Early nurse engagement makes a valuable impact in 3 key areas

Recent analysis of Sedgwick’s claims data shows that employers using 24/7 clinical consultation for workplace injuries saw 34% lower incurred costs than those using an intake process without a nurse triage service. Engaging a nurse immediately after an injury occurs can help ensure the employee receives the appropriate treatment and recovers as quickly and safely as possible.

Identifying the right care

Employers evaluating the use of a nurse triage service should ask what guidelines the nurses use to qualify an injured employee for self-care, telemedicine or in-person care. Guidelines matter because some organizations that rely on triage as their primary revenue model create guidelines that will drive higher initial self-care direction. That creates a false economy that employers often fail to see.

Identifying and coordinating the right care is a key component in a successful nurse triage program. Sedgwick analyzed data after clients moved from an aggressive self-care nurse triage model provided by organizations that rely on nurse triage as their primary source of revenue and found that over-aggressive use of self-care led to a significant increase in lost time duration – 1.8 days versus 14.8 days on claims valued at 12 months.

Improving prescription safety

Another area where employers can engage a nurse early and strategically is through prescription drug utilization review. Indicators developed with the pharmacy benefit management network can prompt nurse engagement and pharmacist or physician peer review, if necessary, to stop unsafe and unnecessary drugs before they are dispensed at the pharmacy. This is an especially helpful tactic to stop opioids and costly compound drugs, and educate injured employees and prescribers. It also improves prescriber practices. Last year, 44% of the prescription drugs requested were denied or withdrawn via utilization review.

We compared claims with two prescription opioid fills and claims with five or more opioid fills and found the average claim duration was 88% higher for claims with five or more refills. The average total paid on the claims with more prescriptions was 191% higher. In fact, when five or more opioid refills were prescribed, non-surgical claim duration exceeded the average duration for major surgery claims by 4.4%. Early pharmacy clinician intervention is critically important for managing cost and safety.

Using data to improve outcomes

Employers should evaluate how their telephonic case management (TCM) referrals occur. Last year, Sedgwick deployed decision optimization for TCM assignment. The decision optimization platform leverages data trends early to identify claims that would benefit from nurse engagement. With the decision optimization software, the average referral time from the date the claim is reported and set up in the Sedgwick claims management software is 13 days vs. 107 with standard business rules. We recently reviewed the outcomes and found that the lag time from the date the claim was received to the date of nurse assignment dropped 10%. Those claims show costs savings including 4% lower average indemnity, 2% lower medical and 3% lower overall incurred, and the nurses closed them 5% earlier.

Engaging a nurse early and using best-in-class guidelines ensure injured employees receive the right care and helps control claim costs and duration.