THE H.R. MANAGER’S MENU FOR RESOLVING HEALTHCARE PROBLEMS: Raymond Rupert MD. MBA. Rupert Case Management Inc.

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The H.R. manager should be aware that there is a comprehensive, easily accessible, cost effective menu of healthcare services,  that extend well beyond the IME.

Let’s explore this menu:

The Independent Medical Evaluation (IME):

If the H.R. manager and the lawyers are preparing for war, then the IME is de rigeur.

At $2500 to $4500 per IME, they are a very costly purchase. The question is whether they deliver value, aside from being a legal defence.

If the objective is to help the employee get healthy and return to work, then the IME may not be the right purchase.  The job of the IME is to document the problem.  The IME gives the employee a label to fixate on.

The IME does not implement an action plan nor provide access to care. The IME does not engage the employee to get back to the shop.

For many H.R. managers, the IME is the only purchase.  However, there are other options available.

The Medical File Review:

At $500, the medical file review is a bargain.  The medical file review should summarize the salient points of the case. The medical doctor who provides the file review should provide a medical opinion and whether the case is being properly or improperly managed.  The doctor summarizing the case may suggest a second opinion from a domain expert.

The Second Opinion:

An expert medical opinion should cost about $500 following a file review.

The medical opinion should be focused on a plan to investigate and treat the healthcare problem in order to get the employee back to work in a timely manner.

Medical Case Management:

Medical case management is not the same as case management provided by an insurance company employee. Day and night.

Medical case management involves a medical doctor working with a team of nurses and other care providers such as psychologists and social workers. They will also have access to specialists.

Case management provided by an insurer or a disability manager is, in many instances, an administrative service provided by an administrative person.  There is often no professional medical or nursing staff involved.

It is very difficult to resolve clinical problems with no clinical expertise. The HR manager should ask that medical case management be provided.

Patient Advocacy:

Accessing resources is challenging in our complex and constrained healthcare system. The job of the advocate is to navigate the system and facilitate access to services. This requires a deep understanding of the system and how it works and how to access services required by the employee.

Motivating The Employee: 

Employees who have been off work for extended periods of time (over 8 to 10 weeks) become demotivated and deconditioned.

It is important to involve the entire family in the communications and to select a realistic return to work date that the family is committed to. The advocate must engage the employee and shift the focus to positivity.

Adjudication Of Medical Claims:

The HR manager will have situations that require medical judgement. Is the shift work accommodation based on real medical reasons or just whimsy?  At Rupert Case Management, we are able to adjudicate any types of medical claims.

The Virtual Medical Director:

HR managers should have access to a medical doctor 365 days per year. For example, when a factory worker is diagnosed with TB and HR learns about it on a Sunday morning, then HR wants access to a medical doctor then and there. This service is available at Rupert Case Management 365.

Accessing An Integrated Healthcare Network:

Medical resources are scattered throughout the country.  HR managers with access to an integrated healthcare network are miles ahead of the competition. And with a one stop shop like Rupert Case Management, the task of finding resources is made even easier.

Insurance Advocacy:

Buying employee benefits is easy. The challenge occurs when the insurer declines a claim. This causes the H.R. manager to re-think the supplier of the benefits. To resolve the matter, there is a need for insurance advocacy which is a core competency at Rupert Case Management.

Healthcare Literacy: 

Understanding the healthcare problem is an important step is getting better. What is sciatica? What does it mean for my future? Is it treatable? With what types of treatment? What happens if I have surgery? Will I be able to life again?

The more information that the employee has, the more prepared he/she will be to engage in getting healthy.  Your vendor should be able to provide the information and research in easy to understand language for your employees.

Medical Administrative Support:

Many employees have the fear of completing medical forms. At Rupert Case Management we help employees to properly fill out medical forms.

Chronic Disease In The Work Place:

Many employees are choosing not to retire. The result is that there will be more older employees in the work place with chronic diseases. It will be important for the HR manager to understand how to help the employee burdened with chronic diseases.

To keep these employees at work, there is a need for proactive medical case management services.

Dental Case Management: 

It is not unusual for an employee to have dental work that can cost over $20,000.

Unfortunately, some of these dental cases result in poor outcomes.

Dental case management is a new service provided by Rupert Case Management to help employees with expensive dental care that has failed.

Summary: 

The menu of healthcare services for HR is extensive. It extends well beyond the IME.

We have provided a brief snap shot into what is readily available.

To learn more from the team at Rupert Case Management call or email:

647 350 5500 / 800 620 7551

info@rupertcasemanagement.com