How nurse triage programs help facilitate early intervention in workers’ compensation claims

When a worker gets injured on the job, it's normal for them to experience confusion.

After all, "a lot of times, an injured worker has never had an injury before," said Erica Fichter, ARM, chief operating officer, medical management and accident & health, Broadspire. Only 14.7% of people have work injuries that require immediate medical treatment during their lifetime, according to a report from the CDC.

A worker who is injured might be frightened or in pain and feel nervous about navigating the workers' comp system. Often, they're just looking for someone - anyone - who can provide clarity and help them through the next steps. "Just being able to talk to that person initially sets somebody at ease. We're advocating for the injured worker," Fichter said.

Enter nurse triage programs. These programs allow workers to call in and speak with a nurse in the moments right after an injury.

By championing early intervention, nurse triage programs can help workers overcome the initial fear and confusion after an injury and set them on the right path to care - all while keeping costs low for employers.

Reduce costs, improve outcomes: The advantages of early intervention

Nurse triage services offer injured workers care and medical guidance immediately following an injury. Often, workers are able to call a 24/7 hotline and speak directly with a nurse. They can help to calm workers and direct them to the next stage of care, which can be important in an already confusing workers' comp system.

"The injured worker actually has the ability to start communicating their medical condition to somebody that's going to be able to put their mind at ease, and be able to speak to them about what happened to them and what it's going to take to help them advance to the next level,"

Fichter explained.

Triage nurses often help workers tackle minor to moderate injuries - think strains, sprains and small lacerations. A triage nurse might be able to use a video conferencing feature to determine whether a small laceration needs stitches or merely a Band-Aid. With these injuries, a worker might know they don't need emergency care, but may not know how to treat the injury themselves. A supervisor might recommend they go to urgent care or make an appointment with their physician. A worker might put this off, allowing the injury to get worse.

A nurse triage line can step in and immediately answer these questions. If an injury just needs self-care, like a minor sprain that can be treated with ice and ibuprofen, they can recommend that immediately. Workers get the care they need, which improves claims outcomes, and employers avoid costly urgent care or emergency room visits.

Without a triage line, employers "run the risk of possibly having the individual going into a medical facility - whether it's a medical provider, an emergency room, anything of that nature - where there could start to be overutilization of services," Fichter said. "Those costs start to add up."

If a worker needs more extensive care, a triage nurse can help them find a provider who is in-network and help kick-start the care process.

"If the individual does need further medical treatment, and they would prefer to be seen in a brick-and-mortar building, that nurse on the phone can give them recommendations based on their geographical location through their ZIP code," Fichter said.

"It's tied into our network, so you're getting that first visit within a network, which is always extremely important in workers' comp."

Whatever a worker needs, the early intervention championed by nurse triage programs can help improve outcomes - helping workers heal - while reducing costs for employers and insurers.

Streamlined claims management and innovative, data-driven decisions

By seeing a worker immediately after an injury, a triage nurse can collect valuable information that helps the claims adjustment process run more smoothly. Effective triage allows workers to receive the right care at the right time in the claims process. The nurse can act as a quarterback of sorts, facilitating communication between the employer, the health care providers, the claims adjusters and other stakeholders.

"When the claim is actually reported into intake, they already have that information ready to go," Fichter said.

The best nurse triage services are constantly improving. Many services analyze their data to detect trends in injury types and treatment outcomes so they can make better decisions about care. In some cases, triage services have even developed algorithms that help determine if a particular injury is eligible for a telemedicine visit with a doctor, rather than an appointment at a physical location. Virtual visits can help workers see doctors more quickly, allowing them to start the treatment process sooner rather than later.

"There's an algorithm that is being run behind the scenes to determine if the injury is eligible for a telemedicine visit versus actually having to go to a brick-and-mortar facility," Fichter said.

"If it's eligible, the nurse will ask the individual that was injured, 'Would you like to have a telemedicine visit?' It is totally up to the individual. If the individual says yes, then we go ahead and make that referral over to a telemedicine provider who will then go ahead and send a link to the individual, who can now have their telemedicine visit."

Video visits are often cheaper than in-person ones, too. As Fichter put it: "Telemedicine is just another way to reduce expenses to a claim file."

Comprehensive, client-centered service

Early care in workers' comp is paramount to ensuring claims run smoothly and costs are kept reasonable. Nurse triage programs are also key to helping injured workers get the care they need, when they need it, and they're skilled at helping companies keep their workers' comp costs low.

Broadspire's comprehensive nurse triage program uses cutting-edge technology and data-driven decision-making to get injured workers the care they need while keeping costs low for their clients. Its team of nurses has extensive experience with workers' compensation and liability claims management. The programs use claims management software, telemedicine platforms and mobile applications to help manage claims and facilitate easy communication through every step of the claims process.

Triage programs can be customized to meet a client's needs. As Fichter put it, the program "can be very flexible."

"There are some clients that like to really focus on it. They say, 'I want everything going through nurse triage. It doesn't matter. I want everything going through.' Other clients may say, 'Well, from a location perspective, this location seems to have greater costs as it relates to their workers' compensation cases, so we want this particular location to be linked into a nurse triage program.' "

Other clients may want the triage nurse to ask specific questions on the initial call to help assess whether workers were following safety protocols. If a worker wasn't wearing safety shoes with special grips, for instance, the employer might want to know that so they can increase training around safety protocols. "We can customize questions that the employer may want specifically asked," Fichter said.

All in all, Broadspire's program offers clients strong risk management insights, and technological advances allow them to run nurse triage programs tailored to their clients' needs, improving claims outcomes and creating value for every stakeholder in the workers' comp process.

To learn more, visit https://www.choosebroadspire.com.

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