Case Management

 

Early Intervention Program (EIP)

 

The EIP has proven to be more effective at containing costs and driving best practices than a traditional claim adjuster-driven case management mode. In a side-by-side study versus a traditional model, all key metrics were substantially more favorable with the EIP. An Argus nurse telephonically evaluates new injuries through contact with the medical provider, the employer, and the injured worker. A plan to expedite a quick return to work is developed within 72 hours. Our results are achieved in a broad range of jurisdictions, many which do not allow for direction of care. Argus believes that this EIP Case Management model will be the most effective model at containing workers’ compensation costs while holding down program expenses.

 

Catastrophic Case Management

 

An Argus nurse will provide immediate on-site case management intervention for any catastrophic injury or illness. The team will initiate up to a four-point contact, medical provider, employer, injured worker, and claims professional, within 24 hours of receiving the First Report of Injury. A determination is made at this early juncture regarding what case management resource may be required using preset criteria.

 

Medical & Vocational Case Management Services

 

Effective Medical Case Management is controlling and managing of various types of medical services simultaneously. The objective of medical case management is always to reduce and control medical expenses. We additionally assure quality care to the injured worker, facilitate a timely return to a productive lifestyle, and maintain open lines of communication between the injured worker, physician, and employer. Argus employs an innovative Claims Closure Program to address open worker’s compensation claims and return to work. Our system has a 95% success rate in resolution of lingering claims.

 

Argus believes that the purpose and goals of Vocational Case Management are diverse. The vocational rehabilitation professional’s involvement is to determine and assess vocational aptitudes, abilities, dexterity and interests to provide a structured job search program for the injured worker. The principle focus of the process is to assist the injured worker in returning to a productive lifestyle, which includes employability and placement issues, thereby providing the insurance carrier with considerable cost savings.

 

Independent Evaluation Service

 

Argus can assist in the coordination of an Independent Medical Evaluation or Second Opinion Examination on an issue involving an impairment rating or attainment of maximum medical improvement. If needed, Argus can provide a peer review to address the medical necessity or impairment rating issues to determine if there is value in an independent evaluation at that time. If an independent evaluation is indicated, Argus will coordinate the setting of the appointment and deliver any medical documentation including peer reviews to the evaluating physician.

 

Life Care Planning

 

Life care planning is the process of determining and analyzing the needs of an individual with the onset of a disability. The Life Care Plan (The Plan) is a comprehensive client centered analysis that reviews the onset of the problem, the impact on the client, and the treatment projections for the future, often to the end of life expectancy. It includes medical and non-medical needs and addresses the whole person: including psychological and social factors, which impact treatment and/or the physical and psychological stability of the client.

 

Case Management

Guidelines for Determining the Necessity of a Life Care Plan:

 

  1. When the client has sustained a catastrophic injury.
  2. When the physician has determined the client will need lifetime medical treatment.
  3. When a claim has been inactive and suddenly medical bills are submitted from providers.
  4. When a claim involves an elderly client with multiple medical problems.
  5. When determining cost effective measures between home care versus institutional care.
  6. When it has been determined there are several injuries involved.