There is general consensus that timely return to work for those who are injured or ill is a desirable goal.

In 2014, key stakeholders in the return to work process are looking for innovative ways to improve return to work outcomes that are timely, effective, efficient and cost-conscious.

A telephonic approach to case management may be one way of improving return to work outcomes without the associated costs. "What is telephonic case management?" provides an overview of telephonic case management.

Telephonic approaches can be used as a standalone method for simple cases, and as an adjunct tool for more complex cases.

Common features of an effective telephonic case management that are linked to earlier return to work include:

• Return to work as a clearly stated goal. >  
• Defining return to work and what it means for all parties involved in the return to work process.
• Return to work needing to be the focus of discussions amongst the key parties.
• Prioritising the support of the individual, rather than simply assessing and monitoring the injured employee and trying to limit benefits.
• The provision of sound coping strategies that allow an injured employee to self-manage injury and/or illness.
• Focusing on overcoming the obstacles to the return to work process that may distract from diagnosis and therapies.
• A clear distinction between telephonic assessment and stepped care. Assessment is the process of evaluating progress and any barriers to future progress and may include the obtaining of existing employment and medical records, conducting telephonic interviews or administering online questionnaires. Stepped care starts with the least intensive intervention that will be effective in achieving the preferred outcome. It also provides further support as needed over time or according to the needs of the case.
• Effective integration of line managers into the return to work process and keeping them informed.

As well as improving results, use of the telephone for case management can be a more cost effective method of delivery:

• Rehabilitation costs include the time taken to arrange appointments and conduct meetings. There are also the travel costs associated with getting to and from meetings. Conducting case management via phone reduces or eliminates many of these costs.
• Telephonic coordination can streamline treatment services, and reduce the number of treatment sessions while maintaining or even improving client satisfaction.
• By centralising after-hours contact staff in a central location, ongoing training is easier to coordinate and more cost-effective.
• With mentors or supervisors able to listen in on case management calls, it is easier to conduct quality audits.
• By promoting access to appropriate health services related to a particular client’s condition, one does not waste time and money on pursuing unnecessary courses of treatment.

Australian Case Study

The following Australian study (Iles et al., 2012) reported in a recent UK report, provides positive evidence of the effectiveness of telephonic case management and costs reduction when implemented within a day of the injury occurring.

The intervention reported on involved early reporting, employee-centred case management and removal of return to work barriers. A quasi-experimental pre-post design was implemented with 16 selected intervention companies and a control group of 492 matched companies without intervention. There was an average of 21 months post-intervention follow-up.

There are two main features of the intervention:

The first was early appropriate medical intervention consisting of a 24-hour telephone contact line operated by trained injury managers to provided immediate professional assistance and encourage early reporting of a workplace injury. The aim was to receive the injury notification within 20 to 60 minutes of the occurrence. Anything longer than 24 hours was deemed to be a delayed injury report.

The worker was able to obtain care from their preferred medical practitioner or offered medical care at a preferred local clinic. Preferred medical specialists and allied health practitioners were also used. The goal was to shorten waiting times for appropriate procedures so as to encourage return to work to suitable duties.

The second intervention occurred at the workplace. Once the injury was reported, an injury manager was nominated to manage the process and guide the worker, employer and other key parties throughout the duration of the return to work. The injury manager facilitated contact between the key parties involved in the rehabilitation and return to work of the worker.

The supervisor or line manager was involved from the outset, and senior management was engaged to resolve any matters relating to alternative duties or lack of support for the worker. Human Resources contact was sought to resolve non-work injury issues or obstacles.

The injury managers managed cases by telephone contact or directly at the workplace with regular appointments. Injury managers were selected on their communication skills and ability to project manage.

Injury management software assisted with timely case management actions and streamlined electronic communication. The injury manager role undertaken was similar to a return to work co-ordinator, but the high level of specific training and consistent application of all processes were intended to allow the injury managers to perform their role at a higher level. The injury manager was an employee of the intervention company and was authorised by the worker to liaise with the key parties regarding their situation. Medical confidentiality applied.

The primary outcomes were average number of days of compensation and average cost of claims.
Secondary outcomes were total medical costs and weekly benefits paid. 3,312 claims were analysed.

In companies where the intervention was introduced, the average cost of claims was statistically significantly reduced from $6,019 to $3,913, and the number of days of compensation significantly decreased from 33.5 to 14.1 days. Medical costs and weekly benefit costs were also significantly lower after the intervention. Reduction in claims costs occurred across industry types, injury location, and employer sizes.

Iles et al. (2012), concluded that this model of claims management was effective in reducing the number of days of compensation, total claim costs, total medical costs and the amount paid on weekly benefits.
 

(Adapted from: Telephonic support to facilitate return to work: what works, how, and when?)