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Nurse Case Management Assessment

Helping organizations maximize cost efficiency and quality in nurse case management.

Medical expenses can significantly impact workers' compensation costs, leading to negative effects on indemnity costs associated with lost time. At Marsh, we understand the importance of effective nurse case management in directing treatment, managing medical costs, and reducing disability durations.

When utilized effectively, skilled nurse case managers can lead to better cost outcomes and improved employee satisfaction. However, many employers struggle to understand the value and effectiveness of their nurse case management programs. Our Nurse Case Management Assessment helps you identify medical and disability management cost leakage associated with your nurse case management program. We also evaluate the quality of your clinical case management services, with the ultimate goal of improving your workers' compensation cost outcomes.

Our proven assessment process

We follow a comprehensive process to help you optimize your program:

  • Analyzing claims: Our team of specialists conducts an in-depth analytic exercise of claims to determine potential over and under-utilization of nurse case management. We evaluate claims at a specified cost threshold, comparing those with and without nurse case management assignment. This analysis helps determine appropriate nurse case management staffing levels, the need for more focused triggers in claim selection, and the cost benefit of field case management.
  • Evaluating managed care program: We review documents and conduct interviews with your managed care partner to assess your existing program against 12 key elements, including triage processes, treatment and disability duration guidelines, supervision, quality management, and claim closure criteria.
  • Statistically valid sample audit: We conduct a sample audit of closed claims to assess the impact of nurse case managers throughout the case management process. Our proprietary audit platform compares specific treatment costs to national guidelines, ensuring adherence to recognized medical treatment protocols. We also evaluate nurse case managers' role in obtaining timely releases for return-to-work, escalating to other resources when roadblocks arise.

Actionable insights and recommendations

Our analysis aligns with the Official Disability Guidelines (ODG), enabling us to benchmark medical costs and disability durations. We identify trends and quantify leakage associated with claims that do not meet ODG standards, providing an indication of annual savings potential. Our team of specialists compiles a comprehensive report that benchmarks your nurse case management program against generally accepted industry best practices, provides insight into the utilization of nurse case management and criteria/triggers for appropriate referral, estimates leakage for medical costs and disability duration for claims with nurse case management, and identifies cost drivers and highlights savings potential. With this information, we deliver targeted recommendations to improve your nurse case management program and cost outcomes.

Realize savings and enhance collaboration

Marsh's Nurse Case Management Assessment empowers employers to better understand their program challenges and implement targeted recommendations for cost reduction and process improvement. By optimizing collaboration between nurses and adjusters, you may be able to achieve significant savings while ensuring the highest quality of care for your employees.

Contact us today to unlock the full potential of your nurse case management program and enhance your workers' compensation cost outcomes.

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