IPMG Blog

Insurance Program Managers Group

Community Impact in IPMG’s Enhanced Case Management Program

Posted by Kim Gaston, Clinical Field Service Director on Oct 17, 2019, 2:53:11 PM

One of the greatest costs to employers and insurance companies is the cost of poor health of employees and insured.  Most insurance programs aimed at improving health and habits fail to gain traction and often lack established support systems for patients on the path to recovery.  Intervening into someone’s life with suggestions on how to improve their health can be met with dismissal or skepticism, often from the people who need help the most.

To address this challenge, IPMG offers an Enhanced Case Management program that’s designed to make these transitions easier. The program works to improve employee health and reduce comorbidities that might complicate recovery. It’s especially useful for complex group health and workers’ compensation claims.

Our enhanced case management program uses a combination of solutions to help create healthier habits. From nutrition, functional fitness and emotional health and wellbeing, we focus on patient care that’s safe and accessible. It takes a team to turn a life around, which is why we coordinate case management to target progress at every level.

Here’s how it works.

 

The Program

The program also uses system triggers to identify and prioritize claims that are delaying injury recovery, healing and return to work. Candidates are selected based on comorbidities such as obesity, diabetes, hypertension or hyperlipidemia (an abnormally high concentration of fats or lipids in the blood). Next, we reach out to the employee and offer the support to help them achieve their personal health goals. 

The initial program length is 8-12 weeks. It includes establishing a health baseline, creating individualized goals and a plan to help them achieve that goal.

The program focuses on improving nutrition, functional fitness, stress management, mental and emotional support as well as disease management and opioid intervention.

Our enhanced case management program is:

  1. Patient-centered: A partnership among practitioners, patients and their families ensures that decisions respect patients’ wants, needs and preferences, and that patients have the education and support they need to make decisions about their own care.
  2. Comprehensive: A team of care providers is wholly accountable for a patient’s physical and mental health care needs, including prevention and wellness, acute care and chronic care.
  3. Coordinated: Care is organized across all elements of the broader health care system, including to account for specialty care, hospitals and support.
  4. Committed to quality and safety: Clinicians and staff enhance quality improvement to ensure that patients and families make informed decisions about their health.

 

Barriers to Breakthroughs

Although IPMG’s enhanced case management program has demonstrated proven success, the biggest barrier is often the initial buy-in.

When asking someone to change their lifestyle and take on a new relationship with their health, diet and lifestyle, there’s most likely going to be some pushback and questioning involved. Participant skepticism of the program’s effectiveness and intention can slow initial results, as well as lack of commitment from the involved parties. 

IPMG assigns a multi-disciplinary team to help with this program.  It includes nurse case management, physician enhanced case management, claims team, risk management team and integrated claims coordinator. We have found that breaking down the silos between divisions has earned a substantial impact on improving employee health and a positive claim outcome.  

Here’s how the program worked for one employee, Phil R.:

“During my time off, I had conversations with my nurse and an IPMG adjuster, Julie Page. They were both very pleasant to talk to and I continually updated them on my medical status. I finally was able to get a doctor’s release to return to work, still having pain in both knees. I received a phone call from Dr. Kim Gaston who was concerned about my medical condition, as well as my career. She understood my feelings and situation I’m in, wanting to work but having medical issues.

Dr. Gaston offered me an opportunity to sign up at a local gym of my choice and provide me with a professional trainer to help me recover. I’ve been going to the gym on a regular basis for the last 3 months. I lost approximately 15 pounds and feel much more energetic. My most recent doctor’s visit with all my lab work, results were excellent. If I never receive the call from Dr. Gaston I would have never even walked into a gym. I tend to do things for others and very seldom make time for myself. Dr. Kim motivated me to be a healthier person which also made my family very happy. Many thanks.”

 

Before receiving structured help with Enhanced Case Management / After completing the structured recovery:

Phil R BeforePhil R After

Just like it worked for Phil R., our team is ready to work with your employees in a holistic and positive way. If you’re ready to inspire effective change in the health and wellbeing of your employees, our enhanced case management program will create a plan and identify the best strategies for you and your organization.

To learn more about enhanced case management program, click here.

 

Tags: employee benefits, case management