We understand in these challenging economic times that companies need to manage costs. We do the same thing every day for our business. But of late, we’re starting to wonder if some in our industry are being a bit penny-wise and pound foolish when it comes to setting guidelines for disability management companies.

We get the concept of guidelines, no seriously…we get it!  But when they are eight pages long and unchallengeable, we take issue. Invariably, case managers end up spending too much time figuring out what the guidelines will or won’t permit that they risk not doing what they should be doing to address a case. These guidelines can have an adverse effect—because they take the focus away from the task at hand—returning the worker to the job as safely and quickly as possible.  It’s like asking a world class sprinter to compete with combat boots on…he’s still faster than most…but not as fast as he could be.

So, are we asking our clients for blind faith, to believe that we’ll always do the right thing and not overbill them? Well, yes and no. Yes, we want them to have faith that we will close cases as safely and quickly as possible and we won’t overcharge them. But, no we don’t ask them to do so on blind faith. Instead, we show them data that illustrates the cost-savings of dedicating the appropriate level of care that each individual case requires versus focusing on billable hours.

We don’t doubt that there are disability management firms that will agree to all eight pages of guidelines. What we do question is their ability to save their clients money in the long run. Is their focus really where it should be? When presented with eight pages of guidelines we take a close look to determine which, if any, will inhibit our case managers from focusing on what they are trained to do. Then we take a deep breath and make a few suggestions to the guidelines which we know in the long run will result in better outcomes for everyone involved.

That’s how we separate the companies that truly understand how to save money from the ones who save pennies on the pound.

With the 4^th of July approaching we take a moment to honor our country and celebrate our independence as a nation. However, we can’t help thinking about how the concept of independence applies to our industry—specifically the role of independent case managers.

Like most, if not all companies in our industry, from time to time we employ independent case managers (in fact some companies employ nothing but independents) when we don’t have coverage in a specific region. Typically this happens when a client asks us to expand our services outside of areas where we employ full-time ICM case managers. While not ideal, we work with independents who have a proven track record delivering solid service.

However, we’re seeing a trend by clients who want their needs managed by employees of case management firms versus independents subcontracted by those companies. The reason—they are looking for more control and accountability. We couldn’t agree with them more.

As a company, we are committed to dedicating the appropriate level of care that each individual case requires versus focusing on billable hours. Our case managers are measured against this metric because it helps us close cases faster and return a healthy, productive worker back to the job as soon as possible. We’ve found that this practice results in a lower cost to the employer and an employee who feels connected to the company throughout the recovery process.

As much as we communicate this philosophy to the independent, it is far more challenging to get them to consistently practice what we preach. Let’s face it—an independent’s livelihood is based on how many hours she or he can bill. And while their skills and experience can be on par with our full-time case managers, they may not manage cases as effectively or as efficiently as our full-timers.

So how do we bridge the gap between delivering accountability and more control in regions where we do not have full-time coverage?

We do it in conjunction with our clients.

Recently several of our clients have provided us in advance the estimated number of cases they need managed in a specific area so that we can hire a full-time case manager there. We then train them to manage according to our practices which results in more control and accountability. We call that a win.

This July 4^th we’ll celebrate Independence Day, truly our most significant event as a country—a significant moment in our history—one that has spurred this nation on to bigger and better things. At the same time, we’ll take pause and wonder about the independents in our industry. Is it time to move on from a business model that includes independents as our industry continues to evolve for the good of the injured worker, the employer and everyone associated with the recovery process? We think the answer is self-evident. In our business model, all case managers are indeed not created equal.

There are certain professions that attract special people—those individuals who strive to make a difference in other people’s lives. In our business we believe that the true difference makers are our case managers. We’d like to take the opportunity to use this platform to recognize them for the work that they do.

The last 11 quarters have been very good to us—we’ve increased revenue every quarter for almost three years. While there are many people to thank, our most important assets are the people on the front lines every day, caring for the injured workers and helping our clients keep their costs down and their productivity up.

We know that the role of case manager comes with inherent challenges. At the same time, the job can be very rewarding. We asked a few of our case managers to share some of their insights and most memorable stories.

The Rewards

Rewards can come in all shapes and sizes. A simple thank you for a job well done goes a long way. Actually changing someone’s life is a nice reward like the experience one of our case managers had with a Spanish-speaking amputee who developed a neuroma on his stump after he had returned to work. He had been frustrated with his physician, didn’t understand his options and his depression caused by the situation adversely impacted him at work and at home. After the case manager explained that the workers’ comp process gave him the opportunity to choose another physician, his outlook changed dramatically once he switched doctors. He became a completely different man, re-engaged with his fellow employees and had a much brighter outlook on his prospects. The case manager had gained his trust which made the recovery process much smoother for everyone. Talk about a turnaround!

By its very nature, workers’ comp can sometimes carry a negative stigma. The injured worker might wonder if the employer has his or her best interests in mind while the employer may question the seriousness of the injury and the associated costs. There is no better outcome than when the injury actually builds a stronger bond between the employee and the employer because the case is handled so well from both ends of the spectrum.

Then there are the special experiences that stay with case managers forever. One case involved a person who lost his leg in a job accident. The adjuster had been extremely unresponsive and when he did respond, always said “no” regardless of the request. Naturally, the family was suspicious of anyone associated with the case—including the case manager. However, throughout the recovery process the case manager assisted the injured worker with everything—from obtaining his prostheses to customizing his vehicle to taking his daughter’s calls on weekends, holidays and evenings due to the complications associated with his injury and subsequent comorbidities.

Eventually the man passed away and a few months later the daughters asked to meet with the case manager. It was during that get together that she truly understood the impact she had had on the man and his family.

When she arrived, she was presented with a bird house that the man had crafted while recovering at home. It was such a personal gift that the case manager made an exception to her rule of never accepting gifts from claimants. Today, the bird house sits in her yard as a reminder that when she gets challenging cases like this she knows that this is the work she was meant to do and that she truly can make a difference in people’s lives.

These are just a few of the experiences and insights shared by ICM case managers. If you are a case manager and would like to share your story, please submit it to Jamie Slotten at jslotten@integratedcare.com and we’ll feature it on a future post.

The other day the local paper published Atlanta’s pollen count. The article proclaimed that the city was approaching a new city record—5,733 particles of pollen per cubic meter of air. That’s a mere 280 below the all time record experienced on April 12, 1999. The information came courtesy of the Atlanta Allergy & Asthma Clinic which assuredly does a brisk business this time of year.

We don’t mean to make light of the pollen—many of us at ICM battle allergies every April. But it sure makes for a good trivia question which got us to thinking. What other obscure facts can we share that will make you appear more informed than your friends, or better yet, your teenage kids who purport to know everything?

The next time someone challenges your knowledge on a particular subject, pull out one of these gems and stop them in their tracks.

World History

Armored knights raised their visors to identify themselves when they rode past their king. This custom has become the modern military salute.

The custom of shaking hands with the strangers originated to show that both the parties were unarmed.

Everyone in the Middle Ages believed — as Aristotle had — that the heart was the seat of intelligence.

In 1892, Italy raised the minimum age for marriage for girls – to 12.

The ancient Egyptians slept on pillows made of stone.

The seven wonders of the ancient world were:

1. Egyptian Pyramids at Giza

2. Hanging Gardens of Babylon

3. Statue of Zeus at Olympia

4. Colossus of Rhodes – huge bronze statue at the Harbor of Rhodes that honored the sun god Helios

5. Temple of Artemis at Ephesus

6. Mausoleum at Halicarnassus

7. Lighthouse at Alexandria.

US History

At Andrew Jackson’s funeral in 1845, his pet parrot had to be removed because it was swearing.

New Orleans’ first Mardi Gras celebration was held in February, 1826.

New York’s first St. Patrick’s day parade was held on March 17, 1762.

President George Washington created the Order of the Purple Heart in 1782. It’s a decoration to recognize merit in enlisted men and non-commissioned officers.

The first US Marines wore high leather collars to protect their necks from sabers, hence the name “leathernecks.”

And finally, one fact that we couldn’t resist…..

40% of women have hurled footwear at a man!

Ultimately, a company’s success or failure is driven by the decisions it makes. Many organizations are structured so that a limited number of executives in the corporate office hold the keys to the kingdom.

ICM has taken a different approach and it is paying big dividends for everyone in the company. While we believe in strong leadership we do not make decisions in a vacuum. We are nimble enough for senior executives to be out in the field meeting with clients, prospects and staff and attending key conferences but their greatest insights come from a select group of team members representing various facets of ICM’s business.

The ICM Leadership Council is comprised of case managers, salespeople, human resources and senior executives and it is an integral part of the decision-making process. The purpose is to take a 360 degree approach to setting policies and creating programs so input and ideas from all aspects of the business are considered and carefully weighed.

The Council also plays a role keeping fellow team members informed of what’s going on behind the scenes so they have a better understanding when new programs or policies are introduced enabling them to intelligently execute them in the field.

We are purposely bold in recruiting talent, placing a call to leaders who want to make a difference within an organization. Visit our Case Manager page on our Web site and you’ll be greeted with this headline: ICM Empowers Its People To Manage Cases and Their Careers. We believe that empowerment can only happen when the case manager feels valued, has forums to share insights and remains informed.

In addition to driving key decisions, the Leadership Council mentors new recruits, helps resolve issues and keeps case managers in individual states up to speed on policies that might impact them or their patients.

The Best Ideas Come From Brainstorming Sessions

Great satisfaction comes from brainstorming sessions sparked by lively discussions involving the many different perspectives represented on the Council. A growing company like ICM can run the risk of losing some of the greatest qualities of a smaller organization—the feeling of family. When there are regular two-way discussions between the field and home office, that feeling of family remains strong. There are times when sparks fly, but without that type of energy a company can remain stagnant and that simply isn’t ICM’s style.

Council members, particularly case managers who have joined ICM from other organizations, are particularly enthusiastic about the group because they have never worked for an organization that listens directly to the field in this manner. As one member stated, “The Council enables us to incorporate an accurate perspective to the corporate/management level, and to ensure that management’s decisions can be applied to the daily process of managing each case and case load to improve the injured worker, referral source, and employer.”

But don’t let the seriousness of the above statement fool you. The Council is also a great deal of fun—as long as you don’t mind fending off creative pranks from time to time. We are absolutely serious about the services we perform and the trust placed in us by our clients, but we are also a group of connected people who enjoy working together to make ICM the best it can possibly be. And trust us when we say that we are only as good as our people. Remember, when it comes to the talent we seek, Only Leaders Need Apply.

We typically use the ICM blog to share our thoughts on the disability management industry but for this post we’re sharing  some of the thoughts of our newer employees.

In 2009 we set out to significantly change how things are done in the industry and it is hitting home with our two most important audiences—customers and employees.

Customers are showing their support by fueling our growth—asking us to expand territories and take on a larger number of their cases because they know we get the job done the right way.

To keep up with growth we have been aggressively seeking qualified case managers and have welcomed many new employees into our family. They have been attracted by our culture, structure and other company attributes we share during the recruiting process. We understand that when prospects consider leaving their positions, they are taking a risk. We all know there is nothing worse than finding out that the company you have joined does not walk the talk. Based on the comments below, we are excited to see that our newbies are even more enthusiastic AFTER they’ve joined ICM. It doesn’t get more gratifying than that!

Here are just a few of the comments we received in late 2009:

Transitioning to ICM

“I just wanted to say how friendly and welcoming everyone has been and most importantly how happy everyone is to work here. I have never experienced anything like it and it is soooo nice.”

More Than a Year into an ICM Career

“It’s incredible to me to realize that I’ve been a part of ICM for 13 months already. My last post was extremely stressful and I felt alone in an office filled with management personnel, support staff and coworkers.  Granted I did have some very dear friends/colleagues there that tried to be supportive and helpful but they felt as stressed out and unappreciated as I did.  Here, I work in my only little home office far away (geographically) from supervision and co-workers yet feel like I always have a “buddy” to call on that will do their best to help even if busy with their own assignments.   And consequently it makes me want to be as helpful and supportive to them when I receive a call or email request.

Having worked in this business for 20 odd years and in the same type work environment (meaning working out of my home without a traditional office setting) I need to commend the ‘powers that be’ who have chosen so wisely in building a team of experienced, knowledgeable people willing to stick their neck out to help a coworker; someone they probably have never laid eyes on before and rarely ever see in their day to day work life with their only initial connection being offered a job with ICM.

2009 has been a great year for me. I have finally found the perfect job and I work with the best people. Thanks to everyone”

A Rare Attitude Found at ICM

“It’s been approximately five weeks since I became part of this incredible organization and I’m so thankful to work with each and everyone of you.

In all my years in the workplace, I have always been a person who looks forward to Monday mornings, as opposed to a “TGIF” person.  Before coming to ICM, I have never been a part of an organization in which there were more then fifty percent of “Monday morning” people.  Amazingly, ALL of the people in our company have the “Monday morning” mentality.  I hope everyone realizes that this is extremely rare for a company to have everyone on the same page.  Simply put, we all have a passion for our job and our company which will lead to ICM being the LEADER in our industry!”

We’re certainly not claiming to be perfect—ICM will continue to evolve to make our services even better and our company an outstanding environment for personal and professional growth. But we know we are headed in the right direction and our people are feeling and acting like they are a part of something much bigger than a cog in the proverbial wheel. And probably why we have more than our fair share of “Monday morning people!”

As we’ve come to expect, Joe Paduda has blogged about some issues that are near and dear to our hearts. He poses the question,  “Where’s the value,” to the several different “customers” who factor into the work comp managed care buying decision.

Let’s focus on three specific “customers” and their needs according to Joe:

“For the adjuster, the definition isn’t quite so apparent. With a desk swamped under case files and a screen stuffed with flashing ‘red flags’ on critical diary entries, there’s less focus on finding the cheapest wheelchair and more interest in picking a vendor that can take work off the adjuster’s desk, do it competently and without claimant complaint, and provide documentation that, at a maximum, is readily cut-and-pasted into the claim file.”

We’ve found adjusters that are doing everything they can to stay above water—averaging 180 files on their desk at one time. When we talk about our services with them, their number one goal is to close the file with the best solution possible. In our world, the best solution is attained when we place our focus on closing cases as quickly as possible versus an emphasis on billable hours. That means dedicating the appropriate number of hours per individual case up front which typically results in faster, and safer resolution in cases and fewer files on the adjuster’s desk. But what does that mean for the employer?

Once again we turn to Joe:

“For the claim manager, it’s about closing files, minimizing litigation, and avoiding those calls from Home Office management about low network penetration and excessive use of non-authorized vendors, while struggling to keep overworked, underpaid, and unappreciated adjusters on the job and out of the clutches of headhunters.”

The formula for claim managers is much simpler. They want a resource that can help them close files—with the required processes and documentation to minimize litigation. At the same time, 180 cases on an adjuster’s desk can lead to burnout and good adjusters are hard and expensive to find.

Now, onto the employer. Joe, take it away:

“For the employer, value is fast, thorough medical care that gets the injured worker back on the job and keeps her/him there…unless the employer is dealing with declining revenues, in which case they don’t want John/Jane Doe back at work no matter what, as there isn’t any job for her/him and they sure don’t want to yet another unemployment claim.”

Let’s focus on the first part of his equation—getting the injured worker back on the job and keeping him/her there. The employer plays a major role here—larger than he thinks. When he takes action on a case within 24 to 48 hours and it gets in our hands, the average amount of lost work days is 29. Wait longer and the average skyrockets to 179 days.

When each “customer” realizes that we’re all in this together, the value of a managed care provider that consistently closes cases quickly and safely skyrockets. And in that “case” everybody is a winner.

“Time flies,” is an oft-used adage but when a new decade beckons, it takes on an added dimension. Most of us remember where we were at 12:00 AM on January 1, 2000. Many breathed a sigh of relief when computers didn’t shut down and the world didn’t come to a screeching halt when Y2K came and went. Of course, many consultants toasted to the millions they earned addressing the threat of Y2K posed to their clients.

Before we look forward, let’s glance backward as evidence that time certainly did fly:

Jared Fogle of Subway “fame” was first referenced on January 26, 2000. Wow, that’s a lot of bad commercials.

The first use of Homeland Security to describe a government agency to combat terrorism was February 1, 2001, seven months before 9/11.

On May 14^th, 2001, the Chicago Tribune first introduced texting to their readers, “which allows users to punch in a brief message that is instantly transmitted to one receiver.”

How about these short descriptions of things that are now part of our daily vocabulary?

Oct. 29, 2001: The “iPod (is) a $400 pocket-size hard drive that carries up to 1,000 songs in a metallic case about the size of a pack of cigarettes.” (Today, an iPod that holds 1,000 songs costs $100 and is the size of a pack of gum.)

June 17, 2002: “Ringtones constitute only the first movement of an entire symphony of new music services mobile network operators and entertainment companies are planning to offer consumers.”

July 14, 2002: “Phones with digital cameras that shoot and e-mail photos are popular in Asia. … Motorola plans to introduce a camera phone in the U.S. at the end of the year, though it’s unclear whether the phones will take off here.” Try finding a phone with out photo capability.

May 31, 2002: ” ‘American Idol: The Search for a Superstar,’ (is) based on a popular series in England. Musical hopefuls will vie for success, with a celebrity panel of judges knocking them off one by one.”

Other dates of first-blips on the screen: Facebook (May 25, 2004); Wikipedia (Jan. 16, 2005); Sudoku (May 25, 2005); YouTube (Dec. 29, 2005); Taylor Swift (Sept. 28, 2006); Twitter (March 14, 2007) green jobs (April 16, 2007); and Lady Gaga (Aug. 6, 2007)

What’s in Store for the Decade to Come

Disability management? Workers’ Compensation? Rather than predict what is to be we’ll focus on what we hope will come. Let’s start with changes to our industry like more transparency between disability management firms, TPAs/insurance firms and employers. Transparency begets trust and that elevates everybody. Better care, tighter controls on expenses and better bottom lines.

Now, what can we expect by way of innovations, popular culture and the economy? Your guess is as good as ours. However, for those of us who were kids in the 1960s and 1970s the decade won’t be a success unless we see something really cool. Flying cars—Jetsons style.

We’ve seen just about everything in our 20 years as disability management specialists—including some disturbing trends. In his recent pull no punches blog, “How to Know if You’re Being Ripped Off,” Health Strategy Associates principal Joe Paduda provides his Top 10 signs that your work comp managed care provider might be ripping you off. We believe every self-insured company should be aware of this list but share it with you along with one significant caveat.

“If the ultimate goal is to safely return the injured workers to the job at the lowest cost to the employers then results are all that matter.  When case managers do their jobs properly and manage each individual case with that key goal in mind versus measuring success by the number of hours billed, they achieve the best outcome as safely and economically as possible.”

In other words, when you partner with resources that measure success not by how much they can bill, but instead on how quickly and safely they can return the worker to the job, then Joe’s list become moot. However, it is definitely a two-way street and you must do your part as well. That means addressing an injury or illness immediately because when you do, everyone wins and your bottom line is the better for it.

Now for Joe’s list in descending order. Please note his caveat that not all TPAs are out to rip you off—we completely agree. But, be on the lookout for those who are.

How to know if you’re being ripped off

In the work comp managed care/claims world, some vendors’ revenue maximization efforts are getting ever more clever. I know, I know, I’ve posted on this several/numerous/multiple times before, but to my never-ending amazement, these practices continue. So here are the top ten warning signs to watch out for (sorry for ending with a preposition…)

Before you start, realize that all TPAs are not out to rip you off, all managed care vendors are certainly not either, and the soft market and unreasonable demands by employers have forced many claims administrators to look for revenue wherever they can get it.

That’s fine, as long as you know where your dollars are going…

10. Your TPA won’t let you use your own managed care vendors.

9. Your TPA won’t offer a bundled price, including all managed care services. Even worse if you never asked for one.

8. Savings reports focus on reductions below charges and don’t show reductions below fee schedule/UCR.

7. The TPA determines which cases ‘need’ case management - and your case management fees continue to grow. sometimes this appears to be OK, as the cost per hour is a deal, but it’s highly likely the hours worked are ever-increasing.

6. The TPA won’t sign any statement like this one (NOTE: See www.joepaduda.com for the referenced statement). Unfortunately, that doesn’t mean the TPA isn’t lying, as some may sign the statement anyway knowing it isn’t true.

5. The TPA won’t provide copies of any contracts with managed care vendors.

4. The TPA agrees to provide a great deal on claims admin services, with the fine print noting that they have complete control over managed care, investigative, legal, and other claims support services.

3. The TPA’s claims admin price is way, way better than the competition’s. There is no free lunch, and if the deal is too good to be true, rest assured you’re getting ripped off.

2. The claims staff you meet during the pre-implementation meetings disappears when claims come in, replaced by inexperienced/non-experienced/completely ignorant ’staff’

1. You are paying for bill review on a percentage-of-savings-below-charges basis, which motivates the vendor to find the highest-billing, highest-utilizing providers and let them run roughshod over your bank account, all the while trumpeting the ’savings.’

We’re back from the National Workers’ Compensation and Disability Conference & Expo in Chicago. Chicago was as beautiful and accommodating as ever—even the weather cooperated! If you’ve never been to the city, by all means get there—but book your trip during the summer. You’ll thank us for the advice.

We have to say that the show was missing its typical buzz. Down on the exhibit floor we saw steady traffic but there seemed to be lacking a bit of the energy we’re used to seeing at the show. So, we made every effort to infuse energy into our area on the floor. Check out some of our pics. We have to admit that the strangest booth we saw featured pet insurance. We’re not really clear what application pet insurance has for our industry—but it is fun to speculate.

Industry insider Joe Paduda posted his first impressions from the show on his blog. For a solid show overview, go to http://www.joepaduda.com.

In a follow-up post, Joe addressed a topic that is near and dear to our hearts, “The Latest on Vendor-TPA Relations.” It focuses on the “pay to play” business models that many of the TPAs are requiring of their managed care vendors.

“Word from several sources at the comp trade show is some managed care vendors have deals whereby the commissions/fees they pay the TPA for the privilege of doing business are increasing with volume.”

Joe explains the model:

“The way it works is simple, if not necessarily, or even usually, in line with clients’ best interests. The vendor agrees to pay X percent for the first Y dollars of revenue, X+ for the next Y dollars, X++ for the next Z dollars, etcetera.

But some vendors are applying the higher payment levels retroactively. Yep, if the TPA delivers Z dollars, the X++ commission rate applies to ALL revenue. That’s why employers are being told they can get these services at very low – or no – cost. Hat seems like a great deal is – for the TPA. Unfortunately the TPA’s interests are not always, and in some cases are most definitely not, aligned with the employer’s.”

Yes, this is a disturbing trend, one that does not reflect well on our industry and something that must change. A couple of months ago we blogged about this very issue. Allow us to dust off the old soapbox and step back up to the microphone:

“If the ultimate goal is to safely return the injured workers to the job at the lowest cost to the employers then results are all that matter.  When case managers do their jobs properly and manage cases with that key goal in mind versus measuring success by the number of hours billed, employers take notice.  Their filter for choosing the best resources is pretty simple—achieving the best outcome as safely and economically as possible.”

We don’t intend to play that game and know that in the log run, the pay for play behavior will be very much like the dinosaur exhibit at Chicago’s Field Museum of Natural History—once dominant but now, very much extinct!