Medical Case Management:
EKC’s Medical Case Management programs are useful to claims administrators, insurers, self-insured companies, attorneys, and anyone who has an interest in facilitating a positive medical outcome while making the best use of available medical expenditures. EKC has the experience and credentials to expertly manage any aspect of a catastrophic injury or complex medical case, from case management oversight to task-specific interventions. For this reason, EKC’s clients refer complex cases for a variety of case management interventions including:
• Medical review of file to identify treatment issues and potential high cost drivers which may be resolved through case management intervention
• Complete case management assessment with goals and recommendations
• Medical Cost Projection of future treatment and injury related services
• Specific interventions such as navigating a critical transition point in the case, resolving issues of complex or conflicting treatment, facilitating a significant change in facilities or treatment plan, or establishing the causal relationship of certain treatment or pharmacotherapy
• File review for a “second opinion” as to the progress and effectiveness of the current case management effort
Our Certified Nurse Case Managers’ extensive medical knowledge and experience can have a substantial impact on treatment direction and outcome in both the short and long term. We work closely with the injured party and treatment professionals, telephonically and in the field, making and implementing recommendations wherever necessary to further the goals of the case and achieve an optimal and cost-effective end result. EKC’s Case Management intervention can be helpful in most serious injury or medical claims, especially when the following “red flags” are suspected:
• Catastrophic, serious, or multiple injuries
• Complications resulting from treatment of monolingual patients
• Pre-existing conditions or complications interfering with treatment or prolonging the facility stay
• Medical “crisis” necessitating additional resources
• Ongoing treatment with no apparent end-point or plan
• Multiple diagnoses/multiple specialties involved
• Suspected secondary gain motives interfering with treatment
• Planned major surgery, hospitalization or discharge
• Home services or modifications requested or needed
• Reserve increases or medical expenses approaching reinsurance thresholds
• Multiple prescriptions, possible adverse interactions, or multiple specialties prescribing medications
• Need for cost projection for reserving or settlement