This month we provide an inside look at a healthcare case manager, the choices she made on the road to success, and the challenges ahead.
Sherrie Lynn Campli, RN, CCM, Case Manager in Readmission Risk Reduction Program at Aetna
HIN: Tell us a little about yourself and your credentials.
(Sherrie Lynn Campli) I’ve been a nurse for 32 years. I graduated from nursing school in 1980 from an RN diploma program. I did go back to school at one point to finish my BSN but I wasn't able to given the work level I was in. Then I got married and had a baby; but I hope to someday. I have worked in numerous areas of nursing throughout my career, and received my case management certification in 2005.
What was your first job out of college and how did you get into case management?
I went to a small community nursing school in Philadelphia, and most of us were hired straight out of school to work at its hospital. I started out doing typical med surg nursing, and took advantage of multiple opportunities over the years, including working on an IV team where nurses did all the intravenous access. At that time the early '80s we had an oncologist who wanted to work with the IV team doing chemotherapy, which was kind of new. It was there that I developed a strong love of working with cancer patients, with whom I've spent the majority of my career. I left that small community hospital after six years and went to work for Fox Chase Cancer Center doing experimental chemotherapy from a research background. I loved that, too. I loved working with those patients because you develop a relationship with them, and they have this strength. And I loved being on the cutting edge of cancer therapy. I eventually left to work in a private practice, and then moved into hospice. I'd gotten married, had a baby, and was having a hard time with the commute, so I ended up back in a small, local community hospital, but I didn’t enjoy it. I left there to work for an agency, where again, I got to do a lot of different things in an outpatient setting: occupational medicine, working in office settings, utilization management. I ultimately ended up in a local insurance company, where I started doing case management, and then I moved into my position at Aetna, where I became certified.
It's been a long, winding journey. And it probably will continue to be. I’m always trying to learn new things. But case management has been a great opportunity. It is a different way of doing nursing; it's not hands-on nursing, it’s a different perspective.
Has there been a defining moment in your career, perhaps when you knew you were on the right road?
I don’t know if I have had one defining moment because the road has been so different all the time. Like right now, this is the right road that I’m meant to be on. When I got into the insurance industry I had a young child, so I started teleworking, which enabled me to work normal hours and have a good balance between my work career and my family. Each time I’ve been in a different part of my career, it’s always been right for that moment.
In brief, can you describe your organization?
Aetna is one of the major insurance carriers in our area. They are very patient-oriented and have a set of core values. They strive for integrity, excellence, caring and inspiring each other.
What are two or three important concepts or rules that you follow in case management?
As a nurse I strive to make the patient the center of what I do. So that’s probably the biggest thing for me how I work with patients. They’re at the center. It’s about them. It’s not about me.
Also, just being there to listen to them and be an advocate for them. Part of our role as case managers is to give patients information so they know how to become a better advocate for themselves. That’s the newer trend.
Years ago, when I first got out of nursing school, people with insurance would go to the doctor, and the doctor would tell them what to do, and the patients didn’t really think about a lot of what they were doing. It’s becoming a different world. People have to be consumers, they have to be educated, and they have to take hold of their own healthcare decisions which is different, particularly for the elderly population. So as case managers, we’re there to work with them so they know how to become an educated healthcare consumer.
What is the single most successful thing your organization is doing now?
We’re moving towards a motivational interviewing style, motivating people and empowering them so they can step in and take control. Our goal is to help our patients come up with the goal they need to set. Rather than telling them “You really need to quit smoking because you know it’s not good for you,” have them discover that for themselves. And then we continue to follow up with them and set a plan of care with them. It’s a collaborative process.
I work in the readmission risk reduction program. It’s one of Aetna's biggest programs this past year - pinpointing those people that, based on certain criteria, like age and prior admissions, might have a higher trend of readmission, and doing proactive discharge planning. Determining those at high risk for readmissions, and working with the hospitals, calling the member while they’re still in the hospital and checking in on them and then once they get home, making sure that they have the information they need. For example, sometimes people end up back in the hospital because they don’t understand the medications they’re supposed to be taking, because they’ve been in the hospital two times and medications have changed, they’ve got 20 pill bottles and they don’t understand what they’re supposed to be taking, or what they shouldn’t be taking.
Our goal is to try to get them connected with everything they need, maybe home care nurses, doctor’s appointments putting the whole puzzle together so they don’t end up back in the hospital. It’s an ongoing process, and we’ve been making changes throughout the year. There are challenges. But we’re trying to re-tweak as we go along to make the program successful.
Do you see a trend or a path that you have to lock onto for 2013
Healthcare reform, and upcoming changes such as affordable care for everyone, preventative care, having patients understand and be a collaborative part of their care. Aetna has been on this path in light of ongoing reforms. And what helps patients to be collaborative is the motivational interviewing trend that we’re doing here at Aetna. Helping them to become a collaborative part of their care, rather than just saying, “Well my doctor told me to do this.” We ask them, 'Well, do you know why you have to do it?' All of these pieces collaboration between members, providers, healthcare insurance companies and government agencies, everybody has to collaborate together in order to have this become a success.
What is the most satisfying thing about being a case manager?
One of the most satisfying things comes at the end, when your patient thanks you for being there. Just before this interview I was closing out a member I'd been managing for the past couple of months and he told me, 'I really appreciate your calling me.' It eased his mind knowing that somebody was there for him, being an advocate for him, listening to him, answering questions. So, when somebody tells me thank you, thanks for checking in on me, I really appreciate your concern, that’s the most satisfying thing. It's when you know that you’ve done a good job.
What is the greatest challenge of case management and how are you working to overcome this challenge?
I think one of the biggest challenges, with my current position being telephonic, is not having face-to-face time. Sometimes patients or even providers are suspicious of the call, or might not be willing to work with you. They don’t know who you are. You could be anybody calling them. So I think telephonic is a challenge in itself, because you’re asking people very personal questions and they don’t know who you are. But once you overcome that boundary you can begin to develop the relationship.
I also think that there are still people who are very suspicious of working in an insurance company setting, perhaps from watching TV or movies, and they might resist working with you. So that can be a challenge. That’s where motivational interviewing comes in, helping them to understand that we’re all trying to work together for the benefit of the patient.
What is the single most effective workflow process, tool or form case managers are using today?
Motivational interviewing. When we do case management here, we have different assessment tools that we can use. I like to think outside the box and not just do everything. The most successful thing for me is to just listen to the patient and roll with them. Not just try to read a questionnaire to them. So for me it’s very effective to be a good listener and think outside the box and get the information that I need from them in order to then turn it back to them and try to help them understand their healthcare.
Also, I love humor. I think it’s great to have fun. Even when you are with a patient, even if they’re dying, it’s still okay to laugh. I like to laugh and I like to make people laugh. And I think that’s helped me bond with patients.
Where did you grow up?
I’ve lived in the Philadelphia area my whole life. Right now I live in the suburbs outside of Philadelphia.
What college did you attend? Is there a moment from that time that stands out?
I attended Northeastern Hospital’s School of Nursing. And then I did some of my college credits at Eastern University.
Nursing school was really hard. I remember thinking, 'Am I ever going to get through it?' But at the same time, we really had a lot of fun. We laughed a lot. And I am still friends with those women now.
Are you married? Do you have children?
I’m married and I have one daughter, she is 17 and a senior in high school.
What is your favorite hobby?
I haven’t had time for a lot of hobbies. Right now my hobby is filling out college applications with my daughter.
But really, one of my favorite things to do is travel and see new places and try new foods and learn about new cultures. Growing up, we always went on family vacations. And then, when I got out of nursing school, I lived with a friend from nursing school and we started traveling in Europe. I just loved it. I didn’t get married for quite some time so I was able to do that. Now that I am married we try to travel when we can; I want my daughter to learn about other cultures.
Is there a book that you recently read or a movie that you saw that you would recommend?
I recently saw The Help. I read the book and saw the movie. Also, The Hunger Games I read the trilogy and saw the movie, which wasn’t as good as the book.
One of my favorite books of all time is The Secret Life of Bees. I loved the women in that book. They are strong and step out of the box. I just love books that show women that have this bond who empower each other. It's by Sue Monk Kidd. She’s a wonderful writer.
Any additional comments?
I’ve always wanted to be a nurse. Back in the 1970s, there weren't a lot of career options for women, and I think I just watched too many episodes of M*A*S*H. I wanted to be Hot Lips Houlihan. But I can never remember a time when I did not want to be a nurse. I'm somebody who wants to keep learning new things and expanding my role as a nurse. And I hope that I can continue to do that.
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