Workers' Comp

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

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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.
 

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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.
 

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Staffing and Productivity

Pre

Post 

120 RNs

102 RNs

  • Billable hours per RN per day: 5
  • Billable hours per RN per year: 1,223 year
  • Billable hours per RN per day: 7.5
  • Billable hours per RN per year: 1,851 year

 

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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

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Outcome

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

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Year one Staffing Efficiencies:
34% Improvement in case manager productivity
627.5 Additional hours per case manager per year
Claim Outcomes:
57 Average business days saved per claim
$8,500 Average savings per claim
6.5 to 1 Client return on investment
 

 

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