Archive for the ‘Case Manager Profile’ Category

10 Tools to Complement Chronic Care Management

April 23rd, 2015 by Cheryl Miller

Despite new CMS payments to physician practices for select chronic care management (CCM) services, almost half of healthcare organizations lack a formal chronic care management program, leaving critical reimbursement dollars on the table, according to new market metrics from the Healthcare Intelligence Network (HIN). Almost 45 percent of 119 respondents to HIN’s 2015 Chronic Care Management survey, conducted in January 2015, have yet to launch a CCM initiative, the survey determined. However, 92 percent of respondents believe the Medicare CCM reimbursement codes that became effective January 1, 2015 will prompt comparable quality overtures from private payors, underscoring care coordination’s importance in a value-based healthcare system.

How to best capitalize on these reimbursement opportunities? Follow-up with patients immediately following hospital discharge is the most common component of CCM initiatives, according to 81 percent of respondents. Following are nine more tools to complement chronic care management, in respondents' own words:

  • Holding care manager, primary care provider (PCP) and clinical team reviews;
  • Any patient over a certain risk score gets a phone call from the physician or advanced practitioner registered nurse (APRN) for a follow up with the patient.
  • Utilizing a structured assessment tool in the electronic health record (EHR);
  • Coaching the patient to wellness and holding them accountable;
  • Addressing psychosocial issues with care coordination strategies;
  • Having a life planning agenda; knowing what to do if symptoms worsen, and what end-of-life agreements are in place;
  • Conducting motivational interviewing to support lifestyle changes;
  • Coordinating with nurse practitioners; and
  • Using remote monitoring devices for heart failure patients.

Source: 2015 Healthcare Benchmarks: Chronic Care Management

Chronic Care

2015 Healthcare Benchmarks: Chronic Care Management captures tools, practices and lessons learned by the healthcare industry related to the management of chronic disease. This 40-page report, based on responses from 119 healthcare companies to HIN's industry survey on chronic care management, assembles a wealth of metrics on eligibility requirements, reimbursement trends, promising protocols, challenges and ROI.

Meet Deborah Vermillion: Home Care CEO Aims to Keep Seniors at Home as Long as Possible

March 13th, 2015 by Cheryl Miller

Deborah Vermillion, RN, MSHCA, CSA, CDE, President/Owner of ComForcare Homecare, a non-medical home care business.

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.

HIN: Tell us a little about yourself and your credentials.

(Deborah Vermillion) I have been in the healthcare workforce for 36 years. I am a registered nurse. I have a master's degree in health care administration. I am a certified senior advisor. I am also certified in diabetic education.

What was your first job out of college and how did you get into case management?

My first job out of college was in an intensive care unit (ICU)/coronary care unit (CCU) at Allegheny General Hospital in Pittsburgh as a staff nurse. After four years as a staff nurse and supervisor, I entered medical sales in the home care equipment and infusion industry. During that time it was very important to manage discharge planning as it related to the items we were providing. That was the beginning of my entry into case management.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

I always knew that I wanted to be a nurse. My nursing education has led to continued growth and career development, and has been the springboard to all that I have achieved.

In brief, describe your organization.

I own a non-medical home care business. We provide activities of daily living (ADL) and instrumental activities of daily living (IADL) care to seniors in their homes. Our goal is to keep seniors at home for as long as possible. Because I am a nurse we also provide private duty nursing services. We will be expanding this product line through accreditation this year.

What are two or three important concepts or rules that you follow in case management?

  • Follow all cases through to completion.
  • Pay attention to all client details in order to avoid any unforeseen issues.
  • Understand that we are working in their environment, not an institutional environment. Adjust our approach to achieve the best results without being overly invasive.

What is the single most successful thing that your organization is doing now?

Because of our care for each of our clients we have been able to keep readmission rates to a minimum. When we last measured we were at five percent.

Do you see a trend or path that you have to lock onto for 2015?

We need to continue to pay attention to details. We have instituted a more robust quality management program that we hope will bring a stronger platform to our already complete care.

What is the most satisfying thing about being a case manager?

Being able to keep the client at home, aging in place up to their death.

What is the greatest challenge in case management and how are you working to overcome this challenge?

Communication between the various organizations that care for the client in the home. I constantly have to chase the Medicare agencies to ask for cross communication; most of the time they do not call back and obviously do not feel the importance in communicating to support continuity of care.

What is the single most effective workflow, process, tool or form you are using in case management today?

We have a Dementia Wise Training program that certifies our caregivers in dementia care. It is 8.5 hours of training. It has truly raised the bar of care for our clients with dementia, and it makes care much easier for caregivers as well.

Where did you grow up?

Pittsburgh, PA

What college did you attend? Is there a moment from that time that stands out?

University of Pittsburgh. Graduation day stands out. It was a very difficult five-year program and I was extremely proud and happy when I made it through.

Are you married? Do you have children?

I have been happily married for 28 years and I am the proud parent of two great sons — ages 24 and 27.
Yes and yes.

What is your favorite hobby and how did it develop in your life?

Snow skiing. I learned at the age of 22. I have improved every year and have become a relatively good intermediate skiier.

Is there a book you recently read or movie you saw that you would recommend?

American Sniper.

Do you have any additional comments about case management or the industry in general?

I believe that the case management industry needs to employ the very best. They need to be given full knowledge so that they can advise their clients of all their options as accurately as possible.

Meet Case Manager Patty Hedrick: Helping Clients Achieve Their Highest Level of Independence

January 17th, 2014 by Cheryl Miller


Patty Hedrick, RN, BSN, BA, CRRN, CCM, CLCP, CEO of Med-Legal Healthcare Consultants, Inc. and North Star Elder Care, a geriatric care management company

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.

HIN:Tell us a little about yourself and your credentials.

(Patty Hedrick) I love to travel. My goal is to set foot on all the continents during my lifetime. I am an avid reader and a seminar junkie. My motto is to never stop learning. I enjoy walking, Zumba, yoga, sailing and spending time with family and friends. Being a nurse was something I had always wanted to be, but I wasn’t sure what area I wanted to specialize in. During nursing school my father had a severe stroke. After working closely with the rehabilitation team, I knew I wanted to specialize in rehabilitation nursing. Upon graduating from Seattle University with my BSN, I completed my minor and obtained my BA in rehabilitation. Since then, I have continued taking ongoing classes and programs. I am a certified geriatric care manager (GCM) and have obtained multiple other certifications including rehabilitation nursing (CRRN), case management (CCM), disability management (CPDM), life care planning (CLCP), and coaching. I am a testifying expert and have travelled internally as a subject matter expert. I enjoy speaking, writing and am a contributing author to several books.

What was your first job out of college and how did you get into case management?

After graduating from nursing school, I was a staff nurse on an acute rehabilitation unit. I enjoyed the multi-disciplinary approach of the rehabilitation team: all the different disciplines working together to help our patients regain their independence. We had a discharge planner on our unit and she would help the patient transition from the hospital to home or other setting. The discharge planner was responsible for communicating with the family, insurance company, providers, etc. One of my patients was a workers' compensation case and he had an external nurse case manager. The field of case management was just starting to expand. I was offered a position and training to become a nurse case manager. With my nursing and rehabilitation background it was a great fit. My son was young, and as a field case manager, I was able to work some from home. I started my own case management company in 1999, and have been growing strong ever since.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

Yes, when I realized I had come full circle. I started working with the elderly as a nurse’s aide while in nursing school, and loved hearing their stories and life lessons. All my training in rehabilitation, case management, disability management, life care planning and elder care have brought me back to where my heart is, which is working with the elderly. We launched North Star Elder Care, a resource for seniors and their families.

In brief, describe your organization.

We are a healthcare consulting firm providing case management, life care planning, legal nurse consulting, elder care and nurse coaching services. We offer a wide variety of services helping the elderly, disabled, and sick, navigate through the healthcare system.

What are two or three important concepts or rules that you follow in case management?

The ultimate goal of a case manager is to help your client achieve their highest level of independent functioning. Therefore, it’s crucial to obtain a comprehensive medical history and thorough initial evaluation. Start with a good road map. Secondly, have good systems in place, including checks and balances, to maintain consistency and easy access to information. In an emergency, it is important to have all the signed releases, contact information, etc. easily accessible. Lastly, make time to network with others in your field. Share resources, attend networking and educational events and support each other.

What is the single most successful thing that your organization is doing now?

Expanding our elder care services division by providing geriatric care management services.

Do you see a trend or path that you have to lock onto for 2014?

Elder care is going to continue to explode. The first baby boomers turned 65, and many have elderly parents, too. It is difficult to navigate through the healthcare system and many people don’t have the time.

Another area that is expanding is nurses becoming nurse coaches and entrepreneurs. Nurses are starting to realize that there are many opportunities, both within and outside the hospital setting. I attended a conference with the National Nurses in Business and it was exhilarating to see all the different ways nurses are using their skills. We created Nurse Coach Alliance, a Web site for nurses providing coaching, resources and educational opportunities.

What is the most satisfying thing about being a case manager?

When you are able to put all the pieces of the puzzle together. For many people, the healthcare system is a puzzle and is very difficult to understand what is happening to them. Often times, they are missing some of the pieces. By finding the pieces, we are able to coordinate their services and providers, make modifications as necessary, and help them to reach their maximum level of independence.

What is the greatest challenge of case management and how are you working to overcome this challenge?

I think it is getting needed services approved that have been denied by the insurance carrier. For example, utilization review will often go strictly by guidelines, when as a case manager we will see there is often more to the picture. Not everyone has a case manager to go to bat for them.

What is the single most effective workflow, process, tool or form case managers are using today?

Keeping an extensive resource list with providers they know and trust and understanding how to navigate through the healthcare system.

Where did you grow up?

I was born in Seattle, Wash. and grew up in North Seattle. I moved to California in 1988, when I got married.

What college did you attend? I attended Seattle University.

Is there a moment from that time that stands out?

Yes, I remember my first day in pathophysiology. The professor started class by informing us that a minimum of over one-third of the class would fail. I had heard horror stories about this class and I was terrified. If you failed pathophysiology, you were out of the nursing program for an entire year. I could not fail. That night I had nightmares that I flunked the class. I knew I had to face my fear. The next day I went to the instructor’s office and shared my concerns. She was extremely helpful and recommended to me the best way to study for her class. I knew then if I did exactly what she told me, I would be fine. I ended up doing well in the class.

Are you married?

Yes, for 25 years to Gregg.

Do you have children?

Two children, Ben and Rachael.

What is your favorite hobby and how did it develop in your life?

I love to travel, and love seeing new places. I have gone to all the continents on my bucket list. My husband traveled extensively for his work, so we would meet him wherever he landed.

Is there a book you recently read or movie you saw that you would recommend?

I recently saw Saving Mr. Banks which I enjoyed, and I am currently reading The Signature of All Things by Elizabeth Gilbert.

Any additional comments?

Case management has opened many doors for me and has been the stepping stone for me taking my nursing degree in many different directions. It has given me the opportunity to use my nursing skills to travel internationally, become a published author, expert witness and speaker. And in the process, I have met some extraordinary nurses.

Click here to learn how you can be featured in one of our Case Manager Profiles.

Meet Case Manager Susan Headley: Ensuring Employees Healthy Enough to Return to Work

January 2nd, 2014 by Cheryl Miller

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.

Susan Headley, BA, MBA, CWCP, Case Manager at Macon Occupational Medicine

HIN: Tell us a little about yourself and your credentials:

(Susan Headley) I recently graduated in June 2013 from American Sentinel University with my masters in Business Administration and Healthcare. Before that, in 2011, I graduated from the local college — Macon State College — with my bachelor's degree in management and information technology. I have a Certified Worker’s Comp professional license (CWCP). I also hold a Georgia adjuster’s license.

What was your first job out of college and how did you get into case management?

While an undergraduate at Macon State College I worked in the bookstore doing their accounting. When I was getting ready to graduate a friend of mine who worked at Macon Occupational Medicine, where I’m employed now, said, “I know it’s an entry level job, and you’re about to graduate, but we have a position and there’s room for advancement.” I knew that I wanted to be in healthcare strictly because changes are always going to happen, but it’s always going to be needed. I applied and got hired and have slowly worked my way up to where I am now.

Has there been a defining moment in your career perhaps when you knew you were on the right road?

I would have to say taking the job at Macon Occupational Medicine. I had worked in healthcare as a young teen doing volunteer work in hospitals just for the fun of it. I had one of those mothers that wouldn’t let us stay home during the summer without having activity. And I really enjoyed it. When I got introduced to the case management side — it being a new model for the business — it really caught my eye and I think that is what has defined where I am now.

In brief, describe your organization.

Macon Occupational Medicine, LLC is an occupational health facility, which means we do anything from pre-employment physicals to return to work, drug screening, anything that a company might need for their business, or for their employees. Regarding the work comp side, if someone gets injured on the job we treat them and follow their care until they’re well enough to get back to work.

What are two or three important concepts or rules that you follow in case management?

Our case management is a little bit different than how nurses do it. It’s strictly work comp-related. Three things that stand out to me are:

  • Everything has to be work related. If it’s a non work-related case of course there’s no need for me to manage it. It goes back and they have to deal with their personal physicians for care.
  • Another key thing in case management is making sure that the employee has returned back to work as a whole person to the best of their ability. We don’t want them to go back into the workforce and hurt themselves further because we missed something.
  • Because we are a work comp facility, our customers are actually the employers. So we try to make them happy. And if they see a concern in the workplace, for instance, if we send an employee back and they’re not wearing their knee brace like they’re supposed to, then the employer will call us up as case management and say, “We have some really big concerns about this. I think they’re further going to hurt themselves. What can we do to fix that?” That’s when we meet with the patient and make sure that they understand the end result of what we want them to do and the big picture.

What is the single most successful thing your organization is doing right now?

The case management model has been in place about two years. We were finding that employers wanted one person they could deal with for their people. We have two case managers on staff. And we manage all of the cases from start to finish. You get hurt. We take care of you. If we can’t we send you to a specialist and we still manage your care until we release you to go back to work. So that employer knows they can pick up the phone and call me and I’ll know anything there is to know about their employees as to why they’re not at work, when they’ll be back at work. And it’s grown into an amazing thing. To my knowledge and my boss' knowledge, we’re the only healthcare or occupational facility in the state of Georgia that offers a case management program for worker’s comp.

What is the most satisfying part of your job?

Because we work for the employer, it's making sure that employer is happy while also maintaining the goal and making sure the employee is better, which can be a challenge sometimes. It's a complicated field in that the employee may feel one thing and the employer feel something else.

But it’s very gratifying when you see these people come in with cut off limbs or what have you and you watch them evolve from an injured employee to a well person and knowing you had a hand in that. It’s very rewarding.

Do you see a trend or path that you have to lock onto for 2013 and beyond 2014?

There’s always going to be people getting hurt on the job. I don’t think that that’s ever going to change. The trend now is that people are starting to learn more about it, and where the loopholes are. So, staying informed and keeping ourselves a step ahead is key. And sometimes that can be a huge challenge, especially if the employee knows how to work the system. And we want to try our hardest to prevent that.

What is the greatest challenge you’re facing right now?

As I said before, staying informed and one step ahead.

Where did you grow up?

I am a military brat. I grew up originally in Arkansas and spent most of my childhood there. We dabbled a little bit overseas and ultimately ended up here, in Georgia. I've been back here since 2001.

What colleges did you attend?

For my undergrad I went to Macon State College, which is now called Middle Georgia State College, receiving my bachelor's degree in business and information technology. I received my master's degree in Business Administration and Healthcare online at American Sentinel University. I found out about them from a friend who was in another business program and on active duty, so it worked well for his schedule. I also wanted something I could work into my schedule. I applied to this program and found it very interesting. It didn't require a nursing background, but I was able to gain a lot of knowledge about the nursing side of things. I really enjoyed the program. I had some wonderful teachers who taught me a lot. It took me a year and a half to finish the program. I’m happy to say I’m a graduate there. And if they offered a doctorate program for me I would be there too.

Are you married?

No, and no children either. I think that’s probably the only reason I made it through my master's in a year and a half.

What is your favorite hobby and how did it develop in your life?

I'd have to say right now it’s scrapbooking, and it happened because my friends started having children and wanted to create memory books, but not something we had when we were kids. So we started scrapbooking every weekend. Of course as life gets busy and the kids get older you find less time for it. But we have tried to stick with it; every quarter or so we set aside a weekend together and scrapbook if possible. It’s getting harder and harder the older we get. But it’s definitely something I enjoy doing, even on my own, if I have spare time. I’ll put a page together. It’s fun. There’s no thinking required.

Is there a book you recently read or movie you saw that you would recommend?

No. I wish I had time for things like that. I just finished a class back in September so I haven’t had a real chance to sit and read or even go to the movies. I can’t remember the last time I went. I am now working on my doctorate in education in organizational leadership with an emphasis on healthcare administration at Grand Canyon University.

Click here to learn how you can be featured in one of our Case Manager Profiles.

Meet Geriatric Care Manager Trish Colucci: ‘Jersey Girl’ Finds Passion Helping Others

November 26th, 2013 by Cheryl Miller



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.


Trish Colucci, RN, Certified Geriatric Care Manager, Certified Gerontological Nurse, Certified Case Manager, current president of the New Jersey chapter of NAPGCM, Owner of Peace of Mind Care Management Services, LLC

HIN: Tell us a little about yourself and your credentials.:

(Trish Colucci) I have been a N.J. state Registered Nurse (RN) since 1985 and have additional certifications in gerontological nursing, case management, and life care planning. Currently, I am the president of the N.J. chapter of the National Association of Professional Geriatric Care Managers (NAPGCM). Prior to that I served two years as treasurer and two years as vice president.

What was your first job out of college and how did you get into case management?

When I graduated, I started working as a floor nurse at a local hospital. Although I always saw myself in pediatrics, there were no positions available at the time, so instead I accepted a position on the orthopedic floor. It was serendipitous! In that unit, I developed a love for working with elderly folks. I was later offered a shift in career to insurance case management, at the time when that field of nursing was brand new. In that position, I developed valuable organizational skills and clinical knowledge that helped me coordinate care for our catastrophically ill or injured claimants and to ensure that they received the best medical care possible.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

Years later, I gave birth to my son who has Down Syndrome, and who had a lot of special medical needs. I was able to utilize my case management skills (which were now second nature) to coordinate a team of top-notch doctors who addressed Michael's multitude of medical problems and worked together, with my management. It was after that that I noticed friends coming to me to ask advice for coordinating care for their own loved ones. It helped me realize how valuable my case management skills were and how they could be helpful to others trying to navigate the confusing worlds of medical care and insurance.

In brief, describe your organization.

Peace of Mind Care Management Services, LLC is a care management firm that assists families, guardians and caregivers with the management of their loved one's personal and medical care. We specialize in crisis management, often finding families confused and overwhelmed by their responsibilities in an arena with which they are not familiar. As care managers, we assess the situation and create a specialized plan of care that addresses the needs of the client within the available budget. We offer support, resources and guidance so that families feel more comfortable and informed in making important decisions for the care of their loved one.

Serving as president of the New Jersey chapter of the NAPGCM has opened my eyes to opportunities for care managers on both the local and national levels. Although the field of geriatric care management has been around for over 25 years, it is not well known by the general public. Our chapter's main focus over the past year has been on developing a solid, working public relations committee, and to make, "geriatric care management" a household word and the first point of contact for families who need help with their loved one.

What are two important concepts or rules that you follow in care management?

  • The most important concept in care management is a trusting relationship. Our clients need to know that as care managers we provide honest, caring advice that is in their (or their loved one's) best interests. We are not financially connected to any resource we may offer to a family, and this keeps our advice objective and trustworthy. We refer to resources we would use for our own family members and this provides an extra level of trust with our clients.
  • Compassion is another important concept. At Peace of Mind, each client is as precious as the next, coming to us with his or her own history and special needs. We reach out to our clients and their caregivers with compassion and empathy, developing an understanding about where they're coming from so we can tailor our guidance in a way that makes them the most comfortable.

What is the most satisfying thing about being a care manager?

What I derive the most satisfaction from is the look on the face of a client or caregiver we've helped. Seeing on their faces the signs of relief...of tensions easing...because they got the help they needed to care for their loved one, provides me, as the care manager, the signs that I've done a good job for the family. Even in situations where clients are in the process of dying, knowing that I have coordinated their care such that they will leave this world feeling comfortable and loved, makes me feel good about the work I do.

What is the greatest challenge of care management and how are you working to overcome the challenge?

What I love about being a geriatric care manager is the diversity of duties, however that's one of the things that makes this job such a challenge! Each day brings forth some new challenge, and my schedule can change hour-to-hour. It helps to be flexible! I am fortunate to have a strong, warm and wonderful care management team made up of nurses and social workers. When we are faced with tight situations, we reach out to one another for assistance and support. Whether it's a race against time to get medical equipment in the home before a client comes home from the hospital, or a family member who needs extra hand-holding and reassurance on a particular day, or an unexpected emergency with a client that needs immediate attention, we are ready to act.

Where did you grow up?

I grew up in Denville, N.J. and am the eldest of three girls. I am a "Jersey Girl" through and through. My dad was a police officer and my mom was a bank teller. Sounds like the makings of a good Bruce Springsteen song, doesn't it?

Click here to learn how you can be featured in one of our Case Manager Profiles.

Meet Geriatric Care Manager Jullie Gray: “We Need More People That Specialize in Aging”

September 27th, 2013 by Cheryl Miller

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.

Jullie Gray, MSW, LICSW, CMC, Principal, Certified Care Manager Aging Wisdom, Inc., and president of the National Association of Professional Geriatric Care Managers (NAPGCM)

HIN: Tell us a little about yourself and your credentials.

(Jullie Gray) I attended the University of Washington where I earned a bachelor’s degree in social welfare, master’s degree in social work with a specialty in healthcare, and completed a certificate program in geriatric mental health.

What was your first job out of college and how did you get into geriatric care management?

My very first job in healthcare was as a medical assistant in a practice made up of mostly older adults. I loved it!

After I completed my master’s degree in social work, I landed a job with a public hospital district that had many programs besides just the hospital’s programs. For years, I worked in the acute care hospital with people of all ages.

The hospital system also owned a geriatric medical practice (primary care clinic but specializing in older adults). I was recruited to manage that clinic, which I did for several years. Being focused solely on management was fine for a while but I started to miss clinical work. I had the opportunity to work in the hospital’s hospice program part-time (a job I absolutely loved). I took the part-time position because I wanted to start a private care management practice. I did both jobs for several years and then my practice demanded more and more time so I quit my hospice work and the rest is history!

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

As my career progressed, I came to realize my most favorite patients (clients) were older adults. At one point while working as an emergency room social worker, whenever an older person would arrive, I would gravitate towards them. I found they had so much life experience to draw upon; they had fascinating lives and I just knew I had found where I wanted to go next in my career.

In brief, describe your organization.

I am the president of the National Association of Professional Geriatric Care Managers (NAPGCM) and a principal at Aging Wisdom, a care management, consulting and home care company located in Seattle, Washington.

The National Association of Professional Geriatric Care Managers (NAPGCM) is an organization whose mission is to advance professional geriatric care management through education, collaboration and leadership. The NAPGCM is over 2000 members strong. Our vision is to define excellence in care management and we are looked to as the gold standard in the field.

What are two or three important concepts or rules that you follow in care management?

  • Follow the code of ethics and standards of practice of NAPGCM;
  • Do good work; and
  • Be responsive and follow through with what you say you are going to do.

What is the single most successful thing that your organization is doing now?

At NAPGCM we are helping care mangers from across the country to do their best work. We provide a great deal of business and clinical support to practitioners so they in turn can serve their clients at the highest level.

In my practice at Aging Wisdom, we have gathered together an amazing team. We try to nurture our employee’s creativity and encourage them to grow as practitioners. We know that by investing in our staff, it pays off for our clients because they are all performing at their best.

So, really, in both of my roles, I focus my energies on nurturing strengths and promoting a culture of professional growth and development.

Do you see a trend or path that you have to lock onto for 2013?

There’s not enough people in the field of geriatrics who understand the special needs of older adults, and the problems that come up when people age. Right now there’s a shortage of not only care managers who understand older adults but if you look around at the medical field, there’s a shortage of geriatricians, social workers and nurse practitioners. As I understand it, nurse practitioners are no longer being offered specialized geriatric practice training; instead they are focusing on adults for a generalist view. This worries me; we need more people that specialize in aging.

What is the most satisfying thing about being a care manager?

It’s hard to pinpoint just one thing that makes my job satisfying. I guess like most people, I want to know that I make a difference. I am fortunate to have a job that allows me to help people. And, at the same time, my clients help me by sharing their wisdom. Working with older adults is tremendously rewarding because they come with a lifetime of experiences. Even those who have memory problems are able to draw upon their rich history and find creative ways of coping. My clients have a tremendous sense of humor even in the face of really difficult challenges. The fact that they let me be there for them during their most vulnerable moments in life is a real honor.

What is the greatest challenge of care management and how are you working to overcome this challenge?

The greatest challenge for me right now is juggling my role as president of NAPGCM and as principal of a growing company. Being president of NAPGCM, I have access to a great team of fellow board members and staff. They help keep me on track and inspire me by their commitment to excellence.

In my practice, I’m lucky to have a wonderful business partner. We laugh a lot and set small and large goals for ourselves. Because we’ve assembled a really great team, we are able to let go of many responsibilities and feel confident that the work will be done right.

What is the single most effective workflow, process, tool or form care managers are using today?

I think most practices are using some sort of care management software program. These programs typically interface with Quick Books to help with invoicing. Even though no software program is perfect, I can’t imagine working without one to document case notes and invoice clients.

Where did you grow up?

I was born and raised in Seattle. In fact, I often joke that I was born at the University of Washington Hospital, obtained my bachelor’s and master’s degree there and will probably end up there at the end of my life to complete the circle. I can honestly say that I was born a Huskie! Usually, that story gets a good laugh.

What college did you attend? Is there a moment from that time that stands out?

I attended the University of Washington. The moment that stands out for me is when I attended my first social work class. I knew right then that I was at home! The profession really made sense for my values, personality and temperament.

Are you married? Do you have children?

I am happily married. I didn’t get married until I was almost 40 years old. This year I turned 50! It was weird turning 50 because it seems like it just snuck up on me so fast. I actually celebrate my age even though I know many people worry about growing older.

We don’t have any children but we do have a rescue dog named Gracie. She’s a Shepherd mix and loves to jump on top of me (all 50 pounds of her) early in the morning around 5:30 AM. It’s her way of getting me out of bed to take her for a long walk before my workday starts. Can’t beat that for motivation!

What is your favorite hobby and how did it develop in your life?

My husband is a landscape photographer so whenever we have a chance, we visit national arks and soak in the beauty. I love to watch him photograph and sometimes I even pull out my own camera to try to capture a scene.

Is there a book you recently read or movie you saw that you would recommend?

I really enjoy a book called The Leadership Challenge. By Kouzes & Posner. It’s helped guide me in my role as president of NAPGCM and also in my own practice.

Any additional comments?

I would encourage anyone who is interested in the field of care management to think about joining NAPGCM, and you can click here to get to the Web site. We have started a great webinar program for budding entrepreneurs called the Building a GCM Business Series. The association is ready and eager to help care managers be successful in their careers.

Click here to learn how you can be featured in one of our Case Manager Profiles.

Meet RN Case Manager Turned Grief Coach Audrey Pellicano: “We Don’t Grieve in Front of People, We Grieve Alone”

August 7th, 2013 by Cheryl Miller


This month's inside look at a grief coach, the choices she made on the road to success, and the challenges ahead.

Audrey Pellicano, RN, M.S., Case Manager, Corporate Grief Recovery Specialist and CEO, Wise Widow

HIN: Tell us a little about yourself.

(Audrey Pellicano): I was widowed in 1990, at 37. My baby was 2 ½ months when my husband Joe died and I also had a two-year old, a four-year old and a six-year old. I spent 37 years in healthcare, as a nurse, specializing in case management and health sciences. I have my bachelor’s in nursing and received my master’s in health sciences. In 2009 I went into grief coaching.

I also recently started the first Death Café in New York City. There's usually 12 to 14 people who get together at a nice coffee place, and over coffee, tea and dinner or dessert, everybody discusses death. Everyone is there for a different reason. This is not a group of grievers. I’ve had some people who are with hospice. I’ve had journalists who are looking to write about the whole new trend. I had one woman who had attempted suicide twice. I had a young college student who was studying, taking a class on death and dying and she thought she would find information to write on a paper. It’s a wonderful concept, and the ages range from college students to a woman in her 80s. Outside of the Death Cafe, we talk about life and ignore death as if we could avoid it. In the Death Cafe, we openly talk about death, dying and living fully.

How did you get into health coaching?

I've been coaching my entire life. For 10 years I was a case manager at a managed care facility. It was very frustrating. When I first began it was very satisfying; the patient load was low and I felt as if I was impacting people’s lives. I got to know the patients and their doctors well; the doctors knew who I was, and what my purpose was in helping the patients. But by the time I left the workload was about 260 patients. It was impossible to effectively help these people change their diet, incorporate exercise. It was just overwhelming. So I left and started grief coaching.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

That would be after I left case management. After spending 27 years in healthcare, I thought I should help coach people who were diabetic, or who had heart disease, but the idea didn’t give me energy. And then one day, like a light bulb, I realized I needed to work with people who were grieving. I realized “Of course you’re supposed to be helping widows and people who have lost loved ones.” When my youngest daughter went off to college in 2009 I made my major move. I started doing it part-time so I could develop the business until I was comfortable enough to quit my full-time job.

Can you tell us a little bit about your grief recovery work?

Six years after my husband died, I came across a book called the Grief Recovery Method, by John James and Russell Friedman. It just hit me one day that I was not doing well; that I hadn’t moved emotionally forward after losing Joe. I was actually dating someone and he broke it off and I was absolutely devastated. And I realized that I couldn’t handle the goodbye. That’s when I said, “Oh boy, you’ve really not been looking at this grief at all.” We’re not a society that talks about it. Most often we don’t grieve in front of people, we grieve alone.

Can you tell us about your organization, Wise Widow?

As a grief recovery specialist to corporations, I provide information and training for managers and co-workers focusing on the necessary tools to support a returning employee after a personal loss. I use the Grief Recovery Method in my practice. I have not had a client that hasn’t had an 'aha' moment. I believe in it because it’s not long-term talk therapy. We’re in a society that wants it now, but you have to do the work in order to reach your goal. And this is just that. It’s a seven-week program, and there’s an assignment and my clients understand from the beginning, if you don’t do the assignment, we need to change your appointment because I will not meet with you. If they don’t do the work, we can’t move forward to the next step.

I also speak on Healthy Living After Loss where I incorporate meditation, yoga, guided imagery and nutrition. And I offer presentations on Moving Forward After Loss and The Right Thing To Do: Grief Support at Work.

What concepts or rules you follow in coaching?

The people that I work with have to be ready to work within the parameters of my program. It could be anywhere from two to 10 years since their loss, and it could be any kind of loss — it doesn’t have to be the death of someone. It could be a financial loss, any kind of a loss that triggers the same loss issues, but they have to be willing to work at shifting their grief.

How have your nursing and case management skills informed your coaching?

I was a telephonic case manager — I worked by phone. People would say, “You can’t be effective by phone.” But I disagreed. It enabled me to be comfortable starting my business virtually. As far as nursing goes, I know a lot of questions to ask that the lay person may not know. I work with the boomer generation, women my age, mid 50s to 70, and many of them already have some kind of chronic illness, weight gain and have been through a lot of changes. Let’s say they have hypertension. Most of them have absolutely no idea how the foods they eat are affecting them.

Do you see a trend or path that you have to lock onto for the coming year?

Focusing and being there for the baby-boomer women, whom I believe are going to make a lot of changes in the way they look at grief, in the way they move forward with their lives. Baby boomers are far more demanding; they’re going to make a change with end-of-life care; they’re more demanding about physicians, more selective. It’s a very strong and powerful group. Part of my mission is making people realize that they will grieve at some time in their life.

What is the most satisfying thing about being a coach?

I think the most satisfying thing for me is helping clients to see that they actually can make a change. Especially the age group that I work with, the tendency is, I’ve been doing this for years, it’s going to be so hard. And it’s not. It’s making things simple for people. And then they feel better, and they actually get better.

Where did you grow up?

I grew up in Brooklyn, NY. Then, when my father got a new job we moved to the suburbs, Westfield, NJ, where my first husband and I continued to live and where I raised my children after he died. In 2009 I spent a year living alone in the Catskills, and then moved back to Brooklyn where I live with my second husband. I’m a city girl at heart.

What college did you attend?

I received my nursing degree from Bloomfield College, Bloomfield, N.J., and my master's degree from Jersey City State University, Jersey City, N.J.

Are you remarried?

I got remarried in October, 2012. I had been widowed for 22 years. I wanted to raise my children, because they were quite young, and my focus was on them. My youngest daughter is graduating college this year. So I felt I guess I could give this a try. My four children were at our wedding and they were very happy for us.

What is your favorite hobby and how did it develop in your life?

I guess yoga is my hobby. I’m a certified yoga instructor. I studied in New York City. A studio had opened in my town, and I'd read about how healthy it was and great for staying in shape.

Is there a book you recently read or a movie you saw that you would recommend?

Having read all the widow books out there, I have to recommend Dr. Joyce Brothers' excellent book, entitled Widows.

I also recommend Rework, by Jason Fried and David Heinemeier Hansson. It’s about business practice. I liked it because as a business owner, a lot of the stereotypical business models frustrate me. This is thinking outside the box. You don't have to have this before you do that. It’s not complicated. You have to have a business plan in place typically, and then it's just go and do it. I like that kind of attitude. I do that in my own life, just go ahead and do it.

Any additional comments?

In June my first eBook was released: Six Secrets to Surviving Widowhood. Within those six secrets is a lot of information about using meditation, guided imagery, making healthy choices. It’s not about the grief recovery method, because I tell people who want to go first towards that healthy lifestyle that they have to get through their grief first. I’ve been there and I know that it’s not going to work if you haven’t allowed yourself to complete the grieving process. I continue to offer my clients ways to get healthy once they've been through the initial program with me, and have been able to lift their grief a bit.

Click here to learn how you can be featured in one of our Case Manager Profiles.

Meet Geriatric Case Manager Denise Digh: Providing Patients, Families with Road Maps to Future

May 3rd, 2013 by Cheryl Miller

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.

Denise Digh, BA, RN, CCM, Owner/Senior Care Manager at Silver Coordinated Care, PLLC/Silver Concierge Services, LLC

HIN: Tell us a little about yourself and your credentials.

(Denise Digh): I have a bachelor’s degree in political science and French, and an associate's degree in nursing (ADN). I am also a certified case manager. I have been a workers’ compensation case manager for many years, working for the State Fund in Maryland and then in field case management. I started my own company, Silver Coordinated Care, PLLC almost two years ago and practice geriatric care management. This grew out of living with my in-laws and helping my husband be a caregiver to his parents for several years, and also being the only caregiver for my mom who has Alzheimer’s disease.

What was your first job out of college and how did you get into case management?

My first job out of nursing school was with the surgical intensive care unit (SICU) and medical step down unit at Johns Hopkins Hospital in Baltimore. I then went into homecare case management for several years. I actually got into field case management when an old regional manager of mine opened her own agency and called me out of the blue to see if I would like a new job. I did and have been doing case management ever since – first in workers’ compensation and now with my own geriatric case management company.

Has there been a defining moment in your career? Perhaps when you knew you were on the right road?

I can’t say I have one defining moment. I just always felt completely comfortable in case management and felt like it was definitely the right road for me. It suits my strengths. I have always been very good at organization and time management and have learned I hate being locked in an office all day!

In brief, describe your organization.

I am the owner/operator of a geriatric care management company, Silver Coordinated Care, PLLC and am co-owner of a senior transportation and concierge service, Silver Concierge Services, LLC. I strive to help adult children obtain superior care for their elderly parents (or other loved ones), whether that be finding the right homecare services, durable medical equipment (DME), renovation company, etc. or by helping them find the perfect senior community. I also do patient advocacy work, attending physician appointments to make sure the doctor is clear with what the patient needs, and the patient, and their loved ones, understand the plans put in place. I also offer medication management services.

What are two or three important concepts or rules that you follow in case management?

I always try to be comprehensive in my assessments, whether they be for finding a community or just doing medication management. I also pride myself on creating custom care plans for my clients — no cookie-cutter reports! I call my care plans SeniorCare Roadmaps™.

What is the single most successful thing that your organization is doing now?

My most popular services right now seem to be finding the right senior community and doing medication management. In fact, the need to find the correct senior community has become so popular, I’ve created a new Web site for families who just need this service. It will launch in a couple of weeks and is called www.NCSeniorHousingSolutions.com. Watch for it anytime!

Do you see a trend or path that you have to lock onto for 2013?

I think there is a subtle but definite trend of people being more open to looking at family care homes rather than large assisted living communities. These homes are in regular neighborhoods and offer all the important services an assisted living does but in a home-like setting. Most homes have only six or fewer residents.

I also see geriatric care management becoming more important and known as the boomers start being seniors and retiring. I think they definitely are looking for more wellness-like programs and the ability to plan out their retirement funds carefully, especially when considering the need for assisted housing in the future. People used to retire at 62 and only lived to around 68 or70. Many people are retiring much later now and living well into their 80s or 90s. It takes a lot of planning to be successful!

What is the most satisfying thing about being a case manager?

I derive the most satisfaction from my clients saying that they didn’t know what they would have done without me. I don’t say that to be conceited but it is a really warm feeling to know that what you did for them is so appreciated and has really changed their lives for the better!

What is the greatest challenge of case management and how are you working to overcome this challenge?

In my industry, the biggest challenge is not being able to get insurance companies to pay for the important services of a geriatric case manager. Other than some long term care plans (which many elderly people today do not have) insurance does not pay for case management services. We could save them so much money by making sure care is superior, medications are being taken properly and everyone is in a safe and healthy environment so that hospitalizations could be avoided. It is an uphill battle.

What is the single most effective workflow, process, tool or form case managers are using today?

There are many different case management systems out there. I don’t use a particular one. I find my big calendar and a smart phone with my email are my biggest helpers!

Where did you grow up?

I grew up in Corpus Christi, Texas and moved to North Carolina when I was 19 as my father retired and he was from there. I still consider myself a Texan even though I now live in Virginia.

What college did you attend? Is there a moment from that time that stands out?

I first graduated from Guilford College in Greensboro, N.C. with a double major in political science and French. Needing an actual job, I returned to school and received my ADN from Surry Community College in Dobson, N.C. The biggest event that sticks out from my college days is the semester I spent in Paris and traveling around Europe. It was a really enlightening time and made me truly appreciate how lucky we are to live in the United States!

Are you married? Do you have children?

I am married to a wonderful husband who can fix anything and supports me in my crazy endeavors. I also have two gorgeous children – my daughter, Taylor who is almost 15 and my son Bear (Barrett) who is just about to turn six.

What is your favorite hobby and how did it develop in your life?

As busy as I am, regular hobbies are difficult but I love to read and do so every night. My family were all big readers and we always had a love of books. I also really enjoy cross stitching, which I don’t have the time to do much any more, and baking. I had a small cake decorating business for a while and it was a great creative outlet. I also wrangle a bunch of chickens and four dogs!

Is there a book you recently read or movie you saw that you would recommend?

I recently read Agenda 21 (by Glenn Beck) which was a very scary view of future possibilities if we don’t start standing up for our Constitution. I’m currently reading House Girl (by Tara Conklin), which is about a modern day legal reparations case, as well as the life of a slave in Virginia in the 1800s.

Any additional comments?

I hope that case management companies allow their case managers to retain their ability to do their jobs with their clients based on the clients’ needs and not force them into cookie cutter forms. That is where you lose the real benefit of a nurse’s knowledge, experience and caring.

I also think case management is a very important tool that is often overlooked in making sure patients have the right care, and families have the information they need and that everyone is on the same page. Planning for the future is getting more and more important with our economic upheavals and the aging of our population. I hope geriatric care management continues to grow and become more well known so more families can take advantage of our expertise.

Click here to learn how you can be featured in one of our Case Manager Profiles.

Meet Healthcare Case Manager Sherrie Lynn Campli – Motivational Interviewing Key to Patients’ Empowerment

March 18th, 2013 by Cheryl Miller

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.

Click here to learn how you can be featured in one of our Case Manager Profiles.

Meet Healthcare Case Manager Lori R. Young – Treating Each Patient Like a Work of Art

March 4th, 2013 by Cheryl Miller

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.

Lori R. Young, RN, CCM, Case Manager Mid-America, North Flex Medical Team

HIN: Tell us a little about yourself and your credentials.

(Lori R. Young:) I’ve been a nurse for more than 25 years. I have a current RN license in both Georgia and Florida, and recently obtained my certification in case management, which I enjoy very much. When I began with Aetna about seven years ago, I spent my first four years in disease management. I was one of six core nurses chosen for a large employer customer team. Only six nurses out of the entire disease management team were chosen, so that was quite an honor in itself. I was also the nurse chosen to meet Ron Williams, our CEO at the time. They selected one nurse for him to talk with and see how we do things, and what our workflow was. Meeting Ron and having that experience was a wonderful experience.

What was your first job out of college and how did you get into case management?

I have actually been a nurse since I was 15 years old. I started in South Florida as a candy striper in a geriatric home there. I would write letters for patients, hold their hands while they were having their blood pressure done. That is how I began in nursing, solely on a volunteer basis.

Seeing the difference that caring and respect made had a big impact on my life. I’m a very positive person. I’ve been an artist for the past 25 years, and that does play into this. Each piece I do is unique and it’s how I view my patients and my members.

What kind of art do you do?

I use multimedia. I am a gourd artist; gourds are natural products and I do high-speed carving, including a seasonal Santa Claus line. Three or four years ago I did a show for HGTV, I was one of six artists featured, and it was the greatest time. I also create a line of jewelry with my mother; she is in Florida, and we make bracelets for the battered women’s facility there. My mom presents them to people who have nothing. And I also make glass; I turn it into what appears to be stained glass. I created an entire line of these and gave them as gifts to a group of nurses I worked with; each piece had their names carved into the glass.

That’s in my midnight hour. It’s so relaxing to do nursing and case management all day long on a full-time basis and have that time of relief. And I think it actually makes me zero in even further the next day when I go to work.

Has there been a defining moment in your career, perhaps when you knew you were on the right road?

There have been so many it’s hard to pick just one. I assisted a family with two children; I was assigned to be the father’s case manager after he had an acute MI. It was the scariest night of this family’s life, and the mom said it was a night that changed their life around. She wrote a letter to Aetna and dedicated a song to me, She’s an Angel, by Alabama.

I still get tears in my eyes when I feel like my patients are holding my hand over the phone or they bring me into their personal lives and tell me how their grandchildren or their elderly parents are. I believe that is such an important part in what we do.

In brief, can you describe your organization?

I am extremely proud to work for Aetna. It’s a company that has helped build and shape America for over the past 160 years. I respect our leadership in (Aetna CEO Mark) Mr. Bertolini and those who work with him. It was about 1850 or 1853 when Mount Aetna erupted, an 11,000-foot volcano in Sicily that led to the naming of Aetna. To this day I still feel such pride and passion in working with them because I feel they shape America on behalf of our members, the communities they serve, and their endless efforts to give. They’re the first ones there when a tragedy strikes. I just can’t say enough for my company, for our company and its leadership.

What are two or three important concepts or rules that you follow in case management?

Privacy is one of the most important concepts, whether you’re in an elevator or whether you are standing with your friend on the corner and talking. We have a very large population of baby boomers and late baby boomers and you just never know who is standing next to you in an office or elsewhere.

People are so unique onto themselves, just like my art pieces - their expectations, their level of knowledge of procedures, techniques, doctors, personalities, the healthcare system itself. There’s so many complexities that each and every person has to absorb; I think proper assessment, and respecting privacy is very important.

I also believe that collaboration between our departments, between our managers, and our higher management is important; that we talk to each other on behalf of our efforts towards each member of patient. What do they need? We can’t be afraid to talk to each other or that it’s going to take too much time.

Lastly, most of us are telephonic, and it is important that our members or my patient knows my sincerity, and the smile on my face. I want to treat every single person like they’re the 8:30 call of the day. I want them to feel that. I don’t want them to think I’m too busy to hear something very important, or that they’re just going to throw something by me and see if anybody cares, and if they get a response. I really do want to be that person that hears them.

What is the single most successful thing your organization is doing now?

With the changes coming in healthcare, there’s a great deal of fear among people: fear of the unknown, fear of whether their children, as they get older, will have insurance. Do they even know what a socialized system is? Do they know whether or not this is going to become the system? Aetna wants to be the forerunner. They want to get it right. And they want to get the information correct and get it out to the people as easily and thoroughly as they possibly can. Aetna Navigator is a tool that our members have access to with private ID and password. It’s a very secure site that each year is becoming more and more user friendly. And reaching out on a community level is very important. I believe there is a great need for Aetna to come to the neighborhoods.

Do you see a trend or a path that you have to lock onto for 2013

The trend that I’m seeing is providing an increased knowledge base to our communities and our existing members. Helping them to understand. It’s difficult for most of us that have been in healthcare for 25 and 30 years; it is quite complex. And to do this not only in a multilingual sense — we have a language line that is just sensational - but to provide people with the most accurate, easy to understand information. I’m going to use ‘accurate’ as the first word, because they hear so much from so many sources, and so many of them depend just on the television. My goal would be for Aetna to provide these people with a better understanding of where we’re headed.

What is the most satisfying thing about being a case manager?

Being a case manager is multifaceted. It is being able to be the patient’s advocate and assist them and their families with their healthcare benefits, and help them utilize their benefits to the maximum degree.

And the most important thing is, again, to let them hear my voice, to let them know how much I care. This is not just a business transaction. This is their life, their family’s life, and I really care that we do this right.

What is the greatest challenge of case management and how are you working to overcome this challenge?

One of our greatest challenges is patient load. We are a very busy team and no matter how busy, we still assist other teams when needed. No matter how busy I am, when I speak with a person I don’t look at a clock. Our case managers’ time management skills are sensational for everything from technical problems (the biggest thing that can slow us down) to the patient who needs to talk for 90 minutes versus the patient who only needs five minutes. Time management is a great skill that case managers must possess. And, the case manager must maintain a balance: after you finish with that 90 minute member, the next person should feel like they’re the first one of your day. And that’s a fine balance.

What is the single most effective workflow process, tool or form case managers are using today?

The most important tool we have is collaboration. It is the greatest tool that I know of, to collaborate with my peers, medical directors, supervisors, and it all requires excellent time management. If you have spent 10 minutes, or you have clicked three times to reach what you’re after and you’re still not there, reach out. Manage your time. We all get caught up in it sometimes. We want to be successful in our search of that unique thing, but as a team, it’s best to be time efficient and reach out to your peers.

We also have a Wiki, which identifies a complete workflow, and we have our central sites that we go to. Aetna has provided unlimited resources - (PS2) performance tools if we need them – if you have a very difficult case and want to look at that discharge plan and get your flow down just a little bit better, it’s available. It’s there for us.

Finally, continuing education. We’re in a very fast-moving medical world. So what they offer us in continuing education is just phenomenal.

Where did you grow up?

I grew up in Hollywood, Florida. I started my prerequisites at Broward Community College and didn’t know anyone except a cousin in Georgia, but I had always heard Georgia was a beautiful place.

In high school I was the recipient of a junior scholarship. It was out of financial need, and it was for dental hygiene because I had six years as an oral surgical and dental assistant prior to becoming a nurse.

Even though I had received a scholarship, I stood up and I said, “Please give this to someone who is going into dental hygiene, I’ve just decided I’m going to go into nursing and become a nurse.” I gave up the scholarship to someone who could definitely go forth and use it for their dental hygiene career.

Are you married? Do you have children?

I do not have children, but I rented about a thousand of them. I was in pediatrics for 12 years. It was an absolute joy. I did not have children by choice. I am married to my absolutely most adorable best friend.

What is your favorite hobby?

It is my art and being outside. I love to create unique pieces. And Mother Nature is one of my greatest past times. We live on a creek and I just love the hummingbird migration time. I feed the birds, the rabbits, and the deer; we had baby warblers, cardinals and wrens this year. I love watching them making their homes and nest. And then they have the babies right there.

Is there a book you recently read or a movie you saw that you would recommend?

Yes, l very much like the David Baldacci series. I just loved the Camel Club (a trilogy). And I was so excited about the new Men in Black movie that came out. But that’s not the one I would recommend. I would recommend Avatar, for its creativity. And I’m an old movie buff. Gunsmoke is one of my favorites.

Any additional comments?

I’m in a place in my career of combining business and medicine. I guess that dreams do come true. I worked very, very hard to get here and I am honored to be with a company like Aetna.

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