We spend a great deal of time speaking with clients to see how we are doing. We suspect that most companies do the same thing. Because we are a metrics-driven organization we tend to focus on outcomes and how efficiently we are able to manage cases. It gratifies us to hear clients praise our case managers, particularly their responsiveness and how focused they are in ensuring that physicians treat their patients with the goal of returning them to work.

Now here comes the epiphany. Clients are telling us that one of the best things about ICM is how easy we are to work with.  In a nutshell they like that we do what we say we’ll do and keep them informed along the way. We tell clients that we will provide timely and concise reports because we know they are juggling multiple cases concurrently. We’ll do more than simply record notes following a doctor visit. We’ll listen intently and ask questions when we believe that the treatment program isn’t necessarily geared toward returning the worker to the job.

The Ends Don’t Always Justify the Means

Think about a project that you contract someone to do for you. Say for example, you remodel your kitchen. The contractor and team do a great job. You’ve discussed your ideas, agreed on a price and work begins. The contractor keeps you informed, addresses issues before they become problems, stays on schedule and delivers a beautiful new kitchen. You are thrilled and every time you show off or use your kitchen your focus is on your wonderful new room. You had a great outcome made better by a solid process.

Compare that to a contractor who rarely communicates with you, quickly falls behind schedule because he’s stretched too thin and doesn’t inform you of issues until AFTER they have become problems. However, the contractor does good work and the final product is solid. The problem—each time you walk into your kitchen you think of the headaches his process caused, you grimace a bit about going over budget and you are a bit worse for the wear. Your good outcome is soured because of the process.

We think it all boils down to a single premise:

The final product is only as good as the process that gets you there.

If the client has a great experience from start to finish, a positive outcome feels exponentially better. That comes from active listening when receiving an assignment, clearly communicating how you’ll manage the case, and most importantly, delivering exactly what you have promised. At least that’s what our clients are telling us!

Every case manager’s mission should be the same—return an injured worker to the job as safely and quickly as possible. Because metrics are such an important part of ICM’s culture, a core value is to identify key drivers that impact our clients’ bottom line. Some of them are fairly obvious—how quickly an injured worker seeks treatment or how focused the treating physician is on getting the worker back on the job. Others are far less transparent such as the following insights provided by some of our case managers.

No Commitment to Speedy Recovery

One case manager recounted a situation in which a seasonal worker cancelled appointments and failed to return adjuster calls. The man had initially taken treatment at a walk-in facility and did not appear for his follow-up appointment. By the time the ICM case manager was engaged, it had been 2 months since the patient had seen a doctor. Several cancelled appointments later, the case manager made sure he attended the appointment she had scheduled for him and after a single follow-up he was released to full duty. The moral of the story? The employee must want the treatment and keep scheduled appointments. He also must feel a sense of connection to the employer in some form or fashion—often the responsibility of the employer. Because if not, there will be no loyalty to the company or a commitment to return to work which only lengthens recovery time and impacts costs.

One Way Telephone Tag

Another example of hidden issues is a worker who waited for the adjuster to call him back with a referral to a specialist. The man continued to work in pain even though it had been 3 months since he had left a message for the adjuster. When the ICM case manager was brought in, she identified an orthopedic specialist and scheduled an appointment. The worker then waited another month to have surgery so he could train his temporary replacement. Even workers who feel a strong connection to the employer can get overwhelmed by the work comp system. And, in this case, prolong recovery by not taking timely action, even if the heart was in the right place.  With better communication and follow-up between the company and the employee, situations like this will occur much less frequently.

The Non-Participating Participant

No matter how well a case is managed, the injured worker has to do his part. Here are a few “must-haves” that drive hidden issues, courtesy of an ICM case manager

1. Attend physical therapy appointments
2. Notify the case manager of cancelled or rescheduled appointments because when the worker goes to the appointment alone, it hinders the case manager’s ability to work quickly
3. Inform the physician’s office that he is out of medication and needs a refill when he begins to run low. (versus waiting until AFTER he takes the last pill!)
4. Let the case manager know of any transportation problems which would interfere with the ability to attend an appointment and give fair notice so other arrangements can be made
5. Notify the case manager of a change in address or phone number

We were struck by The HeartBeat of Case Management, Hidden Prejudices authored

by Peter Moran, RN, BC, BSN, MSN, CCM in Professional Case Management because it provides

such great insight for our profession.

In this particular article Mr. Moran relates the story of a case manager who was called to assess post discharge needs for an elderly Guatemala native, Spanish speaking man who was admitted to the hospital from the airport. The case manager acknowledged that he anticipated a frustrating experience full of the client’s expectations and demands. Interestingly, the case manager’s assessment revealed an individual who had worked in the United States for thirty years and was eligible for Medicare, but needed assistance to navigate the system. What a difference active listening makes!

It truly opened the case manager’s eyes and taught him a valuable lesson. Each of us bring to our jobs our own ethnicity, traditions, disability case management specialty, experiences, etc; yet, every individual suffers from some type of bias. How we handle these prejudices makes a difference to our clients – both the actual patient and the company contracting us to be the case manager. We ask our case managers to think of their own biases and listen openly. It can make all the difference.

What’s going to happen in 2011? We can make some educated guesses but more often than not, we’re left with that “we didn’t see THAT coming.”

Looking back at 2010, who would have predicted that:

·         A 7.0 magnitude earthquake would hit Haiti in January

·         One month later Chile would experience both an earthquake and a tsunami

·         In April Volcanic ash from Iceland would wreak havoc with air travel in Northern and Western Europe

·         The Gulf of Mexico would be rocked with a massive oil spill

However, among the tragedies came significant triumphs. These truly lift the human spirit.

·         Thirty-three miners near Copiapo, Chile trapped 700 meters underground in a mining accident in San Jose Mine, are brought back to the surface after surviving a record 69 days

·         The 2010 FIFA World Cup is held in South Africa, and for a brief period, all countries are united in their love of soccer

·         The first 24-hour flight by a solar powered plane is completed by the Solar Impulse

·         The International Space Station surpasses the record for the longest continuous human occupation of space, having been continuously inhabited since November 2, 2000 (3641 days)

Now, let’s take a peak back 100 years to see what was going on in 1910:

• The union of South Africa is created. 100 years later, they host the planet’s most popular tournament—the World Cup
• The earth passes through the tail of Halley’s Comet
• The Zeppelin dirigible, Deutschland, makes the first commercial passenger flight from Friedrichshafen to Dusseldorf in Germany. The flight takes nine hours. And to think, one can fly from Atlanta to London in those same nine hours.
• The first air flight for the purpose of delivering commercial freight takes place in the U.S. The flight, made by Wright Brothers pilot Philip Parmalee between Dayton, Ohio and Columbus, Ohio. Only seven years earlier, they made their historic first flight. Now, that’s progress.
• Henry Ford sells 10,000 automobiles. The speed limit back then? 8 miles per hour!

So what did we do for entertainment in 1910? Check this out:

Very few people had a phonograph, but there was an abundance of store bought sheet music. Families frequently gathered around a piano, organ, or pianola for sing-alongs. The most popular song in 1902 was “In the Good Ol’ Summertime,” which that year sold a million copies in sheet music. Another popular song was “By the Light of the Silvery Moon.” Soon to follow were songs such as “Sweet Adeline,” “Ida, Sweet as Apple Cider,” and “In the Shade of the Old Apple Tree.” People in middleclass families played lawn games such as croquet or lawn tennis. Young girls, along with their mothers, spent leisure hours doing needle crafts and reading religious novels. Some among the middleclass read westerns such as The Virginian, or they read sentimental sagas, or The Adventures of Sherlock Holmes. Some read Dr. Jekyll and Mr. Hyde, or The Red Badge of Courage, and some read from among Horatio Alger’s 135 novels.

Bring on 2011

We can only imagine what our world will be like in 2110. But for now, let’s focus on 2011 and hope that we see more triumphs than tragedies—and a year of prosperity and hope. At ICM, we’ll continue to work hard to make the worlds of our clients and employees just a little bit better by being the best disability management firm we can possibly be. Here’s to a great 2011!

In past posts we’ve shared our opinion that the workers’ comp industry is broken. Given the economic climate, clients are not asking, they’re demanding accountability when it comes to the costs associated to adjudicate a claim.  In fact, many have created multiple-page guidelines mandating the conditions required for a TPA or case management firm to earn their business. In some cases, these requirements make it virtually impossible for providers to make a fair profit for all their efforts. Thus begins a domino effect which can take the focus away from the most important goal of every workers’ compensation claim: Achieve the best outcome for both the injured worker and the employer as cost-effectively as possible.

The Domino Effect in Action

The impact of such financial guidelines can be counterproductive. For example, in an effort to cut costs, adjusters can fall out of their comfort zone by managing medical issues themselves versus placing them in the experienced hands of case managers. Focusing primarily on costs can relegate case managers to glorified appointment babysitters who provide more administrative than clinical services. In their limited role, case managers don’t affect change and ultimately employees have a much slower return to work rate than they should if they ever return to work at all. The result—employers may enjoy low claim rates but  outcomes often are far from optimal because productivity suffers due to the employee’s absence.  And, excluded from that scenario is the human toll on the worker who has convinced himself or has been convinced by others with their own agendas that he is permanently disabled or chronically injured.

See, we told you the industry is broken!

Outcomes: Today’s Magic Word

Like any good company we try and keep informed about our competitors. Often it is an excellent measuring stick to understand how we are performing in the field. The last few months we’ve seen a common theme. More than ever, our competitors are talking about “outcomes,” and reducing disability expenses. It’s a great bandwagon to be on (we were charter members) and the words undoubtedly resonate with clients. What isn’t completely clear is if these companies have the processes and talent in place to execute them and achieve such lofty goals.

We believe strongly in metrics and monitor closely our performance managing cases. When engaging with prospective clients, we’d love to compare our performance against the competition but we can’t—no one shares this data. Our alternative is to contrast our metrics against the client’s numbers. Invariably our close rates are significantly better than theirs, no matter what resource they use.

Our point? Making statements about outcomes is one thing—it definitely is progress. But, they are only words on a page or content on a website until the numbers say otherwise. We’re glad that so many in our industry are on the Outcome Bandwagon—when we hopped on there was plenty of room. But we’ve been around long enough to know that for some this is only a temporary ride, because when it comes to execution, they can’t hang on.

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.