ADVANTAGES OF CASE MANAGEMENT

TRISTAR Managed Care provides professional case managers experienced in Workers’ Compensation. The medical case manager’s objective is to ensure the delivery of quality health care at the most appropriate level of service in a timely, cost-efficient manner with a focus on expediting return to work.

Advantages for Claims Administrators:

• Reduces both medical and indemnity costs without compromising healthcare quality
• Minimizes the number of days a case remains open
• Medical case manager provides impartial and objective review of treatment plan
• Early identification of “red flags” and complex cases with possible solutions
• Ensure quality care with timely and cost effective treatment based on medical necessity
• Improves communication to prevent adversarial relationships with providers and claimants
• Integrated case management treatment plan with bill review system to ensure compliance with treatment plan recommendations.

Advantages for Employers:

• Program is focused on early return to work principles
• Produces a reduction in both medical and indemnity costs
• Reduces indirect costs such as loss of production, replacement costs, and training
• Early, effective communication with the employee by the case manager will prevent miscommunication in regard to modified duty availability and job requirements.
• Reduces incidence of litigation
• Limits the opportunity for psychosocial issues to arise by returning the employee back to work as soon as possible.

Advantages for Employees:

• Assurance of prompt, quality, cost effective medical care
• Employee education - employees are increasingly faced with treatment choices that may result in different outcomes, yet they often are not given accurate information about how a specific treatment may affect their lifestyle
• Medical treatment aimed at returning the employee to his/her job
• Elimination of unnecessary treatment

Advantages to the Treating Physician:

• Established referral procedure to obtain timely approval of proposed treatment
• Effective follow through with authorized medical procedures to completion
• Partnership with the provider to ensure successful outcomes and achieve early return to work

For questions or referrals please contact TRISTAR Managed Care. You may also fill out a referral form and send it to TMC by email.