Public entities nationwide are searching for new strategies to improve the performance of their workers’ compensation programs. A primary challenge has been frequent delays in reporting employee injuries, which sets off a chain reaction of setbacks in sharing and managing injury and claims information. And that situation has traditionally hampered public entities from achieving a high level of program performance.
To address those issues, some public entities are now leveraging early intervention programs, which use a nurse call center on the front-end to assess and triage injuries, and leverage Internet technology on the back-end to proactively manage claims toward optimal costs and outcomes. Awareness and counsel regarding early intervention programs and services can help independent agents and brokers stand out as valuable risk management resources to public entity clients.
Nurse Injury Triage
The first component of an early intervention program is nurse injury triage. When agents and brokers typically think of a nurse’s involvement in the workers’ compensation process, nurse case management usually comes to mind. However, nurses are now getting involved much sooner in the process — on the day of injury — to assess the medical severity and channel the employee to the most appropriate level of care.
Using a nurse call center, a public employee or a supervisor calls a toll-free hotline immediately following an incident. The call center gathers claims information, fills out required forms, and sends the first report of injury via e-mail or fax to all the appropriate stakeholders, including the employer, physician, adjuster and return-to-work (RTW) coordinator.
Using treatment protocols and algorithms, a nurse at the call center systematically identifies the right course of treatment. In severe cases, the nurse will advise emergency care. With minor injuries, however, the nurse may provide simple first aid or self-care guidelines, or send the patient to an occupational clinic in the employer’s preferred provider network.
Janet Selby, workers’ compensation claims manager of the Municipal Pooling Authority (MPA) in Walnut Creek, Calif., implemented this type of nurse-on-call program. Among its many insurance programs, MPA offers workers’ compensation coverage to 20 municipal agencies in Contra Costa County.
“In the past, supervisors tended to err on the side of caution, sending every injured employee for medical care. These managers did not want to be involved in treatment decisions.” Selby said. “The result was unnecessary costs for minor and non-emergency injuries. With the call center, we now have 24-hour access to nurses trained to triage occupational injuries and recommend an appropriate level of care based on medical severity. Employees appreciate being able to speak to a nurse regarding their injuries.”
John Chino, a broker with Arthur J. Gallagher, a large insurance and risk management services firm, said one of his public entity clients reduced workers’ comp claims by 40 percent using a nurse injury triage service.
“Our agency offers comprehensive risk management services to public entities,” he said. “As a result, we are constantly looking for new programs and strategies to save these clients money and reduce their total costs of risk.” Based on the 40 percent reduction, Chino said he recommends nurse triage programs to other public entities as a way to reduce workers’ comp losses.
Internet Technology to Manage Claims
After the nurse call center triages an injury according to medical severity, the next step is to transfer injury and clinical information to claims adjusters. In the past, information was typically received by adjusters via e-mail or fax, but the data needed to be manually re-entered into a claims system for processing.
“Real-time electronic interfaces between claims systems and nurse call centers enable public entities to leverage a more integrated early intervention approach,” said Randy Wheeler, managing director of Aon eSolutions, the client technology arm of Aon Corp. “As a result, public entities are able to simultaneously leverage a nurse’s medical expertise at the point of injury and advanced Internet technology to enhance the performance of their workers’ compensation programs.”
“Injury triage and Internet claims technology are two key components of our early intervention program,” Selby said. “Internet technology helps to manage our claims operation. With the addition of an electronic interface, injury information is now automatically transmitted from the nurse call center into this claims system, eliminating previous process bottlenecks and enabling our member cities, adjusters, RTW coordinator, and nurse case manager to immediately initiate their roles in the workers’ compensation process.”
Internet claims technology offers other benefits through its features and functions, enabling public entities to efficiently and cost-effectively manage claims. First, Internet technology provides an enterprise platform that connects all appropriate stakeholders to communicate and collaborate on optimal outcomes.
Second, Internet systems also use sophisticated business rules to automate routine administrative tasks. Adjusters are then free to focus their time and attention on more complex injuries that require their expert management and personalized service. Business rules also enable public entities to consistently apply best practices throughout their claims operation to ensure quality results.
MPA is just one example of a public entity that employs an early intervention program in workers’ compensation. This hybrid approach uses both nurse injury triage and Internet claims technology to proactively manage injuries and claims. In many cases, public entities have reduced workers’ compensation claims costs by 20 to 40 percent. Agents and brokers must be aware of these new programs and be prepared to advise public entity clients about the outstanding benefits and cost savings this strategy can provide.