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Instinctively, workers’ compensation case managers at Liberty Mutual in Dover, NH, knew that there were several case management interventions that resulted in positive outcomes. Three years ago Liberty hired a consultant to review more than 500 closed files to determine if their instincts were right.
The consultant worked with Liberty Mutual case managers and regional directors to "delve deeply" into more than 500 closed cases with positive return-to-work outcomes, explains Judith L. Strate, BSN, CCM, regional director for training at Liberty Mutual’s commercial professional services training department. "We wanted to know what the medical case manager did on those files that produced positive return-to-work outcomes."
What they found, says Strate, were four critical interventions Liberty Mutual now refers to as "Value Creation Levers." Those levers are case management interventions that positively impact the outcome when they are put into place and followed through with, she explains.
"Some case managers were critical of the process," she notes. "They argued that we paid a consultant to tell us what we already knew. However, what we had was anecdotal evidence — a general concept that certain interventions were important to creating good outcomes. What we have now is verification that when case managers use those interventions they achieve good outcomes."
The four essential Value Creation Levers identified by the Liberty Mutual study are:
• Initiate early discussion with the primary provider to set appropriate return-to-work expectations and a target return-to-work date.
• Obtain and implement modified-duty opportunities.
• Initiate proactive discussion with the primary provider to assess the medical treatment plan.
• Establish proactive and ongoing follow-up with the primary provider.
The study team also identified other interventions that seem to have a positive impact on outcomes, but not to the same degree as the four essential Value Creation Levers, adds Strate.
Those interventions include:
• Initiate early communication with the injured worker to identify return-to-work barriers.
• Send an on-site nurse to medical appointments with injured worker.
• Send an on-site nurse to evaluate the injured worker.
"We have incorporated the Value Creation Levers into our new hire training," says Strate. "As we take nurses through the case management work process, we emphasize how to use the Value Creation Levers as part of the continuum of evaluating and putting together a case management plan for return-to-work," she notes, adding that case managers are encouraged to use and document those levers as they work through case studies in training sessions.