How one CM director maintains quality

Willingness to change ideas is key

Marriott International in Washington, DC, self-insures 200,000 employees nationwide with the help of a staff of 17 case managers scattered across the United States. Managing this decentralized staff and ensuring that employees nationwide receive comparable, quality care is a constant challenge. Rachel Ebert, MS, FNPC, RN, COHN-S, director of occupational health services for Marriott, uses more than one tool to keep her case managers on track.

"The first rule I apply to managing a national staff is to never send a case manager from California to New York City, or vice versa. In order to do a good job, a case manager must understand the demographics of the region, the workers’ comp laws of the surrounding states, and the regional standards of practice for providers," she says.

Audits, surveys, on-site visits

To maintain a consistent quality of care, Ebert uses the following methods:

• Every case manager is audited annually with a standard audit tool and peer review.

• Every month, case managers send Ebert a summary of each active case.

• Case managers are divided into small regional groups of three to four and have conference calls once a month to review active cases and conduct peer review.

• Marriott surveys every employee in case management, as well as the employee’s supervisor and the claims adjuster about their satisfaction with the case manager’s performance.

"If there appears to be a problem with the management of a particular case, I make a trip out there to meet personally with the case manager and see why she or he is making certain decisions. I may find that every decision was made for valid reasons. I may agree with the claims adjuster or supervisor that there is a problem," says Ebert.

It’s not easy managing a large, geographically segregated case management staff. "We’re constantly changing the way we do things and looking for the best way to ensure the system works smoothly and employees get the same quality of care no matter where they are in the country," she says.

"I think there are some positive signs that the case management staff is doing a good job," Ebert notes. "Now, when Marriott goes into a new area, the claims people ask for a case manager to be hired at the same time."