Problem
A large, self-insured employer contemplated unbundling their telephonic case management program from their third-party administrator. They were looking for greater transparency and control over their spend on case management services, demonstrated outcomes, and a clear reduction in their medical and indemnity costs. The employer emphasized that their employees were their greatest asset and therefore wanted to ensure they were well taken care of when injuries occur. A claims analysis was completed using three years of claims data valued at the same point in time. The analysis served as a future baseline for program performance.
Solution
Aligning to the client’s vision, Enlyte created a customized early intervention telephonic case management program that leveraged Enlyte’s risk identification tool for optimal case selection. The program was designed to ensure the employer provided a program that promoted employee advocacy, ensured timely access to quality care and reduced lost time days. Staffing needs were determined from a claims analysis that reviewed case durations and optimal caseloads.
Outcome
After 12 months, claims data was reevaluated to compare year one performance. Results demonstrated in gray box.
26% of Lost Claims Were Selected for Case Management
60 Average Business Days Saved
91% Return-to-Work Percentage
8% Decrease in Average Indemnity Paid
10% Decrease in Average Medical Paid
18% Reduction in Litigated Claims
4.5/5 Employee Satisfaction Rate
Actual results may vary