result. Over the last five years the industry has convinced Employers that the bundling of services is the only answer. They have pushed the assumption that bundling was the only way to produce savings and the integration of services would in fact save you more money. When one company is managing all aspects of your program, are the checks and balances really there? Who is really holding your purse strings?

Review Med held a summit that brought together industry leaders and some of the brightest minds in the industry. Convening in Dallas we set out to discuss this market and what needed to be done. It was evident the tools are available, but employers need the expertise to put it together and someone to manage it thoroughly. If your team assumes your claims partner is capable of managing both expertly, you could be in for great disappointment.

Review Med has been in the business of managing services and generating results for over 18 years. We do not just provide services to the Work Comp market, we develop and analyze programs from a total managed care perspective.

We unbundle the mass produced, “one size fits all” bundled approach and customize programs that fits with individual client’s needs. Every company is unique. Why shouldn’t your Workers Comp program be?

Unbundling isn’t about “reinventing” your current claims program or disrupting your current claims partner relationship. Unbundling is about partnering with the most expert managed care providers and creating a program that is flexible, efficient, and effective. Employers should be cautious to go with the default solution as the best solution.

If your program isn’t working, finding the tools that are necessary and the partners who can deliver outcomes is imperative. If your bill review savings is consistently lower than the market place or if your UR is more costly compared to the market place, it is time ask what you are really getting from your managed care provider.

If you haven’t thought about what you are going to do to stop rising medical costs, give us a call for a free consultation and analysis of your program. We are focused on every relationship and driven by our results.

 

Bringing Talent to Our Industry

Many leaders in the risk management industry are aware of the difficulty we are currently experiencing with regards to attracting new talent. It’s evident to me that there are not enough collegiate programs set in place to funnel qualified graduates into our industry let alone expose students to the many outstanding careers that are available.

 One-fourth of the insurance industry workforce is expected to retire by 2018.

Even more pressing is the fact that one-fourth of the insurance industry workforce is expected to retire by 2018. So, before our current group of leaders enter into retirement, we need to ensure that there is a sufficient talent pool available for the important transfer of knowledge that must take place to not only ensure the perpetuation of our industry, but also the quality of service that we provide to our clients.

The time to act is now.

One way to mitigate our impending loss of experienced employees is to reach out to wider range of college graduates. Those with degrees in liberal arts, science, mathematics and others can be perfectly suited for risk management related careers. Sometimes colleges are unable or unwilling to expose students to the wide variety of professions available after college so we, as an industry, should be willing to accept them with open arms and expose them to the opportunities we have to offer.

Another avenue worth pursuing is to reach out to individuals with backgrounds and prior careers that are unrelated to our industry. I’ve found that many enter our industry from backgrounds other than insurance and risk management, but quickly adapt and seize the opportunities that are presented to them. They offer talents and experience that can benefit us and I feel it’s worth the effort to attract qualified candidates wherever they may be found.

Of course, let’s not forget our veterans. They offer a serious talent pool that is sometimes unrecognized and underutilized. People with prior military backgrounds come from a culture with mission accomplishment in mind. They’re taught to lead, be intuitive and to have a strong work ethic. All of these are qualities that our industry leaders are looking to bring on board to strengthen their team. This also applies to military spouses. They’ve learned to not only adapt to many different environments and situations, but to prosper as well. All critical skills in our industry.

In all, I recommend that we look outside the box when searching for the new talent we need to keep our industry thriving. Speak to your local colleges and universities. Instruct your human resources departments to broaden their searches. Be open to new ways of determining who is qualified to tackle the position you wish to fill. Don’t let qualified candidates get away because they can’t find us. For our industry to grow, it’s up to us to go find them.

Article reposted with permission from the Alliance Of Women.

Formed in 2016, The Alliance of Women in Workers’ Compensation’s mission is to “effect positive change in the workers’ compensation industry through networking, support, mentoring and collaboration. The Alliance is inclusive of all professionals in workers’ compensation, regardless of career stage, with the belief that we can all learn from and support each other. The organization is funded by companies in the workers’ compensation industry who support the organization’s mission.”

For More information about the Alliance of Women, visit www.allianceofwomen.org.

 

Case Study : Nurse Case Management Helps Claimant Avoid Unnecesary Surgery

Claim Synopsis

First Opinion

Second Opinion

Lab Results

Resolution

The Nurse Impact

A few words should come to mind when employers think of Nurse Case Management in Workers’ Compensation claims. Control. Clarity. Containment. Conclusion. Unfortunately, many employers and carriers become fixated on only one. Cost.

Savvy result oriented Employers and Carriers see past the initial “cost” of investment of Nurse Case Management. When utilized appropriately, this is a meaningful cost effective solution to help manage complex medical claims, mitigate cost, and improve return to work outcomes.

Nurse Case Management, What They Do:

The value of using Nurse Case Management as a tool goes beyond “dollars measured.” It is important for employers, carriers, and claimants to have a clear understanding of the nurse case manager’s role.

  • Help claims manager to identify definitive diagnosis
  • Coordinate timely quality medical treatment
  • Ensure medical treatment being administered is related to compensable work injury
  • Manage medical treatment to prevent unnecessary or excess treatment
  • Provide input to the rehabilitation plan and monitor the claimants progress
  • Act as liaison among providers, claims adjusters, the claimant and the employer.
  • Educate claimant on medical diagnosis and treatment processes (Improving Morale)
  • Develop modified duties or worksite modifications to enable faster return to work

It is all in the Numbers:

Although determining the return on investment is not as explicit or as exact as for example bill review, recent research has concluded and proven nurse case management does in fact impact your programs bottom line.

In the recent study, “The N Factor: How Nurses Add Value to Workers Compensations’ Claims,” Liberty Mutual Insurance Co. set out to examine if nurse involvement does in fact reduce the costs of work compensation claims. The study had significant findings:

  • 18 percent lower future medical costs
  • 26 percent lower overall claim costs
  • 15 percent faster claims resolution

Another cost driver reduced by Nurse Case Management to note? Litigation. According to a pilot study administered by Medstar Medical Management, litigation rates dropped by one-third and the duration of cases were reduced by 50% when a nurse was involved.

When to Use Nurse Case Management in Workers Comp Claims:

There is no exact formula for determining when nurse case management is needed. Every claim is unique.

Here is some proven criteria of when it is effective:

  • Undetermined diagnosis
  • Pre-existing conditions or multiple conditions unrelated to work injury
  • Comorbid conditions
  • Complex diagnosis
  • Claimant visiting multiple treating physicians/specialties
  • Surgery is recommended/required
  • Claims with high use of pain medications and narcotic substances
  • Claimant displays low motivation for returning to work
  • Return to Work is delayed without apparent medical reasoning

It is important to keep in mind: timing is key. Early intervention is vital to the success and prevention of excess costs and confusion.

Employers should continue to focus on capturing the impact of Nurse Case Management on claims with a holistic mindset. Nurse Case Managers are vital clinical resource to help navigate claims and generate solutions.

 

Sources:

The N Factor: How Nurses Add Value to Workers Compensation Claims Official Study

Read More about how NCM impact Workers Compensation Outcomes

Review Med Mentoring Initiative

This past fall Review Med launched an exciting in-house mentoring program for our staff’s young family members. Over several days during the fall and winter break, we invited our team to bring their children to join us for a working day.

“We wanted our families to gain exposure to work ethic and witness life skills being put to action. We thought it would be a fun experience and hoped ultimately they would gain a greater sense of respect and pride for their parent’s careers and hard work.” — Nelletta Ivey, Vice President, Operations

We were ecstatic at the response in participation in the program and inspired by the positive impact on morale for both our staff and the kids who participated.

Businesses started implementing similar mentoring opportunities for employees’ youth more than two decades ago when the Ms. Foundation created “Take Our Daughters To Work Day.” This program initially was launched in effort to bridge the gender gap by exposing young women to the workplace and motivate them to attend college and enter the workforce. This national program now includes both boys and girls to interact and get exposure to the work world.

We wanted to incorporate this purpose and mission on a smaller scale for our organization and our employees. As a corporation with an executive board that is comprised predominately of women, we know firsthand how important it is for any gender to gain exposure to strong mentors and productive workplaces. We believe that these interactions increase youth’s opportunity for success. Developing and empowering our company’s core, our team, is central to Review Med’s success and we were elated to extend this effort to their families.

“Young Adults who have mentoring exposure, are 130% more likely to hold leadership positions and 55% more likely to enroll in college.” —The Mentoring Effect, 2014

We hoped simply to enrich our employees’ youth with an engaging experience in a typical work day at Review Med. They would witness what hard and soft skills are necessary to succeed in a workplace, inspiring these youth to consider their futures and encourage them to start career discussions.

“It was such a great experience. I have never been able to bring my child to work and experience what I do at work. [My son] loved it and actually wanted to come back this coming Monday. It was good to see how his work ethic would be and he did really well. He quickly learned how to scan, fax, stuff envelopes and load paper in the printers. He is anxious to come back soon and has my nine year old asking me when he can come. He enjoyed sitting at his own desk and working. He said it reminded him of office scenes from a movie. We were also able to have some quality time together.”–  Connie Gaona, Utilization Review Representative

A surprising effect having these students in our work place? The entire Review Med organization felt inspired and fulfilled during the program. The ability to show our students what we do for a living, was uplifting. We all ended our day with a greater respect our own hard work and purpose.

“My niece thoroughly enjoyed working here for the day.  She stated that it was a great experience to see how an office works and to be able to help be a part of getting our product out.   It made her feel like getting out into the real world will not be so scary.  She would love to come back one day.  My experience with her here was an honor to show her what I do for a living.” —  Tami Johnson, Utilization Review Lead

Our team was honored to host this pilot program and proud of the youth that joined us.  We eagerly look forward to the next group of students that will get involved this spring.

Helpful Resources:

Mentoring.Org

Daughter and Son to Work Foundation