Transcript Page title second line if necessary

QBE EUROPEAN OPERATIONS
The Role of the Case Manager
BICMA Conference – Glasgow
10th October 2007
Rosie Corless
QBE – Rehabilitation Manager
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
QBE EUROPEAN OPERATIONS
2
So, QIE for example…
 Occupational Health
 Task Analysis
 Riddor Triage Service
 Minor & Major Injury Management Service
 Whiplash Scheme – Motor
Injury Management
Occupational Health
Consultation with
client
Task Analysis
Sickness Absence
QBE EUROPEAN OPERATIONS
Incident
Return to
Work programmes
RTW
SAW
Effective
Outcomes
3
The Challenge for the Case Manager.
QBE EUROPEAN OPERATIONS
4
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*
QBE EUROPEAN OPERATIONS
5
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
QBE EUROPEAN OPERATIONS
6
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..”
QBE EUROPEAN OPERATIONS
7
Mission Impossible?
QBE EUROPEAN OPERATIONS
8
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
QBE EUROPEAN OPERATIONS
Max Wolstenholme
Admin Assistant
9
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
QBE EUROPEAN OPERATIONS
10
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:
QBE EUROPEAN OPERATIONS
17/06/2003
11
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
QBE EUROPEAN OPERATIONS
12
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*
QBE EUROPEAN OPERATIONS
13
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
QBE EUROPEAN OPERATIONS
14
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
QBE EUROPEAN OPERATIONS
15
CMSUK Corporate Members
QBE EUROPEAN OPERATIONS
16
QBE EUROPEAN OPERATIONS
The Role of the Case Manager
BICMA Conference – Glasgow
10th October 2007
Rosie Corless
QBE – Rehabilitation Manager