GBCARE: Enhanced Medical Management Services
Mar 19, 2020

We have previously reported to you on the decisive, enterprise level steps Gallagher Bassett has taken during the activation and engagement of our business continuity programs and the claims best practices we have enacted to effectively manage all matters with potential coronavirus exposure.

 

We now turn our attention to several critical steps we have taken to ensure proper medical treatment and optimize access to medical care for injured workers through the integrated GBCARE platform.

 

 

In this bulletin, we address the following: Telemedicine as a partial answer to restricted medical care access; GBCARE's Nurse Case Management response to the changing provider landscape; and Nurse triage hotline (PC365) to address potential COVID-19 exposure

 

Telemedicine as a Medical Provider Alternative
With recent COVID-19 developments, employers and injured workers are expressing concerns regarding the ability to keep appointments at provider facilities. Additionally, many health systems are restricting elective procedures to preserve capacity for COVID-19 patients.

GBCARE understands that maintaining access to care for injured workers is critical to an employee's well-being and achieving superior outcomes. To ensure maximum access to medical care, we are encouraging telemedicine scheduling options, where medically appropriate, with all GB Resolution Managers and GBCARE nurses, to ensure continuity of medical service.  These include:

 

  • PC365 Referrals to a telephysician - At point-of-injury referring injured workers to telecare where the injury meets medically- appropriate triage criteria (~20% of triage events)
  • Telephysician networks addressing 47 of 50 states
  • Telerehab (physical therapy, chiro, etc.) partnerships with the major workers' compensation service providers 

 

To date, telemedicine has seen limited adoption within our industry due to injured worker preference for face-to-face care. However, as injured worker preferences and access to traditional office visits rapidly change in this environment, GBCARE is prepared to support and respond with these robust telemedicine alternatives.

Nurse Case Management in the age of COVID-19
In addition to lessened access to physicians for injured workers, we are also finding that GBCARE field case managers are often restricted from care facilities in an effort to minimize population congestion within a facility.

Our nurse case managers will continue to conduct onsite visits where essential, confirming in advance our ability to access facilities and injured workers. Our nurses have also undergone robust training, to ensure that they, and their patients, are protected from COVID-19 infection. If an onsite visit is not essential or prohibited by the provider, we will provide services remotely.

Please note, that under any circumstance or scenario, we continue to accept and respond to all referrals, working actively with our Resolution Managers to ensure continuity of care to injured workers. These services are critical, now more than ever, as GBCARE nurses may be the only clinical professionals available for claimants that might otherwise be unintentionally overlooked in our strained healthcare environment. Our nurses will maintain medical management communications, track progress, and ensure that injured workers are complying with their prescribed treatments including promoting proper use of prescribed medications.

Our commitment to supporting injured workers on their journey of recovery is unwavering, as is our commitment to providing our clients with superior claim outcomes. Though COVID-19 poses unique challenges in the delivery of medical care, our GBCARE clinical team continues to deliver for our clients and their injured workers.

PC365 as a COVID-19 Exposure Hotline
Gallagher Bassett actively maintains point-of-injury clinical triage support through our Priority Care 365 (“PC365”) solution, for clients who have enrolled in this service.

We are pleased to share that clients who have not previously enrolled in this service can now direct injured workers presenting potential COVID-19 exposure to our newly formed PC365 Hotline. Using the hotline, injured workers may call with their concern/symptoms and receive guidance regarding medically-appropriate care and physicians within their local community.

Following each hotline call, a Point of Injury Report is sent to the client supervisor to notify them of the disposition of care. The nurse triage detail is also sent to Gallagher Bassett for claim set up.

For both existing PC365 clients and for prospective PC365 Hotline clients, we have made the following service enhancements in light of COVID-19:

 

  • The injured worker and their supervisor can call a toll-free number to speak directly to a Registered Nurse (RN) 24 hours a day, 7 days a week, 365 days a year.
  • PC365 nurses follow industry-leading triage guidelines to direct care as appropriate based on symptoms and circumstances. Medical guidance will include seeking emergency room care if appropriate, or treatment through an urgent care facility, engaging treatment through the injured worker's primary care physician, or self-care.
     

We have put in place several additional protocols to serve injured workers. PC365 nurses will provide guidance to integrate telemedicine solutions where appropriate. These protocols will evolve as the CDC modifies their recommendations.


We will continue to monitor the COVID-19 pandemic and adapt our solutions to meet the evolving needs of our clients and injured workers. As the COVID-19 situation continues to unfold, we will share updates about our operational practices. You may also subscribe to The Network to receive additional notifications.


We stand ready to serve and help. 

 

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