The Role of the Case Manager

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The Role of the Case Manager

• BICMA Conference Glasgow
• 10th October 2007

Rosie Corless QBE Rehabilitation Manager
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Why Case Management...the drivers?

• Government initiatives IB spend
• NHS acute v chronic
• Cost of absence to business bottom line
• Claims cost escalation
• Insurance Market employers brokers
  solicitors
• Insurers diversifying products need for case
  managers

• It is not the strongest of the species that
  survives, NOR the most intelligent, but the one
  MOST responsive to change.
• 
  Charles Darwin

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So, QIE for example

• Occupational Health
• Task Analysis
• Riddor Triage Service
• Minor Major Injury Management Service
• Whiplash Scheme Motor

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The Challenge for the Case Manager.
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Is To

• Act as IP Advocate
• Use clinical best practice
• Objective v Subjective
• Act as Mediator Negotiator, Evaluator....
• Be honest
• Query Statutory Services v private funds?
• Understand case law
• Know Reality

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And Their Role

• Independent
• Advocate
• Assessor face to face/telephone/desk top
• Plan implement health, social vocational
  services
• The link between all parties
• Interpretor of all the facts
• Budget controller
• Educator client independence

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Case Management Definition

• ..A collaborative process which assesses, plans,
  implements, co-ordinates, monitors and evaluates
  the options and services required to meet an
  individuals health, care, educational and
  employment needs, using communication and
  available resources to promote quality cost
  effective outcomes..
•  

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Mission Impossible?
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The QIE Rehabilitation Team
Rosie Corless Rehab Manager Nurse
Emma Linskill Rehab Team Leader Occupational
Therapist
Rebecca Gallagher Rehab Advisor Occupational
Therapist
Bianca Kelly Rehab Advisor Occupational Therapist
Max Wolstenholme Admin Assistant
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So The Team

• All previous Case Managers Clinicians
• Work with outsourced case manager panel
• Train support
• Set KPIs SLAs Audit Review
• Explain decisions
• Focus on early intervention
• Look for Case Managers with Professional Body
  Membership - CMSUK

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Case Management in Action The Benefits

• 39 year old Carpenter injured back whilst lifting
  at work.
• Date of Accident
  06/04/2003
• Date Referred to Case Manager 16/04/2003
• Assessment
  17/04/2003
• Predicted time off Work 6 months
• Case managed telephonically by case manager. Long
  wait on NHS for physiotherapy as recommended by
  GP.
• Course of private physiotherapy arranged.
  Education on back care and a gradual return to
  work initiated in conjunction with treatment
• Rtw date
  17/06/2003

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Case Management in Action The Benefits

• 31 year old - Severed L arm ( non dominant)
• Date of Accident. 17/07/2002
• Referral Rehab Unit 15/08/2002
• Referral to Case Manager 14/11/2002
  Claim
• Assessment
  16/01/2003
• Surgery to remove piece of bone.
• Gym membership, work site Ax, CBT Therapy,
• Myo-electric arm prosthesis.
• Supportive employer - Single handed
  keyboard/trackerball mouse.
• IP rtw planned 24/09/2003. Further panic
  attacks additional CBT Therapy
• Rtw date 18/11/2003 on gradual basis
• Full time 13/07/2004

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How CMSUK Assists

• Developing Case Management in UK!
• Started small Inaugural Meeting (8), 2000
• Worked with CMSA
• Now over 300 members
• Allows those practising case management to come
  together
• Set UK Case Management Standards
• Education Training
• Quality Assurance

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Where CMSUK is Now

• Charitable Status
• 5 Committees Standards and Education
• Membership
• Events
• PR Marketing
• Website
• Enhanced Web Site case manager search facility
• 2 Day National Conferences Study Days
• Education Fund
• Ongoing support from our members

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CMSUK 6 Core Statements

• To promote Public Wellbeing
• Establish UK standards for Case Management
• To promote initiatives in Education
• An all encompassing organisation for Case
  Management
• To build Public and Private partnerships
• Work with Government to challenge health and
  social care boundaries

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CMSUK Corporate Members
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The Role of the Case Manager

• BICMA Conference Glasgow
• 10th October 2007

Rosie Corless QBE Rehabilitation Manager