How to Move From A Sick System to a Health Care System?

The Case Manager

The US has the best ‘sickcare’ system in the world. Today, doctors and other healthcare professionals have numerous tools to keep people alive and treat them for complex conditions. One example is cancer care. Years ago, cancer was viewed as a terminal disease. Today, due to advances, cancer is now considered a chronic disease.  

But what if we can prevent diseases like cancer, diabetes, obesity, COPD, arthritis, and other chronic conditions or injuries from occurring by taking better care of ourselves? 

Employers pay the brunt of health insurance for their employees and their families. They don’t have to do this, but they do it to retain staff and have a healthy workforce. According to the Centers for Disease Control and Prevention (CDC), six in 10 Americans have at least one chronic disease, and four in 10 have two or more chronic diseases. The National Institutes of Health (NIH) estimates that by 2030, nearly 50% of U.S. adults will be obese.

As nurse case managers, we recognize that healthcare costs are rising with no end in sight.  Healthcare spending in the United States has been steadily increasing over the past several decades. Between 2010 and 2025, national health expenditure increased from approximately $2.6 trillion to $5.6 trillion. We hear that this is unsustainable – but what is being done to address the issue? How can ‘WE’ take better care of ourselves to prevent chronic medical conditions and workers' compensation injuries that result from preventable medical conditions? 

In this post, I would like to share how Workers' Compensation Nurse Case Managers can promote wellness as part of their role by bridging clinical care with workplace support, empowering injured employees, and guiding employers toward healthier and safer environments. Here are some strategies that can help: 

Empowering Recovery and Resilience

Educate and engage injured workers

• Simplify medical information so workers understand their diagnosis, treatment, and recovery expectations.
• Use teach-back methods and culturally appropriate materials to reinforce health literacy.
• Encourage active participation in care plans, therapy, and return-to-work strategies.

Address whole-person wellness

• Screen for mental health concerns, substance use, and social determinants of health.
• Connect workers to counseling, peer support, and community resources.
• Promote self-care strategies like sleep hygiene, nutrition, and stress management.

Advocate for safe and timely return to work

• Collaborate with providers to ensure functional capacity evaluations and realistic work restrictions.
• Coordinate modified duty plans that support gradual reintegration.
• Celebrate milestones to build confidence and motivation.

Building Safer, Healthier Workplaces by sharing insights on injury trends and prevention

• Analyze claims data to identify common injury types and workplace hazards.
• Recommend ergonomic improvements, training, or policy changes to reduce risk.

Promote a culture of care

• Encourage employers to view recovery as a collaborative process, not just a cost center.
• Offer education on mental health in the workplace, especially for high-stress roles.
• Help employers understand the value of early intervention and supportive communication.

Facilitate wellness initiatives

• Suggest on-site health screenings, flu clinics, or wellness challenges.
• Advocate for employee assistance programs (EAPs) and resilience training.
• Share success stories to reinforce the impact of wellness on productivity and morale.
• Provide rewards for wellness activities for employees and their families. 

Serve as a liaison

• Translate clinical updates into actionable workplace accommodations.
• Ensure timely communication between providers, insurers, and employers.
• Build trust by being a consistent, compassionate presence throughout the claim.

Use data to drive better outcomes

• Track recovery metrics and report progress to stakeholders.
• Use predictive analytics to identify at-risk cases and intervene early.

Cost containment and patient education are competencies that nurse case managers strive to improve in their everyday work. Nurse Case Managers can add wellness education to their skill set and claim the savings that can be achieved by educating workers about prevention and teaching them how to care for themselves if/when they develop a chronic medical condition. If you are doing these things, start showing these activities and related savings in your reports. Your value grows the more you do. 

I hope this article provides you with some ideas on how, as a nurse case manager, you can help contain healthcare costs as part of your role through wellness and prevention. Most of all, stay well!  

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