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QBE EUROPEAN OPERATIONS
The Role of the Case Manager
BICMA Conference – Glasgow10th October 2007
Rosie CorlessQBE – Rehabilitation Manager
2QBE EUROPEAN OPERATIONS
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
3QBE EUROPEAN OPERATIONS
RTW
SAW
Effective
Outcomes
IncidentConsultation with client
Occupational Health
Task Analysis
Sickness Absence
Injury Management
Return to
Work programmes
So, QIE for example…
Occupational Health
Task Analysis
Riddor Triage Service
Minor & Major Injury Management Service
Whiplash Scheme – Motor
4QBE EUROPEAN OPERATIONS
The Challenge for the Case Manager.
5QBE EUROPEAN OPERATIONS
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*
6QBE EUROPEAN OPERATIONS
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
7QBE EUROPEAN OPERATIONS
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..”
8QBE EUROPEAN OPERATIONS
Mission Impossible?
9QBE EUROPEAN OPERATIONS
The QIE Rehabilitation Team
Rosie CorlessRehab Manager
Nurse
Rosie CorlessRehab Manager
Nurse
Rebecca GallagherRehab Advisor
Occupational Therapist
Bianca KellyRehab Advisor
Occupational Therapist
Emma LinskillRehab Team Leader
Occupational Therapist
Max WolstenholmeAdmin Assistant
10QBE EUROPEAN OPERATIONS
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
11QBE EUROPEAN OPERATIONS
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
12QBE EUROPEAN OPERATIONS
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
13QBE EUROPEAN OPERATIONS
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*
14QBE EUROPEAN OPERATIONS
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
15QBE EUROPEAN OPERATIONS
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
16QBE EUROPEAN OPERATIONS
CMSUK Corporate Members
QBE EUROPEAN OPERATIONS
The Role of the Case Manager
BICMA Conference – Glasgow10th October 2007
Rosie CorlessQBE – Rehabilitation Manager
