As Americans practice social distancing to prevent further spread of COVID-19, it is important injured employees safely continue to receive the services they need for their claims to progress. For this reason, Genex continues to provide field case management services in a way that prevents the spread of COVID-19 and supports the health of your injured employees and our case managers alike. Our services, including case management, are considered an essential business as it relates to Insurance and Healthcare Services and meets criteria for continued operation under mandated shelter-in-place scenarios.
Our case managers are using their deep expertise and local knowledge to ensure your injured employees get the care they need, including:
- Acting as “liaison nurses” and checking in with injured employees to alleviate their health concerns and answer questions.
- Coordinating care and assisting providers with options for treatment if they are unable to see the injured employee.
- Coordinating ancillary services.
- Educating injured employees whose elective surgery has been cancelled about home exercise to avoid atrophy and prevent further delays when surgery is able to be rescheduled.
- Completing home visits as needed or if the injured employee lives in remote areas, providing return-to-work education and ensuring compliance.
- Utilizing long-term relationships with local medical providers to ensure injured employees continue to receive treatment when other providers have closed their doors.
- Drawing on long-term relationships with local hospital administrators to ensure catastrophic case management services are delivered to injured employees, medical record information is accessed and critical health care updates are shared by providers at facilities where adjusters are unable to access due to the crisis.
- Reassuring injured employees with regular personal phone calls to help alleviate concerns, avoid unnecessary trips to the ER and limit additional phone calls to already overwhelmed claims professionals.
Leveraging Telehealth
In the event a provider does not support Field Case Manager attendance at appointments, and a telemedicine appointment cannot be coordinated, the Field Case Manager will immediately following up after the appointment with the medical provider and injured employee, and will report medical results to the claims administrator. Additionally, if the treating provider offers a telemedicine alternative, the Field Case Manager can arrange/schedule a telemedicine visit with the treating provider in order to maintain continuity of care in a non-face-to-face setting. While we believe strongly in face to face interaction to achieve optimum medical improvement and return to work, we are committed to safety during the pandemic and can coordinate telemedicine visits as warranted.
From the field: keeping claims on track
A Genex field case manager encountered an injured employee who wanted to cancel his surgery and treatment out of fear of contracting COVID-19. The case manager took time to educate the injured worker about the virus, including best practice measures for prevention. She then stressed the importance of proceeding with the return-to-work plan and encouraged the injured employee to move forward with all his pre-op appointments. To help relieve his fears and provide an additional safeguard, the field case manager brought a facemask for the injured employee to wear to all appointments.
The case manager had previously ensured that peer-to-peer was successfully achieved through the primary physician and utilization review, and all parties were satisfied with the plan, including the injured employee, therefore averting litigation. However, at the last minute, the injured employee became anxious about the surgery. The case manager consoled him on the phone, reminding him about his 92% chance (per the provider) of pain relief post-surgery, and the injured worker’s own determination to return to work. The case manager convinced him to attend all appointments and move forward with the surgery.
From the field: in-person home visits
An obese injured employee requested a home visit because he needed to stay home to care for his ailing wife. Genex’s field case manager went to the claimant’s home and remained in the doorway while conversing with him to comply with COVID-19 social distancing precautions. She reassured the man by asking about his symptoms and providing emotional support. The case manager also confirmed that a DME vendor had taken measurements for a wheelchair and that another vendor was working on installing a wheelchair ramp for the residence. This personal interaction helped relieve the man’s anxiety and allowed him to get the services he needed.