According to the National Council on Compensation Insurance Workers Compensation, the average cost for all claims between 2016 and 2017 was $40,051, with 8 percent of claims reaching the $100,000 mark. Claims that exceed $100,000 (and can run into the millions) typically involved head injuries requiring the worker to receive prolonged care.
This was the case for a 44-year-old injured worker who became a paraplegic as a result of his injuries. He suffers from a closed head injury and spinal cord injury / paraplegic at T-12 with the development of chronic pain syndrome. Because of the severity of his case, there was no possibility of him returning to work. He was provided with extensive rehabilitation at Rancho Los Amigos in Los Angeles.
“This was a challenging case,” shared Maria Ramirez-Ryan, senior medical case manager. “The injured worker’s lawyer enlisted the help of a nurse case manager on the case because the injured worker was experiencing difficulties with his long-term medical care and did not feel that he was receiving the treatment he needed. There was a lot of miscommunication. And basically, he didn’t understand the worker’s compensation system, which can often be overwhelming for those experiencing severe injuries.”
When Maria was assigned to the case, she was responsible for coordinating all of the recommended treatments managed by multiple providers and disciplines. She went above and beyond the call of duty by making frequent home visits to ensure timely delivery and proper functionality of all the durable medical equipment. Being a Nurse Case Manager, she also oversaw the proper management of medication.
Immediately upon taking the case, Maria took the initiative and coordinated an evaluation by a Brain Injury and Spinal Cord Specialist at the injured worker’s home. As a result of the evaluation, it was determined that the number of home health hours necessary could be reduced from eight hours every day / seven days per week to four hours a day every other day. “The type of home health care being provided was almost unheard of for a paraplegic,” said Maria. “As it turned out, he did a good job of taking care of himself. His previously approved treatment exceeded what has needed for his level of care.
The evaluation also disclosed that the injured worker had all the proper equipment to maintain his muscles function; robotic exoskeleton walking device, stationary bike, weight lifting, and exercises pad. The Injured Worker was overdoing an exercise program at home, thereby causing more harm to his joints due to his paraplegic condition. A new exercise program was developed for the injured worker.
Additionally, Maria worked with the injured worker’s physician to change to a different medication delivery system so that medication was sent out every three months. This bulk medication also resulted in significant savings.
The overall reduction of in-home health services resulted in a savings of $1 million for Broadspire’s client. Moreover, the injured worker experienced better health outcomes, so much so that his attorney insisted Maria remain on the claim to oversee the injured worker’s care needs for as long as possible. “I feel very good about my work on this case,” admitted Maria. “As I do with all my cases, I got him the best treatment for what he needed.”
This case serves as a confirmation that Broadspire’s case management program can save their clients’ money all while, at the same time, ensuring that the right care is being given to injured workers. And in the words of Verna Jackson, vice president, Broadspire Case Management,
“nothing is quite as thrilling as knowing that we have positively impacted our injured worker’s quality of life in a cost-effective manner even after 30 years in the business of case management.”
