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Target deploys clinical case management

Target deploys clinical case management

DENVER — A successful pilot program involving tens of thousands of employees and a control group proved to retailer Target Corp. that clinical case management efforts could significantly reduce short-term disability durations.

The pilot program, launched in 2011, involved managing claims from 38,000 employees in the pilot group and the control group. It reduced STD durations by 7%, speakers told the Disability Management Employer Coalition's 17th annual International Conference.

The retailer's adoption of clinical case management included applying medical disability guidelines to make claims eligibility decisions, comprehensive training for case managers, and developing a “trigger list” to help case managers identify situations needing additional input from clinicians or peer review services.

“It was a significant cultural change for us, moving from a completely unmanaged program where for virtually all STD requests ... you got your time paid” to a program that was comprehensively managed, said Michelle Steen, Target benefits analyst manager in Minneapolis.

Applying clinical case management practices to address STD claims came amid efforts by Target to outsource the administration of leave programs.

Target consulted Aon Hewitt and applied a two-phase approach: the pilot phase followed by a rollout to remaining eligible Target workers. The pilot phase lasted four months, said Gloria Gillette, claims operation leader for Aon Hewitt.

A control plan gave Target insight into what was happening with claims as it applied new processes, and it helped the employer gauge resulting outcomes, Ms. Gillette said

“The control plan was our way of looking throughout our operation to see what data we could follow to give us that information,” Ms. Gillette said. “It was to ensure compliance, tell us how successfully the processes were being implemented, and identify areas for process improvement and training.”


Feedback came from several sources including weekly dashboard reports on claims activity, employee satisfaction surveys, and frequent huddles with case managers to discuss what was working well and what needed improvement.

There was also a “comprehensive audit program” for additional feedback, Ms. Gillette said. “The result was an ability to identify needed adjustments quickly.”

Target also matched employees in a control group with employees in the pilot program for similar demographic characteristics, disability program use and disability durations, said Deborah LaBonar, manager of analytic consulting in the absence management group for Aon Hewitt.

After four months, durations among the pilot group dropped by 7% compared with a baseline measurement. The control group saw durations increase by 11%.

“What we would assume is that, all other things being equal, had we not implemented this program, then the pilot group would also have trended up at about the same pace as the control group,” Ms. LaBonar said.

It was a big step rolling the program out to 135,000 employees after testing it on 38,000 employees, Ms. Gillette said. Target did that by using the “tools and processes” tested in the pilot, with some improvements, she added. Case managers, for example, received additional training in physician contact and caseloads were adjusted to better address complex claims.

“The result was that we were ready to roll out to the remaining 90% of the population immediately after the conclusion of the pilot on the following Monday,” Ms. Gillette said.

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