Vendor Strategies that Shift Outcomes

In the first episode of MEC Connect Impact Stories, Tina D’Andrea, Sr. Nurse Case Manager at MEC, shares two powerful real‑world cases that demonstrate how the right people, results-driven processes, and trusted vendor partnerships can drive meaningful outcomes for injured workers — while delivering measurable cost savings for insureds.

Tina walks listeners through a complex lightning‑strike injury involving long‑term Intravenous Immunoglobulin (IVIG) therapy, where creative problem‑solving and collaboration with a vetted pharmacy management partner improved continuity of care, enhanced the injured worker’s quality of life, and generated significant annual savings. She also recounts a severe COVID‑19 catastrophic claim that progressed from ECMO and transplant consideration to a full‑duty return to work, made possible through coordinated clinical oversight, strategic rehabilitation placement, and effective bill negotiation.

These Impact Stories highlight MEC’s commitment to putting people first, leveraging proven processes, and partnering with best‑in‑class technology and vendors to achieve results that matter — better recovery outcomes for injured workers and responsible cost management for employers.

Transcript

Speaker 0:02

Hello and welcome to MEC Connect Impact Stories, a companion series to the MEC Connect podcast from Midwest Employers Casualty. I'm Sarah Hance. This season, we're sharing impact stories, real-life examples from MEC's medical management consultants that spotlight catastrophic claims, loss mitigation strategies, and smarter care decisions. Each episode highlights how outcome-driven medical management helps control costs while delivering meaningful, life-changing outcomes for injured workers. Today, Tina D' Andrea, Senior Nurse Case Manager, will share an impact story focused on vendor strategies that shift outcomes. Let's get started.

Lightning Injury And CIDP Diagnosis

Moving IVIG From Hospital To Home

Severe COVID ARDS And ECMO Care

Rehab Planning And Major Bill Savings

Speaker 1 0:45

Thank you, Sara. Sometimes simple thinking outside of the box and making small changes can have a big impact on both the claimant and on your cost. Choosing the correct vendors is a very helpful step in this process. This first case is an example of just how this can happen. In this first case study, our claimant is a 38-year-old male who was injured when he was 23 years old. He was employed as a carpenter with our insured. While he was walking into a metal trailer on a job site during a thunderstorm, he was carrying tools when he was indirectly struck by lightning. The following day, he developed weakness in his bilateral upper extremities. This continued to progress down both his legs and caused them to get weaker as the week went on. He developed other symptoms which included tingling and numbing in both his hands and feet. Diagnostic testing was performed and he had an abnormal EMG and nerve conduction studies. With his symptom history, he was initially diagnosed with chronic inflammatory demyelating polyneuropathy, or CIDP. This is an autoimmune disorder that affects the peripheral nerves. With CIPD, the immune system attacks the myelin sheath, which is the protective covering of the nerve fibers. This leads to nerve damage and can cause symptoms like muscle weakness, numbness, and tingling. The treating provider attributed this diagnosis to the lightning strike. The provider started him on intervenous immunoglobin therapy or IVIG. IVIG is a treatment used to boost the immune system in people with certain immune disorders and immune deficiencies or autonomic disorders. IVIG is a mixture of antibodies, immunoglobins, collected from healthy donors. These are infused with the patient's bloodstream to help strengthen their immune response. He started receiving IVIG, immunoglobin therapy, intravenously, which is given to prevent further organ breakdown and he had improvement. He responded well to the treatment, which is what we wanted. However, IVIG is very costly. The claimant was receiving his infusions every four weeks. The treatment was being administered over a two-day period, which involved the claimant spending one week in a month in the hospital facility away from his family. We also started having issues with the facility being able to obtain the IVIG being prescribed for him. This caused the claimant to have to wait longer than four weeks at a time, sometimes missing several doses at a time, causing his symptoms to increase. We worked as a team to address all these issues the claimant was having as well as trying to mitigate the cost of the treatment. It was costing approximately $20,000 for each infusion, so that's $20,000 every month. Our first concern was that the claimant was not receiving his infusions as scheduled. We were able to reach out to our PBM, our pharmacy management group, and they were able to provide the medication through one of the pharmacies in their network. This would also allow us to provide the service to the claimant in his home. We discussed this with the treating provider and the claimant, and both were in agreement with trying to do the infusions at home. The provider was also open to changing the IVIG being prescribed to a different medication, which was more cost effective as long as it could be administered as prescribed. He did not want any further delays or any gaps in treatment. We were able to set the claimant up to receive the treatment at home. The claimant was very happy with the change as he could now schedule the infusions to allow him not to miss time with his family every fourth weekend. He was able to schedule these infusions in the evening so he could sit and watch television or just interact with his family. The provider was happy as now he was receiving the infusions without any delays due to the facility not being able to accommodate and obtain the medications. There was also a savings benefit to the insured because of this change in treatment. With the claimant receiving his treatment at home through our pharmacy management vendor, we were able to realize a cost savings as well. A cost savings of $4,281 a month or $51,379.20 a year. Given the claimant's young age, this is a significant savings over his expected life expectancy. At this current time, the claimant remains on his IVIG treatments and is still receiving them outpatient in his home. He is doing well and is working full duty with another employer. This is just one example how a small change using a vetted vendor can make a significant impact on the claim. Our second claim is another example how utilizing the correct vendors can help mitigate costs for us without having any impact on the quality of care provided to the claimants. The second claimant is a 51-year-old man who started experiencing COVID symptoms when he was 47 years old. He was employed as a police officer for insured, and he tested positive for COVID and was started on a ZPAC, which is the brand name for azithromyosin, which is an antibiotic used to treat various bacterial infections commonly prescribed for infections such as bronchitis and pneumonia, which is what we commonly saw with COVID at the beginning of the COVID pandemic. His symptoms continued to get worse until he was admitted with shortness of breath and an O2 sat in the 70s to the hospital. Normally oxygen saturation is in the 90s, so this should show you how significantly lower his was. He was treated with REM desivir and dexomethasone. He continued to deteriorate till he was intubated and diagnosed with ARDS, which stands for acute respiratory distress syndrome, secondary to COVID pneumonia. He was transferred to the COVID ICU where he was eventually placed on ECMO. ECMO stands for extracorporeal membrane oxygenation. It's a life support technique used for patients with severe heart or lung problems. It allows the heart and lungs to rest and heal by temporarily taking over their functions. He developed a left lower extremity DVT or deep vein thrombosis. A DVT is a condition where the blood clots form in one or more of the deep veins of your body, usually in the legs. He was started on nicocardipine for hypertension, and more small clots were noted in the atrial and venous oxygenator. He still had clotting mostly on the venous side. He was diagnosed with the right pneumothorax and a chest tube was placed, and he started to show improvement. However, there was some slight air leaking noted. He was diagnosed with the right lower extremity DVT as well. He developed heptopathy, which is an abnormal disease state of the liver. Ediology was unknown. He was receiving tube feedings. He was referred to the transplant team to be evaluated for a possible lung transplant. There was a nurse case manager assigned to the file, which did an excellent job of communicating with the team and providing frequent updates. The claimant underwent multiple complications, including infections, fevers, as well as the previously mentioned blood clots. It was determined that he was not a candidate for a lung transplant. There were plans to start to move him to a long-term acute care facility where they could continue to monitor his treatment. He was taken off ECMO and a tracheotomy was performed and he was placed on a ventilator. A peg tube was placed for tube feedings. He did surprisingly well with this, and a significant change in his condition took place. They were able to wean him off the ventilator and he was able to be removed from the tube feedings to start eating a regular diet. He was no longer going to require a long-term acute care facility at discharge. The trach was able to be removed and they were preparing him to move to a rehabilitation hospital. He was severely deconditioned, so he was going to need rehabilitation to go home. At this point, we were able to get one of our bill review vendors involved, and they were able to assist with negotiating the price of both the rehab facility as well as to negotiate with the hospital once he was discharged. After 46 days, the claimant was transferred from the hospital to a rehabilitation facility. Our vendor was able to negotiate with the facility that allowed the claimant to be close to his family. He stayed in the rehab hospital for 15 days prior to being sent home. The claimant continued to do extremely well and was eventually able to return to work full duty as a police officer. It is amazing how he went from the need for a possible lung transplant to full duty as a police officer. Now to address the savings we were able to achieve for the insured, by getting our bill repricing vendor involved to negotiate with the hospital in the rehab facility, we were able to negotiate a cost savings of $643,874 for the hospital stay and $15,354 for the rehabilitation hospital for a grand total of $659,228. Thank you for your time and for listening. I hope this was interesting and showed how MEC is able to provide significant cost savings providing the correct vendors, which we have highly vetted. Thank you.

Speaker 10:30

Thank you for listening to MEC Connect. We hope today's impact story offered valuable insight into how thoughtful medical management can influence recovery, return to function, and long-term outcomes for injured workers. Be sure to follow MEC Connect for more impact stories throughout the season. Thanks for listening.