The way workers’ compensation cases are tracked from admission to discharge can be a differentiator when an employer is selecting an occupational medicine provider to become its partner in the management of workforce health and well-being.
Case trackers perform an important function in occupational health clinics. They know people and systems. They understand when and how to intervene when clinical, social and environmental “red flags” signal the likelihood of costly lost work time and disability.
Case trackers are accustomed to being on the lookout for common warning signs such recurring injuries, multiple physical limitations, behavioral health issues, and clinical conditions such as infection, surgical complications and complex fractures.
Sometimes internal case trackers are perceived as the “fox guarding the hen house.” In practice they optimally function as impartial facilitators.
Case trackers are responsible for communicating with stakeholders – clinicians, patients, employers, insurers/third party administrators, external nurse case managers. In health systems, they help facilitate access to hospital services (e.g., lab, radiology, outpatient rehabilitation) and referrals to specialists, as needed.
Tracking begins wherever the injured or ill worker enters the system. It may be via an occupational medicine or onsite clinic, mobile unit, the emergency department or an urgent care center. To be effective, the case tracker needs access to a reliable, automated tracking system. Every work-related injury or illness – no matter how minor – should be managed to ensure care is promptly delivered and required documentation is completed in a timely manner.
According to Donna Lee Gardner, a nurse and national expert on occupational health program operations, the case tracking process can be visually depicted using a method called case mapping and outlined in terms of structure, process and outcomes:
Structure is the physical setting and standards of care/practice.
Process involves day-to-day operations such as appointment scheduling, searching for resources and exploration of alternative care delivery models.
Outcome is the happy ending at the close of the case.
Employers should expect the case tracker to follow documented policies, procedures and protocols that adhere to a sequence of events. It is reasonable for an employer to expect:
- a patient status report with clearly articulated work restrictions
- accurate information required to complete insurance claim forms
- a summary of individual cases and data on injury and illness trends
- injured/ill employees to understand their treatment plan and instructions
Donna Lee says the most powerful motivator available to the case tracker is teaching and enabling the injured worker to follow his or her return-to-work plan. That means the case tracker must be available to answer any questions and consistently maintain communication with all parties as the case progresses.
It’s the buy-in that makes the difference.
According to occupational health clinic WorkWell’s CEO, “SYSTOC practice management software produced by UL is the most valuable business management tool WorkWell has at hand.”