Arlene Guzik reviews strategies that provide us with effective occupational health case management. Arlene gains our attention by stating that even the United States spends more money per capita on healthcare than any other nation, there is a growing body of knowledge that supports the fact that patients do not receive proven therapies. She lays the background of case management's role in workers' compensation. By focusing on the major concerns found in the workers' compensation system, she reassures us that keeping the injured worker on the job is a vital strategy. Arlene's parting guideline is to establish goals that provide quality medical care in a timely fashion, to maintain productivity of the injured worker, to ensure client satisfaction at all levels, and to assist in controlling the cost of the claim.

Mary Paquette introduces us to the million-dollar claim and methods of controlling this type of claim of reaching the million-dollar level. First, identify the nature of the claim to determine whether it has the possibility of costing million dollars. Case managers can have a role in controlling cost, while assisting the patient; they can notify internal claims/finance staff to flag the claims as they arrive. It boils down to early identification of cases with potential high cost and referring them to claim negotiation specialists, which can result in additional savings while maintaining provider relationship.

Karen Broen outlines the caveats that each case manager needs to consider as she approaches a new patient. Her opinion is that workers' compensation nurse case managers can be likened to an intervertebral disc: "takes a lot of pressure from several different areas while striving to provide safe and appropriate case management within the parameters of state law without bulging in any area and without causing additional discomfort for those with whom she is working." Karen's parting view is that it requires a good sense of humor and a genuine liking for other humans to be within the workers' compensation/case management field.

Frances Snowden BS, RN, CRRN, CCM

Contributing Editor