Integrated program gets injured workers back on the job quickly

Disability, health care case managers work together

Employees who are injured or ill return to work full time more quickly and experience a shorter period of disability when the health care components and disability components of an insurance company work together, a CIGNA study of 60,000 short-term disability claims has shown.

"The health care nurse case managers who coordinate the medical care and the disability nurse case managers who get involved when the patient files for disability play different roles in getting disabled patients back to work. Each role is essential for optimal patient recovery," says Angelica Greene, MHS, CRC, manager of medical and vocational resources.

CIGNA launched its Disability and HealthCare Connection approach to caring for injured workers in 2002, taking a holistic view of an individual’s disability. The approach integrates the services provided by disability nurse case managers and medical nurse case managers to facilitate recovery and return to work.

The study, conducted last year, showed that disability durations were 12% shorter and return-to-work rates were 6% higher among employers who had CIGNA Disability and CIGNA HealthCare coverage.

At CIGNA, the health care nurse case manager coordinates injured patients’ care while the patients are in the hospital, ensuring appropriate and consistent care, following best practices and clinical guidelines.

The disability nurse case managers get involved once the member has filed for disability benefits. They concentrate on the patient’s functional capacity, making sure that the treatment plan supports return to work. They investigate and document the medical limitations or barriers that limit functionality and could inhibit the patient from returning to work. They partner with the vocational rehabilitation counselors who coordinate a return-to-work plan with the employer.

In some cases when the vocational rehabilitation counselor finds out the physical requirements of the claimant’s job, the disability nurse case manager may get involved again, gathering medical information about how the member’s condition may impede his or her ability to perform all the functions of the job.

The health care case managers and disability case managers stay in touch with each other through the CIGNA intranet and over the telephone.

The team takes a proactive approach to ensuring a successful return to work. If patients file for disability while they’re still in the hospital, the disability nurse case manager and the health care nurse case manager may coordinate the case simultaneously.

"If a patient’s condition is likely to mean that they qualify for disability benefits, the health care nurse case manager will ask the patient if they have filed for the disability benefits. The more proactive we are with early intervention, the better we can make an impact," Greene says.

HIPAA regulations require the health care nurse case managers to get signed permission to share any medical information with the disability nurse case managers, she points out.

While the health care nurse case managers look at diagnosis and a treatment plan, the disability nurse case managers concentrate on the members’ functionality and how it can affect his or her return to work.

Whenever necessary, the nurse case managers pull in other professionals to get the member the help he or she needs.

Patients who are ill or injured also may have chronic illnesses, including clinical depression, which occurs in approximately 45% of cases, according to Lynette Dean, RN, CCM, senior nurse case manager.

For instance, CIGNA’s study showed that chronic health issues, such as heart disease, diabetes, and low back pain account for 56% of short-term disability-related medical costs.

When the disability nurse case managers encounter clients with a chronic disease, they refer them to CIGNA’s WellAware disease management program when appropriate for help in managing it. In some case, the disability nurse case managers contact the health care nurse case managers to discuss the problem.

"Injured or ill workers often have multiple problems, including depression, financial loss, and difficulties with personal or family relationships. It may take a team approach to help with all the problems," Dean points out.

When the disability nurse case managers identify an injured or ill worker who has psychosocial needs or concerns, they transfer them immediately to an employee assistance program or ask to refer them to a behavioral health program.

"CIGNA takes a global look at returning people to a productive lifestyle by involving the health care nurse case managers, the disability nurse case managers, and vocational rehabilitation counselors," Greene says.

For instance, the disability nurse case managers call on their counterparts in the health care case management arena for help in complex cases, when patients have multiple problems and are being treated by multiple physicians.

"They can verify treatment providers and partner with them to get approval for a treatment plan that might help the member return to work," says Greene.

CIGNA’s integrated approach to disability management includes a strong educational component to ensure that every person involved in the member’s care understands his or her disability, limitations, and abilities, she notes.

"Many times physicians and the case managers on the health care side have no contact with the patient’s employer and may not be as familiar with the accommodations that may be made for a successful return to work," Greene says.

CIGNA has produced an on-line disability tool kit that educates physicians and their office staff on the disability process and how the disability management process can help in the treatment and recovery plan of their patients.

"Physicians focus on disease processes, what kind of treatment should be happening, and what the outcome should be. When someone who is injured or becomes ill goes to the physician, the concentration is often on just relieving the patient’s symptoms. We want them to go to the next step and look at how the injury or illness will affect the patient’s ability to return to work at their own job or another job," Greene says.

The toolkit includes information on return to work and modified duty, common disability terms, and the basics of short-term and long-term disability.

"It was designed to help health care professionals, including physicians and their office staff, understand the disability claims process and how we make claims decisions. We want them to be able to understand how they can get more effectively involved with disability nurse case management," Dean says.

The team works with the physicians to overcome barriers to returning the employee to work.

The physician may not be aware that that the employee could go back to work part time with job modifications or the treatment plan lacks a focus on return to work.

"Sometimes, there are real challenges to getting a patient back to work. We encourage the doctors to tell us when it’s reasonable for an employee to have a change in functionality and encourage them to include return to work in the treatment plan," Dean says.