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The Role of the Case Manager

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  1. The Role of the Case Manager BICMA Conference – Glasgow 10th October 2007 Rosie Corless QBE – Rehabilitation Manager

  2. 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

  3. Injury Management Return to Work programmes RTW SAW Effective Outcomes Occupational Health Task Analysis Sickness Absence Consultation with client Incident So, QIE for example… • Occupational Health • Task Analysis • Riddor Triage Service • Minor & Major Injury Management Service • Whiplash Scheme – Motor

  4. The Challenge for the Case Manager.

  5. 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*

  6. 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

  7. 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..”

  8. Mission Impossible?

  9. 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

  10. So The Team… • All previous Case Managers & Clinicians • Work with outsourced case manager panel • Train & support • Set KPI’s; SLA’s ; Audit & Review • Explain decisions • Focus on early intervention* • Look for Case Managers with Professional Body Membership - CMSUK

  11. 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

  12. 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

  13. 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*

  14. 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

  15. 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

  16. CMSUK Corporate Members

  17. The Role of the Case Manager BICMA Conference – Glasgow 10th October 2007 Rosie Corless QBE – Rehabilitation Manager