CASE MANAGEMENT
Case Management is: "A collaborative process which assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes."
Within the Ohio workers’ compensation program, this process includes identifying and minimizing potential barriers to recovery, identifying and assessing future treatment needs, evaluating appropriateness and necessity of medical services, authorizing reimbursement for medical services, resolving medical disputes and facilitating successful return to work or claim resolution for injured workers.
By definition, then, it requires multidisciplinary skill sets that enable the practitioner to assess the impact of injuring, the psychosocial implications of threat to the income stream, the features of the health service delivery system, medical treatment regimens, disease management protocols, and realities of the workplace. Its core requirements are assessment, planning and communication. Its target objectives are the right treatment at the right time at the right cost in the right delivery method all aimed at the ultimate goal of safe and timely return to work if at all possible.
CATASTROPHIC CASE MANAGEMENT
Catastrophic claims result from sudden, traumatic occupational injuries that are severe in nature, occupational diseases incurred over time, or medical complications that are secondary to conditions originally allowed in a claim. Catastrophic claims require CAT services due to severely limited mobility and/or cognition that affect the ability to perform activities of daily living care such as eating, dressing, personal hygiene, maintaining bodily functions and ambulation. Catastrophic injuries may include but are not limited to:
Managing a catastrophic case requires that all services be coordinated in a timely manner, as required by the needs of injured workers and their families. Expected outcomes of catastrophic case management include:
Case Management is: "A collaborative process which assesses, plans, implements, coordinates, monitors and evaluates options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes."
Within the Ohio workers’ compensation program, this process includes identifying and minimizing potential barriers to recovery, identifying and assessing future treatment needs, evaluating appropriateness and necessity of medical services, authorizing reimbursement for medical services, resolving medical disputes and facilitating successful return to work or claim resolution for injured workers.
By definition, then, it requires multidisciplinary skill sets that enable the practitioner to assess the impact of injuring, the psychosocial implications of threat to the income stream, the features of the health service delivery system, medical treatment regimens, disease management protocols, and realities of the workplace. Its core requirements are assessment, planning and communication. Its target objectives are the right treatment at the right time at the right cost in the right delivery method all aimed at the ultimate goal of safe and timely return to work if at all possible.
CATASTROPHIC CASE MANAGEMENT
Catastrophic claims result from sudden, traumatic occupational injuries that are severe in nature, occupational diseases incurred over time, or medical complications that are secondary to conditions originally allowed in a claim. Catastrophic claims require CAT services due to severely limited mobility and/or cognition that affect the ability to perform activities of daily living care such as eating, dressing, personal hygiene, maintaining bodily functions and ambulation. Catastrophic injuries may include but are not limited to:
- Severe brain or brain stem injuries or brain damage resulting from surgery or secondary to compensable injury of disease
- Multiple major extremity amputations/fractures/crush injuries/lost use of 2 or more limbs
- Paraplegia/quadriplegia/hemiplegia/diplegia
- Total industrial blindness
- 2nd/3rd degree burns of more than 25% of the body
- Actual anticipated hospitalization in excess of four weeks, i.e., ventilators, ICU, psychiatric hospitalization
- Severe occupational diseases and blood borne pathogens (not end stage); toxic exposure with long term complications
- Any other medical diagnoses identified by the MCO and CNA
Managing a catastrophic case requires that all services be coordinated in a timely manner, as required by the needs of injured workers and their families. Expected outcomes of catastrophic case management include:
- Expediting claim allowance for prompt payment of medical and indemnity benefits;
- Insuring the delivery of appropriate, quality medical services;
- Preventing any further disabilities or impacts to injured worker and their families
