Elevating the consumer experience: Improving outcomes for injured employees

When an employee is injured on the job, there are multiple regulations, requirements, details and steps for the organization, the employee and their medical providers to complete. It can be an overwhelming process. But at the heart of the claim is a person who is hurt and suffering — an individual who may not know where to turn.

In recent years, there has been a dynamic shift in the focus of workers’ compensation claim philosophy. In the past, many employers were interested in resolving claims as quickly and as economically as possible. The injured were often cynical and employers were eager to avoid litigation.

Today, however, employers are expressing more concern with the well-being of their employees and are providing high-quality care to help make them whole again. Companies recognize that employees are their most valuable assets. As a result, claims and managed care solutions must focus on the end-to-end process and provide a personal connection with the injured employee to ensure the best possible outcome.

Ironically, this dynamic change in philosophy is proving successful for both the individual and the employer. This holistic approach is keeping costs and the need for litigation down while elevating the consumer experience to a new level.

Related: The pathway to workplace injury healing and recovery

It starts with the first conversation

Making a personal connection with the injured employee begins with the first conversation and continues throughout their recovery. It’s safe to say, if a claim starts out well, it will typically end well.

Imagine yourself as an injured worker. Worried, in discomfort and with a lot of questions. Where do you turn? This first point of contact is critical. It’s important that the claims team is able to provide information, answers and compassion so the individual feels that they are in good hands right from the start.

An integrated managed care service will connect the injured worker directly with 24/7 access to a nurse triage program. Registered nurses can answer questions, offer reassurance, and provide injury evaluation and care instructions.

It’s important that the representative sets the proper tone for the claim. An empathetic voice and active listener will provide confidence that the claims manager is here to help and is not simply looking to meet compliance standards.

By building a positive relationship with the injured worker from the outset, a better outcome is likely. The claims professional will gain a better understanding of the employee’s individual needs and can help find appropriate resources to get them on the best path for recovery sooner. The employee is more likely to follow through with submitting paperwork, providing necessary information and returning calls promptly.

Related: Does lag time impact claim costs or is it a symptom of a broken system?

On the road to recovery

Each claim is as different as the individual at stake and the path to a positive outcome must be personalized to meet individual needs. A well-integrated workers’ compensation solution will provide a wealth of experienced resources throughout the recovery process, including:

• Nurse case managers – experienced and caring medical specialists who can monitor and guide occupational injury care and access guidelines to manage treatment utilization.
• Behavioral health support – to serve as a patient advocate and foster a non-threatening, friendly, professional relationship. Through this support, additional personal concerns can be identified and addressed to help reduce the risk of litigation. It can also help address barriers to returning the injured employee to work, such as childcare issues or financial worries. These are all concerns that may impact the outcome.
• Return to work strategies – claims examiners, nurses and vocational specialists can provide immediate and continual return-to-work strategies that match the injured worker’s individual claim circumstances. Vocational specialists can help when employees have extensive restrictions and the employer has little opportunity to offer modified duty. They can help shorten the duration of the claim or intervene when providers are not following evidence-based guidelines related to returning to work.
• Surgery nurse services – to help injured employees facing surgery to be better prepared physically and mentally, and to confidently steer themselves toward a faster recovery. This innovative approach is designed to focus specifically on the needs of patients dealing with surgery, which has historically been a significant driver of high-cost claims.
• Physician advisors – to support key decisions that can significantly impact a claim. They can help ensure that the appropriate treatments are provided based on the injury, enhance the utilization review process, and provide medical and pharmaceutical expertise to ensure clients and their injured employees continue on the right path to achieve the best possible outcomes. 
• Prescription drug management – in an era of growing concern over the misuse of pain medications, pharmacy management programs help control the use of narcotics, opioids or inappropriate drugs prescribed to treat work-related injuries.

By offering an integrated approach to claims and managed care, employers can be proactive in engaging resources that help to expedite recovery.

Related: Workers’ comp and pain management experts discuss alternatives to opioids

Making use of technology

Technological advances are also helping to improve and expedite the claims experience. Real-time connectivity allows examiners and nurses to streamline communications and quickly exchange claims information.

Through the use of self-service tools, employers can track and analyze their claims information, access data about trends, run reports and more. At the same time, injured employees can view details about their claim, update information, access forms and take charge of their recovery experience all from the comfort of their home or hospital bed.

Such technology is enabling claims to be processed more quickly and efficiently than ever before and with greater transparency.

Caring counts

When employees are injured at work, it can be an unsettling and stressful time. They may be feeling uncertain about their job, their ability to pay bills, their health and their future. Doing the right thing in each case includes making sure the employee has access to the medical resources they need, listening to their concerns, showing compassion, and being there to assist at every turn. Supportive, collaborative service focused on the individual is good for both employers and employees and making well-being a priority has proven to be effective in improving outcomes and experience.

Related: 10 workers’ compensation issues to watch in 2019

Terri Riley is the SVP, managed care practices and client services at Sedgwick. She can be reached at teresa.riley@sedgwick.com.