EXECUTIVE SUMMARY

Case managers have used many telehealth options during the COVID-19 crisis. These include remote physical therapy, video meetings, and monitoring patients’ chronic conditions and vital signs.

  • Virtual case management services help workers improve their physical functioning, even in cases in which the worker has to stay home because of physical distancing orders and work furloughs.
  • Some workers’ compensation patients are battling COVID-19 in addition to their work-related injury, resulting in strict infection control and more virtual monitoring.
  • NYU Langone Health planned to evolve its telemedicine options over a five-year period. Instead, it greatly expanded its telehealth within one week.

Case management in the era of COVID-19 has evolved, with clinicians and case managers increasing the use of telehealth and virtual technology solutions for communicating with patients and monitoring their chronic conditions.

Some case managers also have handled workers’ compensation cases in which injured workers contracted COVID-19 — making it even more important to keep interventions safe and remote.

“We’ve been getting more patients with COVID, but no other injuries. We treat them like we would patients with respiratory problems,” says Cynthia Bourbeau, RN, CRRN, CCM, CNLCP, rehabilitation nurse case manager, life care planner, and president and owner of Medical and Life Care Consulting Services, Inc. of Belchertown, MA.

“Some COVID-19 cases are mild. The person needs testing and an evaluation process in place to make sure they’re OK to get back into the community and back to work,” Bourbeau says. “Some have nausea and dizziness, a residual cough, and all of them need to be assessed.”

After states issued stay-at-home orders in the spring, workers’ comp case management moved almost entirely to remote evaluation and care.

Health technology companies have ramped up their existing remote care options and rolled out new ones during the crisis. For example, One Call, a network management company that serves the workers’ compensation industry, and Sedgwick, an integrated business solutions company, collaborated on virtual and post-COVID-19 programs to help employees return to work.

“In this new virtual world, we started looking at what were the opportunities and needs for workers as it relates to safety, injury prevention, and wellness,” says Kevin Harried, CISA, CISM, chief risk and compliance officer at One Call in Jacksonville, FL.

The pandemic has resulted in more telehealth options. It also has presented more case management challenges, particularly in workers’ compensation, he says.

“Just like everybody in workers’ compensation, when the pandemic hit, clearly, everyone had a challenge. Everyone saw [industrial] business go down,” Harried says. “Ultimately, I think it will be a slow recovery process, but things are happening, and that’s positive.”

Virtual services are offered where workers are located — which, due to furloughs, often is at home, he notes.

“The opportunity exists for virtual encounters to continue expanding,” Harried says. “Coming out of this socially distanced world, people are more comfortable with virtual encounters in healthcare.”

For example, virtual physical therapy was more widely used during the crisis. Physera of San Mateo, CA, created a process to provide remote physical therapy assessment and treatment.

“Our app is designed and built from the ground up to optimize the remote physical therapy experience,” says Dan Rubinstein, PhD, co-founder and chief executive officer of Physera. “It’s not a video chat; it’s been built-in with HIPAA compliance, and we have a lot of patient and provider interactions with the app.”

The app includes video explanations of physical therapy exercises. Also, it provides a vocal prompt that takes patients through the workout. (See story about remote physical therapy in this issue.)

“We offered our remote physical therapy program through health plans and large insurers for a number of years. Now, we’ve made it available to anyone who can stay out of pocket,” Rubinstein says. “During the crisis, many in-person physical therapy clinics were not able to treat patients in person anymore. We put up a version of our program that anyone can access and pay out-of-pocket at a reduced rate. We also signed up health plans to include us nationwide.”

In the pre-pandemic days, telemedicine was a small portion of clinical care for many healthcare systems.

“We’re fortunate that our institution had invested in pre-enterprise quality telemedicine/virtual health experience and had been focusing on it for a few years,” says Devin Mann, MD, associate professor in the departments of population health and medicine, and senior director for informatics innovation and medical center information technology at NYU Langone Health in New York City. “But telemedicine was such a small portion of the volume of work. We had planned to evolve over the next five years; instead, it happened in a matter of five days.”

The virtual and technological transformation was remarkable, he says. “We were planning to do telemedicine, but not that fast,” he explains. “We trained thousands of doctors in a matter of days.”

The telehealth solutions also connect clinicians via a video connection. Case managers can connect with patients remotely — even those who are hospitalized.

“Rather than have a person come into the patient’s room, we set up a tablet in the patients’ rooms so folks don’t have to go in there 10 times a day,” Mann says. “This limits the personal protective equipment [PPE] burn rate.”

Videoconferencing also works for communication between case managers, clinicians, and families, he says. (See story about telehealth and case management solutions in this issue.)

Case managers can monitor patients remotely, even when the patients experience broadband connectivity issues at home, says Steve Davis, PhD, associate professor in the department of health policy, management, and leadership at West Virginia University (WVU) School of Public Health. (See story about WVU telehealth pilot study in May 2020 issue of Case Management Advisor.) This type of remote case management can work even if patients do not have broadband.

“There is an option to have a device that sits on a table and can be hooked into a landline,” says Davis, adjunct professor in the department of emergency medicine at WVU School of Medicine. “It has a larger button for participants with sight issues; it talks and tells them to enter in their vital information.”

Since the case management and technological solutions were part of a telemedicine study, patients received the technology at no charge. They received a tablet for viewing customized questions about their symptoms, such as heart failure.

“Based on their answers, they’re given some brief education to read and to keep their chronic condition under control,” Davis explains. “The tablet has additional options like a video chat with our project nurse.”

Fall monitoring is another remote option. “It’s similar to the commercials where a person wears a device, and if they fall, they press a button and call for help,” Davis explains. “We get notified if a fall happens.”

The notification helps keep patients out of the hospital after falls that do not cause serious injury, he notes. “It has the added benefit of keeping patients safe at home, so they don’t have to travel into the healthcare setting and risk COVID-19 exposure by other patients, which is the real concern,” Davis adds.

Most of these types of remote case management were available in 2019 and earlier, but they became more important during stay-at-home orders.

“Prior to COVID-19, we’d contact patients and do onsite evaluations of their injuries,” Bourbeau says. “We’d go to their doctor’s appointments, prepare them, and review potential questions.”

Case managers would coordinate the patient’s care and help him or her get answers and treatment recommendations, she adds. “When COVID happened, we started protection protocols,” she says.

For many people receiving case management services, a COVID-19 infection would be life-threatening, Bourbeau notes.

When case managers visit patients’ homes, they use hand sanitizer, disinfectant materials, and they follow infection prevention protocols. “Everyone is protecting the patient as best they can,” Bourbeau says. “Our staff wears masks, gloves, and uses hand sanitizer.”

Case managers ensure home health workers also follow infection prevention protocols. People who visit patients are tested for the virus before they enter homes. They are checked for fever and evaluated to be sure there is no sign of illness, she says.

If staff object to enhanced infection prevention protocols, there are cautionary tales: “I heard of a home care company whose only team in a particular house tested positive and the patient tested positive,” Bourbeau says. “That patient has respiratory compromise, so they’re going to watch him closely.”