Aligned for Impact: How Collaboration Improves TBI Outcomes

In this episode of MEC Connect Impact Stories, Phyllis Ramondetta, RN, CLCP, CCM, our recently retired Senior National Catastrophic Medical Management Consultant at MEC, explores how early, outcome-driven medical management can transform the trajectory of catastrophic workers compensation claims. Through two real-life traumatic brain injury (TBI) cases, MEC’s Medical Management Consultants demonstrate how aligning the right people, processes, and expertise leads to better recovery and more controlled claim outcomes.

Phyllis outlines a 56-year-old man’s recovery after a severe brain injury, highlighting the critical role of on-site nurse case management in coordinating care, supporting families, and guiding treatment decisions. She also examines how selecting the right Centers of Excellence and appropriate long-term placements can preserve dignity while reducing unnecessary costs.

A second case features a police officer whose journey from intensive therapy to greater independence underscores the importance of continuous progress reviews and collaborative decision-making.

These Impact Stories reflect MEC’s commitment to delivering measurable results through expert teams, proactive strategy, and a relentless focus on improving injured worker outcomes while minimizing complexity and cost. 

Transcript

Welcome And Season Focus

SPEAKER_00 0:02

Welcome to MEC Connect Impact Stories from Midwest Employers Casualty. I'm Sarah Hants. This season, our medical management consultants are sharing impact stories, real-world cases that demonstrate how strategic decision making, oversight, and collaboration can make a meaningful difference in complex claims.

Why Collaboration Changes TBI Outcomes

SPEAKER_00 0:21

Today, Phyllis Raymondetta joins us to discuss how collaboration improves traumatic brain injury outcomes. Let's dive in.

SPEAKER_01 0:30

Thank you, Sarah. I would like to talk about a couple of workers' compensation cases that demonstrate what we can achieve when Midwest works together with our TPAs and our insured to get really good outcomes on some of our most severe catastrophically injured clients. At Midwest, our goal of the catastrophic program is to make sure our clients get the best possible treatment upfront and throughout the claim to get them to their optimal functionality. We are very committed to our clients and our stakeholders by providing clinical insight, cost mitigation, and medical strategies for a broad range of catastrophic cases. Leveraging all our resources ensures our injured clients get the best treatment to produce the best outcome in the most cost-effective way. I have two examples to show the value of Midwest, an excess carrier who gives every catastrophically injured client the best shot at a meaningful life after a devastating

Case Study One Severe TBI Fall

SPEAKER_01 1:25

injury. The first case study involves a 56-year-old male that sustained a severe traumatic brain injury. With compassion, excellent medical case management, and workers' compensation claim management, he surpassed all functional outcomes and to this day has a wonderful quality of life. This is what we call a worker's compensation success story. If you picture a man climbing a ladder inside the supermarket where he wasn't employed as a manager, he lost his balance and fell, landing onto his head. His injuries include multiple skull fractures, a large subdural and frontal brain hemorrhage with a midline shift. This resulted in a diffuse exonal brain injury, which is one of the most devastating types of brain injury there is. He was airlifted to a level one trauma center where he had emergency brain surgery to open the skull and evacuate the bleed. His condition was critical. The client was also the sole provider for his wife and two small children, and the wife was beyond distraught and inconsolable.

Nurse Case Management And Rehab Choice

SPEAKER_01 2:23

So, due to the nature of the injuries and the family dynamics, I discussed with the adjuster the importance of a catastrophically prepared on-site nurse case manager who could not only deal with all the complicated medical aspects of the case and coordination of care, but we also needed someone who could navigate the claim and calm the wife and family members who were devastated. The adjuster welcomed our recommendation and secured a nurse who was with him and his family throughout his journey. His injuries required a very long, acute hospital stay, but he was not out of the woods yet. He faced months, if not years, of rehabilitation to get him into the best possible outcome. Midwest was directly involved in the selection of a rehab center of excellence, Spaulding, in Boston, Massachusetts for brain injury. The nurse case manager was an integral part of this case, overcoming extreme obstacles to get the best treatment for the client. We assisted in locating multiple specialists to care for the injured client. After long, arduous acute rehabilitation and multiple stays at a post-brain injury program. Our client has a work capacity of volunteering under supervision. Midwest facilitated the on-site nurse case manager, helped select the brain injury center of excellence for acute rehab, as well as the subsequent rehabilitation facilities using our network penetration and negotiating skills. Our claim and legal team was instrumental in working with the adjuster and defense counsel about the claim, legal, and guardianship issues that arose. Despite pushback from the client's wife, we were able to locate an assisted living community near his family. Without the nurse case manager support and tenacity, he may have wound up in a skilled nursing facility. He is extremely happy in his new environment. He has recovered to a point that we never thought possible given the severity of his brain injury. He is walking with assistive devices. Does require some attendant care, but overall, a home run success story. With careful research, we identified the assisted living community which better suited his needs and quality of life. He was so happy to get out of the long-term brain injury facility.

Assisted Living Transition And Savings

SPEAKER_01 4:36

With that came a $94,000 savings annually.

Case Study Two Police Officer Recovery

SPEAKER_01 4:40

So I'm gonna launch right into the second case study. And in that involves a 50-year-old police officer who sustained a severe traumatic brain injury with multiple orthopaedic injuries. He underwent a hemicraniectomy and a cranioplasty, so brain surgery. When our client was ready for rehab, Midwest recommended transfer to an acute brain injury rehabilitation at Craig Hospital, a center of excellence. This allowed him the potential for the best outcome. During his stay, the staff was overwhelmed at his recovery, but he had a long way to go. After discharge, our client was not able to return to his home due to ongoing cognitive and physical challenges. He transitioned to a long-term brain injury residential program, where he progressed very slowly. His multifaceted therapy was structured and formal for many years. Our client worked very hard in therapy and met all the milestones. His goal was he wanted to live on his own, away from the constant program demands. Midwest worked diligently with our hand-picked on-site nurse case manager to assess his monthly progress. We questioned his physicians and therapists regarding the ongoing need for residential placement. With much effort and patient advocating, the multitude of physicians finally agreed to assisted living placement. So finally, after many years of living in a long-term TBI residential program, our client was able to transfer and transition into an assisted living facility where he has flourished in his own apartment. This was an excellent outcome for our client who is now living independently, driving short distances, and enjoying all the activities the apartment has to offer. Another wonderful success story. From a fiscal perspective, this produced a savings of $12,000 a month or $143,000 a year. These are examples of how Midwest makes a big difference in the lives of our injured clients.

Key Takeaways Cost And Care

SPEAKER_01 6:40

In conclusion, collaboration and communication with all parties is key to our success. Midwest is laser focused on analyzing and evaluating the most severe injuries. With strong medical and legal teams, we develop and implement individual solutions to a variety of complex cases. We use strategies that maximize the injured client's medical outcome and return of function. Secondarily, we provide medical cost containment using Midwest vendors and medical strategies.

SPEAKER_00 7:12

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.