Catastrophic Case Management: Immediate coordinated response by clinical experts

Most illnesses or injuries progress well with traditional case management services. However, a small percentage of cases require more intense and careful management. Early intervention and proper procedure are imperative in the treatment of catastrophically injured people. Clinical situations that require catastrophic case management are characterized by diagnosis, complexity of treatment, and high dollar exposure. Examples of diagnostic candidates for catastrophic injuries include:

• Any life-threatening injury
• Amputations
• Blindness
• Burns
• Crush injury
• Electrocution
• Multiple trauma
• Spinal cord injury
• Traumatic brain injury
• Toxic exposure

In a best practice Catastrophic Case Management (CAT) program referrals are received 24 hours a day, 7 days a week. Once the referral is received the triage nurse reaches out to all involved parties, including the hospital, doctors, and family members and then develops, manages, and implement a comprehensive plan of care as soon as possible. Once the condition and location of the injured worker is established a trained catastrophic case manager in that geographic vicinity is assigned to visit the injured worker. A comprehensive personalized plan of care is established and implemented. Communication is key to keep treatment on track. All involved parties must receive prompt ongoing notification of the status of services and the injured worker’s condition. At Coventry our national CAT director provides oversight and quality control over every CAT case. We closely monitor all open cases and move them to non-CAT status as soon as possible ensuring the injured worker doesn’t receive any unnecessary or extraneous treatment. Once the patient is stable, we provide ongoing support until return-to-work or maximum medical improvement is achieved. We believe the trust established by the catastrophic nurse early in the case is critical, and therefore the case remains with the same CAT nurse until fully closed regardless of the injured workers’ status. Coventry’s award-winning case management program manages more than 900 CAT cases per year through the efforts of more than 360 CAT case managers dispersed throughout the continental United States. Understanding the needs of the injured worker, their families, and their providers, is as important as making sure the proper treatment is provided.