Case Manager™: Frequently Asked Questions
What is Safety Net® Case Manager™?
Are current "best practices" enough?
What is Step By Step® Case Management?
What are the roles and responsibilities with Safety Net® Step By Step®?
Can anyone be a Step By Step® Facilitator?
What happens at Step By Step® Meetings?
Who plays the role of coordinator?
How does Safety Net® know that an employee is off work?
How does Safety Net® know when to send reminders?
What are Job Activity Profiles?
What about absences related to stress?
Isn't medical information confidential?
What do doctors think about Step By Step®?
Who needs Safety Net®?
What is Safety Net Case Manager?
Safety Net Case Manager is a workgroup application that supports direct disability management.
Are current "best practices" enough?
Employers and insurance companies have known for a long time that they can save money by helping people return to work as soon as possible after an illness or injury.
Because managed health care have been successful in controlling medical benefit costs in the USA, it would seem only logical to try to apply them to the control of disability costs. However, although the idea of pre-approving certain tests and treatments might work, giving people a set amount of time off work for a given diagnosis definitely does not. This is because disability is primarily a work issue, not a medical one.
Intuitively we all know this, but we have trouble breaking free of the notion that everything that happens to us when we're sick must be under the direct control of a doctor.
But leaving doctors in control of disability has been an increasingly expensive strategy recently. Some pension plans are in poor financial health because of unexpectedly high numbers and long durations of disability claims. Many of these claims are related to non-physical problems such as depression, anxiety, chronic pain and chronic fatigue that were either uncommon or unknown when the pension and benefit plans were conceived. Clearly we need a new approach. And now, we have one: Step By Step disability management.
What is Step By Step Case Management?
Step By Step disability case management is a common-sense approach to the management of any kind of reduced working capacity: everything from minor on-the-job injuries to longer term sick leave and permanent disability.
Other methods assume that disability is primarily a physical problem to be solved with more health care.
Today we know that the reason why people sometimes stay away from work longer than they need to is often not because of their lack of health care. After all, many people with serious diseases and disabilities are very successful at work. What keeps people off work is that they don't see their work as a supportive place to be when they're feeling less than one hundred percent.
That's why restoring a good relationship between employees and their working environments is so important. Disability should be managed from the point of view of the employment relationship: from the inside out. The most successful strategy of disability case management is not active medical rehabilitation nor is it functional restoration. It is relationship maintenance or restoration.
What are the roles and responsibilities with Step By Step?
The Employee and the Manager are responsible for communicating with each other directly in a series of meetings while the employee's working capacity is reduced. These are called Step By Step meetings.
A Facilitator attends each of these Step By Step meetings. The Facilitator guides the discussion and records the important points that the employee and the manager agree on.
The Coordinator watches the progress of the case from a distance. If the Manager and the Employee seem to be unable to resolve certain problems, the coordinator gets involved. The Coordinator might also ask specific questions of various Consultants. The coordinator has a broad responsibility: to evaluate, plan, implement and document all the activities and decisions involved in the Step By Step process.
Consultants are people with specialized technical knowledge that may be helpful to the Employee and the Manager in solving certain problems. Consultants respond to the specific questions that the Coordinator asks.
What happens at Step By Step Meetings?
In Step By Step facilitated meetings an employee and a manager work together with the help of a facilitator to make clear and helpful statements to each other about what it is that they can and cannot do. Each manager has an opportunity either to make an offer directly to the employee of a return-to-work plan, or to wait until the next meeting when the employee might be able to do more. As part of each meeting, the manager and employee agree on when the next meeting will be, and on how long it will probably take for the employee to recover fully.
Facilitators need specific training both to conduct these meetings, and to record the outcomes properly. Clarke Brown provides this training and runs a quality assurance program with its Authorized Service Providers to ensure the quality of the services they provide.
Who plays the role of coordinator?
Coordinators ensure that the team as a whole is responding adequately to each case. They support the Facilitators by involving consultants if it looks as though the process is stalled because of missing information. They also work with the facilitators to ensure that the meetings are not only well run, but also well documented.
Because coordinators can connect to employers and insurance companies using Safety Net, they can be separated from their clients by a considerable distance. They can also use the mobile connectivity features of Lotus Notes® to serve a number of client organizations. This matches perfectly the way that professional rehabilitation services are delivered today: through a network of independent consultants with a range of qualifications and certifications.
In order to use Safety Net, coordinators must have access to a personal computer running Lotus Notes. When connected to Safety Net via Notes, they can see their entire team's actions in response to an employee's reduced working capacity.
How does Safety Net know that an employee is off work?
Safety Net uses the flexibility of advanced network technology to allow employers many options. Employees can signal their unavailability for work through a call centre, The Safety Net telephone absence recording system, or via the Internet. Alternatively, supervisors can record attendance as usual, and absence information can be imported into Safety Net from an extract of the payroll or human resources system.
Where a call centre is used to receive and record the employee's initial report of absence, the call-taker can verify the employee's name, address, contact phone number and manager's name, record the reason for the absence (for example: sick, bereavement leave, jury duty, etc.) and the employee's expected date of return.
The report of absence travels via the Internet from the call centre to servers at Clarke Brown, where it is routed to the appropriate company's absence reports database. At the same time, the message itself is routed to the employee's manager via email.
How does Safety Net know when to send reminders?
Safety Net stores flexible action timelines. These timelines describe which events an employer wants to occur, and when they should occur.
For example, a company might want managers to call each employee who is off on sick leave on the second day of the absence. Or, it may want to remind a claims administrator to prepare correspondence with the an insurer at various points during an employee's absence. A sickness absence timeline might include a reminder to the payroll office to prepare a record of employment for employees who are approaching the expiry of their sick benefits.
Although a company can define preset timelines and associate them with each type of absence, the Coordinator can always make adjustments to the timelines in each case based on individual need.
What are Job Activities Lists?
Safety Net can store information about the activities associated with the jobs in each organization. It does this in the form of a simple list of activities. For example, here is a list that might be associated with the meat counter in a food store:
- Cut meat to customer requests
- Maintain stock levels and appearance of meat counter
- Order meat as needed to maintain adequate supply
- Wash hands frequently throughout the day
- Sweep floor with sawdust twice daily
- Direct customers to other parts of the store
When a Step By Step meeting is required, this list is sent to the facilitator. The outcome of the meeting must include the employee's statement of which activities he or she can and cannot do.
What about absences related to stress?
Although it does not rely on confidential medical information such as a person's diagnosis, the Step By Step disability management model is particularly well suited to absences from work that are related to stress or other non-physical illness. One of the things that helps people get over a stressful situation is to have someone help them think clearly about what they can and cannot do in realistic terms. This is exactly what happens in a Step By Step meeting.
This is an important advantage of Step By Step disability management over other models. Traditional disability management practices have not been effective in dealing with the increasing problem of long-term disability related to non-physical illness.
Isn't medical information confidential?
In Step By Step® meetings employees are not asked for any confidential information. In fact, discussion of the medical advice that employees have received, their treatment, tests, therapy and so on is discouraged. Facilitators are trained specifically to steer the discussion away from subjects like diagnosis and treatment and onto the job-specific consequences of the health problem.
The information that employees are encouraged to share is not confidential, but essential. In fact, an employee's duty to cooperate with his or her employer's efforts to accommodate his or her needs is already established in many jurisdictions, and is becoming more widely accepted all the time.
What do doctors think about Step By Step disability management?
Step By Step disability case management was created by physicians who recognized a need to rethink the way that disability is managed. Although you may see your doctor for advice on how to recover from an illness, your doctor is most often not in a position to advise your employer on what you can and cannot do. In fact, you are the best person to give that advice. Step By Step disability case management acknowledges this, and relies on you to provide the information that you know best. If at any point a piece of information appears to be missing, and your doctor appears to have it, you will likely be asked to get it and explain it in terms you are comfortable with.
Doctors are relieved to be in a consulting role in the disability management process, rather a policing role. In other models of disability management, doctors often feel uncomfortable with making definitive statements about a patient's job because they have no first hand knowledge of the work their patients were doing before leaving work. In the Step By Step model, doctors find that their patients are treated reasonably and with respect by their employers. And, when doctors themselves are consulted, it is with a specific question that they probably can answer based on medical knowledge rather than speculation.
Who needs Safety Net application software?
Safety Net workgroup software for disability case management meets the needs of those who are trying to reduce the cost of disability while treating everyone openly and with respect. Large employers who are self-insured for a portion of their disability benefits can use Safety Net application software to keep their costs low and their morale high.
Insurance companies can use the Safety Net system to link their network of rehabilitation resources with the employers who sponsor sickness benefit plans. Employers can use the system to participate fully in the effort to return ill or injured employees successfully to work.
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