Telephonic Case Management Delivering High Value

Telephonic case management can be extremely beneficial for patients

When used appropriately, telephonic case management can be extremely beneficial for patients. Numerous studies have documented its value in improving patient outcomes, decreasing preventable hospital readmissions, avoiding lengthy disability periods, and lowering healthcare costs. Knowing when early intervention for telephonic case management is warranted is the first step in achieving these goals.

When Telephonic Case Management Makes Sense

There are cases that are particularly well-suited for early use of telephonic case management. These range from existing comorbidities (e.g., diabetes, heart disease, hypertension, etc.), to an indicated need for back surgery, psychological issues, substance abuse, severe lacerations, or injuries to single or multiple body parts. Other examples where telephonic case management is appropriate include when patients are discharged from the hospital or another healthcare setting, treatment plans which fall outside of evidence-based guidelines, cases where desired outcomes are not met, and when physical therapy/rehabilitation is being extended.

In cases where individuals are experiencing psychosocial issues due to their injury or medical condition which could negatively affect a claim’s status, telephonic case management can prove extremely helpful. By building a rapport based on trust with the case manager, a patient can often regain a better outlook. Or, in cases warranting additional support, the case manager can recommend another healthcare professional (e.g., psychologist, psychiatrist, social worker, etc.) to better support the patient. It is important to establish the need for telephonic case management in high-risk claim cases through evidence-based reports. These would consist of data from utilization management reviews, prior case management reports, pharmacy reports, and other documentation related to any other services/treatment plans for the patient.

What to Expect from Telephonic Case Management

Telephonic case managers deliver a high value both in terms of patient outcomes and cost reductions to payers. They do so through:

  • Patient advocacy while facilitating the individual’s return to work, where applicable;
  • Patient engagement in their recovery and encouraging their adherence to treatment plans while identifying any obstacles to the patient’s recovery,
  • Becoming the patient’s easily accessible clinical resource and assisting in coordinating any needs for additional services, resources, or home care equipment,
  • Serving as a liaison to the patient’s other treating professionals, reporting to them within 24-hours of a patient call or any significant medical tests, procedures, etc., to keep them fully informed, and
  • Staying abreast of established guidelines and benchmarks for evidence-based care and disability periods.

The telephonic case manager supports optimum claims management by assisting a patient’s return to work with their prior level of functionality, for those that are in the workforce and where employers are concerned with extended costs.

Impact on Claims

Telephonic case management has proven to have a real impact on patient outcomes and medical claims. With respect to the latter, 26% of payers experienced lower overall claims costs, 18% experienced lower future medical costs, and 15% experienced quick claim resolutions. (Source: Helmsman Management Services) When applied in appropriate situations, telephonic case management can provide multiple benefits for patients including improved patient outcomes, decreasing preventable hospital readmissions, avoiding lengthy disability periods, and lowering healthcare costs.