How Enlyte’s Customized Telephonic Case Management Approach Boosted Efficiency and Savings for a Major Carrier

Problem

A large carrier considered outsourcing its telephonic case management services to a third party. After evaluating their current program, including the ongoing financial commitment to maintain a large clinical staff, a decision was made to request proposals from outside parties.
 

Solution

Aligning to the client’s vision, Enlyte created a customized early intervention telephonic case management program leveraging Enlyte’s risk identification tool for optimal case selection. The program was designed to ensure the carrier was provided a program that promoted injured employee advocacy, ensured timely access to quality care and reduced lost time days. Staffing needs were determined from a claims analysis that reviewed case durations, optimal caseloads and baseline productivity metrics.
 

Staffing and Productivity

Carrier Solution Included the Following:

• Private labeled program
• Reduction in overall clinical headcount due to an increase in case manager productivity
• URAC accredited program
• Electronic interface of case notes to the claim file
• Life of the claim risk modeling to identify and manage only those claims predicting or demonstrating the need for clinical intervention
• Elimination costs associated with recruitment, hiring, retention, salary, benefits, multi-state licensure, certifications and continuing education
• Clinical dashboard for a transparent view into inventory, costs and outcomes

Outcome

Carrier improved their bottom line without disruption to claims staff or clients during the transition.