Improve recovery with clinical guidance and compassionate advocacy

An employee injury, whether minor or catastrophic, often results in a host of employee questions and anxieties around the processes for reporting the injury and working through the insurance claim.

At Gallagher Bassett, we know that employees need compassionate guidance and advocacy to help them recover both physically and emotionally from an injury. We also recognize, however, that care management resources can add considerable cost to claims. To address this challenge, we have developed GBCARE™, a medical management platform with a suite of solutions that can be selectively deployed based on the individual circumstances of a claim.

We are proud of the people-centric and goal-oriented approach we take in engaging injured workers as early as possible in the lifecycle of a claim. By identifying needs early, we can provide guidance for key clinical interventions when they have the highest impact on both recovery and claims outcomes. The result is superior standards in clinical care that simultaneously reduce the total cost of claims.

Learn more about GBCARE™ solutions

Medical Management Approach

We produce superior claims outcomes by leveraging the professional training of our Resolution Managers and clinical staff with our proprietary decision-support tools.

Priority Care (PC) 365

This telehealth option allows employees and supervisors to speak with a GBCARE™ nurse 24 hours a day, 7 days a week, 365 days a year through a toll-free number.

Clinical Concierge

This early advocacy solution offers innovative risk assessment and targeted clinical support to an injured worker in the critical first days following a claim.

Clinical Services

Our nurses employ a goal-oriented approach to identifying barriers to recovery and return to work, promoting optimal outcomes on both a claim and program level.

Whitepaper: Benefits of delivering clinical support in complex injury cases

Providing clinical nursing services and tailored advocacy strategies in workers' compensation programs can play a vital role in supporting injured workers, reducing potential harm, and mitigating unnecessary risk. Learn how the Gallagher Bassett GBCARE™ team collaborates in a proactive claims management strategy to improve clinical outcomes in complex cases. Measurable results include:

  • Decrease in disability duration
  • Lower litigation rates
  • Fewer lost workdays

READ WHITEPAPER

The right care at the right time — GBCARE™ programs include the following:

In non-emergency situations, employees and their supervisors can speak directly to a GBCARE™ nurse 24 hours a day, 7 days a week, 365 days a year via a toll-free number.

During the call, the nurse obtains all pertinent information and makes treatment recommendations and network provider referrals.

With this program, clients can:

  • Avoid claims by channeling low severity injuries to self-care
  • Direct injured workers to appropriate providers, including telemedicine, avoiding unnecessary ER utilization
  • Improve employee experience with option for nurse virtual connection
  • Track key performance indicators with comprehensive reports spanning integrated solutions.

This early advocacy solution offers innovative risk assessment and targeted clinical support to an injured worker in the critical early days following a claim.

When a claim is reported, the loss details are reviewed for risk. Our team also reaches out via text message to the injured worker to help identify care needs and potential roadblocks to recovery.

Individuals identified as having a high-risk case are then assigned to Clinical Concierge, a limited engagement nurse who provides guidance, compassion, and clinical support with a whole-person approach.

Clinical Concierge will establish a care plan to address individual risk, including co-morbid and psychosocial barriers to recovery, and partners with high performing medical providers identified by Waypoint Provider Guidance.

Cases that would benefit from ongoing clinical oversight after the first 10 days of support are recommended to GBCARE™ Clinical Services for further case management.

Identifying the best providers to treat your injured workers is the foundation for ensuring optimal claims outcomes. Beyond cost savings, identifying the highest-performing providers sets up injured workers for a successful recovery.

Merging GBCARE's™ proprietary Treatment Quality Index (TQI) scoring with Outcome-Based Network (OBN) designation, Provider Guidance prioritizes the highest-performing network providers focused on evidence-based medicine and optimal claims outcomes. This makes it simple to identify the best option when selecting a provider for referral.

Example criteria to identify best providers includes:

  • Adherence to evidence-based-medicine protocols (TQI score)
  • Disability duration
  • Medical cost
  • Litigation
  • Total claim cost.

Clinical guidance is the decision support tool the GBCARE™ team uses to help identify injured workers who would benefit from clinical intervention.

Clinical Guidance dives deep into claim data, identifying hidden risk factors that could delay recovery and return to work. These risks include:

  • Injured worker profile and injury severity
  • Disability durations exceeding expectations
  • Care delivery that deviates from evidence-based medicine per our TQI scoring model.

Leveraging this tool in addition to their own experienced insights, the clinical guidance team recommends appropriate GBCARE™ clinical services such as Field Case Management or working with a Return-to-Work Specialist.

Not all work injuries require clinical intervention to promote optimal recovery, but for high-risk claims, GBCARE™ offers nurse case management solutions, including Telephonic Case Management, Field Case Management, Catastrophic and Complex Case Management, and Return to Work Specialists.

Our nurses have a goal-oriented approach to identifying barriers to recovery and return to work, promoting optimal outcomes on a claim and program level.

The key areas of focus are:

  • Taking a holistic advocacy approach to each clinical assignment by partnering with the injured worker and developing a customized care plan to support their individual needs
  • Leveraging innovative decision support tools to help identify injured worker risks, measure quality care, and provide insight into disability duration and recovery progress
  • Building on the foundation of our nurses' education with specialized training for Behavioral Health and Centers of Excellence.

Connect with our GBCARE Team


Niel Simon

Niel Simon

EVP — Strategic Partner Management, Managed Care Solutions
 Jennifer Cogbill

Jennifer Cogbill

SVP — GBCARE Client Services

Make Gallagher Bassett your partner for workers' compensation

Our customized workers' compensation claims solutions are designed to protect your organization and promote better clinical outcomes for your people. From streamlining claims management processes to advocating for exceptional patient care, Gallagher Bassett works alongside your team to meet the goals that matter most to you.

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