Case Management Focus: It's Time to Highlight Case Management Outcome!


Sarasota, FL ( -- There is a saying in the healthcare industry that workers' compensation insurance is the premier insurance. Think about it – U.S. employers bear the costs of carrying workers' compensation insurance for their employers. There are no premiums or out-of-pocket costs for any medical care delivered when the maintenance is related to workplace injury or illness. Second opinions are encouraged, and you get to see the best doctors to address workplace injury or illness issues with no limits on the amount of time an injured worker is out of work. In addition, the injured worker is PAID for their lost time if they cannot work as determined by the treating physician.

The Centers for Medicare and Medicaid recently reported that US healthcare spending topped $4.3 trillion in 2021…almost $13,000 per person. Meanwhile, work comp medical spending for 2021 was $32.5 billion…or 0.74% of US healthcare spending.

What I would like to share in this column is that case management should be an integral part of all types of health insurance as it is in the workers' compensation system if we want to contain costs, have a wellness model vs. a sick model, and contain the costs of healthcare so that it is not a drain on the rest of the economy. Today, case management is used sporadically in commercial health insurance and has yet to have the impact it could have if it were held to the same standard as in the workers' compensation side of the house.

Having a case manager involved allows all stakeholders to do their job with a central person coordinating various activities.

Including a professional case manager (licensed/degreed healthcare professional) is a must to enable costs to be controlled, return to work to be expedited, and satisfaction scores are better for the injured worker, the employer, the healthcare team, and the payer.

Transitions of care are safe, care is better coordinated, and barriers are minimized, so unexpected costs are limited. In addition, communication is improved with all stakeholders, including the patient and their families. In addition, attorney involvement is less, and return to gainful employment is the norm as the injured worker trusts the system.

Workers' Compensation case managers who are successful in their practice are proactive, anticipate barriers and work to minimize them so that costs are contained. Quality of care is delivered efficiently and cost-effectively. Commercial case managers need to do the same to demonstrate their value as a member of the healthcare team.

Workers Compensation Case managers are required to report their time and the outcomes they achieve for being involved in a case at frequent intervals so that managers, supervisors, and owners of case management companies can ensure case management services are needed and being used to meet the needs of the client efficiently and effectively.

Management reviews cases with the case management team to review the case's goals and the goals being met. This is done so that all involved understand the value of having a case manager on a case. If the case manager cannot justify their role, usually, the case is closed. This is because there is a cost to having case management involved, and those costs must be justified with outcomes that would only have been achieved with case managers.

Case managers strive to achieve outcomes: safe transitions of care, efficient and effective care coordination, return to work, reduction in attorney involvement, cost savings concerning unnecessary care, and high patient and provider satisfaction rates.

If your case management team is not demonstrating outcomes that justify the value they bring to your clients, it is time to look at the training and development your team is receiving. Case management is an effective cost management tool when it is used appropriately. Highlighting the value they bring and the outcomes they produce is critical to demonstrating value.

Thank you for reading this column. If you have a comment, please put it in the comment section or email me at

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