Archive for the ‘Case Manager Profile’ Category

New LinkedIn Forum, CaseTalk, for Healthcare’s Case Managers

February 22nd, 2013 by Cheryl Miller

We are happy to announce the recent launch of CaseTalk…a Forum for Care Coordinators, a new online interactive resource for case managers and other healthcare professionals on LinkedIn, where members can weigh in on best practices, news analysis, and network with others.

We’ve assembled a panel of prominent case management professionals to oversee the forum, who will consistently advise on current issues and advances in case management, and discuss the needs of patients and professionals. They are:

Stacey Hodgman, MS, RN-BC, CCDS, CPUM, senior director of care management at Kindred Healthcare, has been an RN for over 20 years with 16 years of case management expertise and experience working for managed care organizations, short and long term acute hospitals and work site wellness programs. She has worked for Kindred Healthcare since 2007 in care management leadership roles. Stacey is ANCC Board certified in case management, a certified case manager administrator (CMAC) and has served two terms as an elected member of the executive board of directors for the Case Management Society of New England (CMSNE.) She received her nursing and undergraduate degrees from Rivier College and her Masters degree from George Washington University. Stacey volunteers for the Massachusetts Registered Nurses Association (MARN) as a career guide/counselor for new nursing graduates. She has authored articles in professional journals including Professional Case Management, the official journal of the Case Management Society of New England. Stacey is committed and passionate to patient advocacy and improving transitions of care as patients move throughout the healthcare continuum.

Teresa “Teri” M. Treiger, RN-BC, MA, CHCQM-TOC/CM, CCM, principal at Ascent Care Management, LLC, has over 30 years of healthcare industry and 20 years of care management experience. Following years of bedside nursing, Teri worked in managed care, acute hospital, rehabilitation and long term care settings eventually focusing in program design and implementation. Teri has published on case management topics such as patient-centered medical home, advancing technology use, and future trends in care management. She was primary investigator in the 2010 Health Information Technology Survey and participant in the 2012 Survey Update. Teri co-authored chapters on interdisciplinary care transition teams for the American Gerontological Society and business considerations legal nurse consultants for the American Association of Legal Nurse Consultants. She serves on the Editorial Board of Hospitalist Program Management, Lippincott’s Professional Case Management, Case Management Monitor, and CMSA Today.


Ms. Jan Van der Mei, RN, MS, ACM, Sutter Health Sacramento Sierra’s regional director for care management programs supports four hospitals with 800+ average daily census, two medical groups and one multi-specialty IPA. As the care management director, she is responsible for planning and operations for disease management including heart failure, asthma, diabetes, heart health and care coordination/medical office case management for patients with chronic illness, as well as anti-coagulation management. Ms. Van der Mei speaks to national audiences on case management and disease and population management issues and also serves as a Sutter Health internal consultant for system improvements in case management models.

We welcome all healthcare case managers and other healthcare professionals to join our discussions, here.

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

Meet Health Coach Alexis Koutlas: Natural Progression from Nurse to Case Manager to Coach

February 18th, 2013 by Cheryl Miller

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

Alexis Koutlas, BSN, CCM, CHC, specializing in women’s, children’s and health professionals’ wellness

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

(Alexis Koutlas) After graduating with my BSN, I started my professional career in women’s and children’s services. Over time I shifted roles from the bedside to referral and case management for high-risk obstetric patients and pre-term infants. Wanting to understand how these children progressed and what their needs were, I then transitioned to the outpatient arena in pediatric medicine. Once there, my interest led me to preventative medicine, which led me to the discovery of health coaching. Since receiving my Certified Health and Wellness Coaching certification from Vera Whole Health, I look at my nursing role as promoting and supporting wellness, rather than treating just the illness. I’m passionate about supporting children and colleagues, helping them to engage in their own health and well-being, and learning to be the best selves they can be.

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

Out of school I jumpstarted my career in a neonatal intensive care unit (ICU). What a fantastic opportunity that was! I worked in an academic care facility and had the opportunity to work with some very well-respected practitioners. To keep up with changes in the environment of care, the medical leadership created a position for a case manager, which I accepted, working directly for the physicians who were part of the Division of Perinatal and Neonatal Medicine. It wasn’t a traditional case management position; actually, our approach was quite unique. Rather than try and cut length of stay, we looked at the positives for increasing the length of stay of the mom, to decrease the infant’s length of stay and morbidities that occur from prematurity. There was no certification for this at the time. Working together for the best outcome for high-risk obstetric patients, we were able to expand the role to include referral management, supporting patients across the Pacific Northwest, Montana and Alaska.

When did you decide you wanted to go into health coaching?

The transition from treating illness to preventing illness was an entirely new concept that I discovered as I moved into the outpatient arena. Along with focusing on patient wellness, the care environment supports nurses’ own self-care. Better work hours and shorter shifts allow nurses to balance a personal life. My newfound schedule allowed me to engage with my own fitness and health regimens. And along the way, I met such fantastic, energetic experts who see and support the movement of wellness, and I am excited to return that gift to others.

How has your medical and case management background impacted your career as a health coach?

Understanding the physiologic ramifications (medicine) of the lack of wellness — the mental, physical and emotional components — is like the slab of foundation for a home. Understanding the financial ramifications and the necessity for conscious spending (case management) is that budget we maintain to build that home. Health coaching, however, is the covering; the roof, walls, windows and doors. If the roof leaks, the budget will be affected by the cost of repairs and your foundation will be destroyed from mold. Health coaching is the natural progression. Having a background in disease management enables me to help clients explore their own processes and circumstances with a deeper level of understanding.

In brief, describe your organization.

I’m an independent practitioner and specialize in two dynamic groups.

  • The first: families affected by pediatric obesity. Pediatric obesity is not just a child’s problem. It’s a family’s problem, and working with getting these children to engage in their health takes more than working with them independently.
  • My second area of focus: healthcare professionals. I work to get them to explore their own health needs and their role and responsibility as representatives of health, not just disease management.

What are two or three important concepts or rules that you follow in health coaching?

  • Never have a road map for your client.
  • The client has the answers, the client has the answers, the client has the answers. My job is to coach them, weed through all the mush to get to the answers that only they have and know are best for them.
  • I cannot successfully coach someone else if I am not working to care for myself.

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

Health coaching is new. Independent practice is newer. The greatest most effective thing I can do at this time is promote the movement, help people understand why it’s important, and get them to engage in it in a different way. This is trailblazing and so with the weed eater in hand, I keep moving forward.

Do you see a trend or path that you have to lock onto for 2013?
Recognition of the wellness movement. On the West Coast, we are last to catch up to other parts of the country. Defining wellness, making it a household term, is progress in itself. Taking it into western medicine and proving its worth is monumental and will continue to be a work in progress backed by data acquired over time. Unfortunately, automated health coaching set us back from this goal. Two steps forward, one step back.

What do you mean by automated health coaching?

Automated, or scripted coaching from computer generated scripts. For example, you have this diagnosis, and the script encourages such and such questions. Hospitals have purchased the automated heath coaching for their employees. All the employee has to do is click here that they are getting their BP checked, and click there that they walked three times this week. For this, they receive a nominal bonus. The incentive is the bonus. Many employees participate. Many employess punch the buttons. Many employees do not make the changes that are necessary. I had the fortunate opportunity to have an informational interview with the person who has championed getting this service into a local hospital facility for their employees. She agrees, the true success behind this method will be to engage employees without significant issues or the ‘low hanging fruit’. The fact is, nothing replaces one-on-one personal coaching. But for right now, it isn’t a covered benefit, and if it was, would people value it the same way? I liken it to paying for a fitness trainer. The fact is, it’s personal service. It’s expensive. But when I pay for it, I am engaged with it. If someone else was paying the bill, I may show up, but would I engage?

What is the most satisfying thing about being a health coach? How is it different from case management?

As a coach, when the client discovers their sense of direction, that sense of self, that “aha” moment that is life changing, it reaffirms what I love about healthcare. It supports the notion of supporting health and allows the patient to design, dream and discover for themselves. Case management sets up a series of rules, set by a governing body with a focus on finances and limits the patient’s ability to be independent in their choices for improving their care. Although the goals are similar, i.e. patients who are not dependent upon the healthcare system, the methods to acquire the goals are in opposition.

What is the greatest challenge of health coaching and how are you working to overcome this challenge?

Understanding and engagement. People are naturally skeptical. They are unsure what they are getting with health coaching. It’s new. For those who have had exposure, they get it. They understand they have been beneficiaries of the inherited ‘wealth of health’ through their hard work. For others, it is an unknown. The most effective health coaching happens when the person is invested. Not only emotionally, but financially. Since this is not a covered service by insurance, it requires private funding. That can be costly, but the return on the investment is ten-fold. In short, people NEED to pay for the service, for their own sake, to reach success and stay motivated. But by the same token, it’s a cost that many are unwilling to pay if they are unsure of what it can do for them.

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

  • For the client: Getting them to a state of awareness at the beginning of each meeting. We so often go through our days as robots. We eat because it’s time to eat. We make lists and try and accomplish the items on the list. But are we ‘present’ with ourselves? Getting the client to ‘be’ for the coaching time allows them to process on a deeper level.
  • Processes for me as a coach: Working with clients to clearly define, describe, dream and design their goals and utilize both motivational interviewing as well as appreciative inquiry as tools to help clients separate out the mush and reach their own personal levels of success.

Where did you grow up?

I grew up in a little town just north of Seattle, Washington.

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

I attended college at Marquette University in Milwaukee, Wisconsin. It’s hard to pick one moment that stands out because there are so many memorable events in college. However, if I have to pick one, I’ll choose the moment I arrived at the school of nursing. Growing up in the country, arriving at an inner city university was culture shock. Add to that the moment when I sat in nursing orientation and heard the dean speak. “Look to your left and look to your right. One of you won’t be here when you graduate.” I remember thinking – “what am I going to do to be here? What qualities do I have to help me get through this?”

Are you married? Do you have children?

Unfortunately I have never married and do not have children. I believe that this is in part one of the reasons I have always enjoyed working in pediatric medicine. I like to say “even when I’m in a bad mood, somewhere during the day, some child will make me smile.”

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

Designing my own fitness routines and attending fitness classes with my favorite trainers. After years of being a couch potato, when I took stock in my own health, I realized that I needed to make changes to not only be a healthier person, but a better person, a happier person, a better employee and health coach. Throughout my learning, I found great trainers, and have met great friends. I’ve learned what motivates me and what keeps me engaged. I now look forward to creating my workouts and challenges.

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

Ok, this is not a good movie. Not noteworthy in the sense that anyone with great intellect would feel compelled to watch. But for me, I loved “Step Up” – the original with Channing Tatum. Why? Pure and simple, the dance. I am both inspired and enamored with the physical strength, endurance and flexibility of dancers. To me, their movement is its own form of expressive art. I’ve worked with dancers in some of my personal training modalities. Those experiences have led me to appreciate the true talent and physical discipline that each and every move requires. However, buyer beware, this really is a B movie at best. If you choose to enjoy it, think about it from the perspective I’ve shared and see if it doesn’t improve the enjoyment factor.

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

Meet Healthcare Case Manager Michelle Guinane: Empowering Others to Take Control of their Health

February 5th, 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.

Michelle Guinane, RN, CCM, registered nurse case manager in Patient Management Division at Aetna.

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

Michelle Guinane: I am a registered nurse (RN) case manager for a dedicated unit at Aetna. I have been a nurse for 16 years, working in the hospital setting for 10 of those years and specializing in cardiology telemetry/ICU. I also worked in the ER, orthopedics and rehab.

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

I attended Hahnemann University/Drexel University and was offered a position to stay on board at their hospital, but declined due to the city wage tax and the parking fees. Instead, I accepted a full-time home healthcare (HHC) position at Professional Nursing in Valley Forge, PA, where I had been working throughout school to help pay my tuition. I loved working there. It was my first lesson in making decisions independently and helping families to prioritize and manage their families’ care at home. I enjoyed the focus on the patient and the families.

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

Several years after my transition to the hospital, one of the families that I had worked with for several years in HHC called the floor I was working on and explained that a quadriplegic patient I had cared for, the patriarch of the family, had been on hospice with a different agency and was dying. They asked me if I could be there. After my shift I went to their home and was able to offer support to him and his family. He died shortly afterward. I felt very honored and blessed to be part of such a private family time, and felt very much a part of that family.

In brief, describe your organization.

I work in the Dedicated Unit for case management at Aetna Healthcare Insurance, a Patient Management division. I outreach to our insured patients to assist them with educational needs for complex disease management, and help them navigate their insurance plan and benefits. I do this prior to, and following surgery to ensure that they feel prepared for the procedure. Following surgery and/or hospitalization, I also support them all the way through their treatment plan until they feel knowledgeable and confident managing their healthcare. Based on the patient’s diagnosis, I provide them with resources, through Aetna, their employer, and the community, in order to offer them financial, social, emotional and educational support.

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

  • Listen to the patient and the family for identified gaps in care, knowledge deficits, and opportunities to provide them with education and resources. Patients know when you are really listening, and this will help you establish an initial trust quickly so you can help them navigate their benefits and treatment plans and assist with any needed coping mechanisms.
  • Collaboration of care amongst the patient, providers and caretakers is essential in moving patients toward wellness, decreasing miscommunications and helping patients feel confident in managing their healthcare.
  • Let the patient and family know they are never alone on their healthcare journey. In addition to the support and education I provide, there are many wonderful community resources I can utilize to get members motivated and educated. It’s important that they realize that they are part of a bigger community of patients so they do not feel isolated with their diagnosis.

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

In addition to multiple fundraising efforts for hurricane victims, I would say that Aetna’s focus is on healthcare reform laws.

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

Healthcare reform.

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

Having the opportunity to develop a trusting relationship with patients, and being witness to their progression from perhaps fear of their initial diagnosis to developing coping mechanisms and learning about their disease process. It is very rewarding to hear a patient say that they no longer need case management because they feel empowered, to see that they are no longer afraid to ask important questions, engage in resources or have open discussions with family and providers.

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

The economy has taken a toll on many patients’ job statuses, and their goal is to find financial resources, and senior and community centers that can help them to feel part of the community and not isolated. Helping patients to do this, as well as assess their treatment plan progress and help them communicate effectively with providers and family is my focus as the case manager. For example, if a patient is suffering with a particular disease, and I can help them engage in a low-impact exercise regime at a gym, senior center or community center, this helps them increase their mobility, feel less pain and increase their social interaction.

In addition to financial barriers, sometimes it is just a matter of helping the member to overcome their personal fears of their disease, let them know they have support and help them find the courage and confidence to manage their healthcare.

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

We use very specific workflows at Aetna – all policies and procedures are well established.

Where did you grow up?

I grew up in Hatfield, PA.

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

I attended Penn State University for prerequirements to nursing and then transitioned to Hahnemann University (which is part of the Drexel Network) in Philadelphia, PA., where I had a great nursing experience. Hahnemann is a teaching hospital, and you are not allowed to just ask questions; you are expected to engage in dialogue with all areas of the medical team. It taught me to have confidence in my nursing judgment. I had wonderful opportunities to meet and work with some of the country’s top cardiology experts and nurses, and I cherish that time. I felt very well prepared for anything. Hahnemann is a large teaching hospital but very supportive and progressive.

Are you married? Do you have children?

I have been married for 16 years and have two active children: my daughter is 11 and is avid in running, track, volleyball and basketball. My son is eight years old and plays baseball.

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

Cooking is my second passion. My husband is a chef and a large part of our family time is spent cooking and entertaining. Had I not been a nurse I would be running a bed and breakfast somewhere.

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

Reading is my other second passion. My favorite book of all time is non-medical, but inspiring: The Power of One, by Bryce Courtenay.

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

Meet Healthcare Case Manager Patti Tipton: Former Air Force RN Empowers Patients On the Ground

January 14th, 2013 by Cheryl Miller

Patti Tipton, BSN, RN, LNC, CCM, National Care Management, Richfield Dedicated Unit

Tell us a little about yourself and your credentials.

I am a registered nurse (RN), and achieved my BSN in 1988. I have over 24 years of experience in the nursing industry, which includes intensive care unit (ICU), trauma level emergency room (ER), labor and delivery, long term nursing, home healthcare, management, and case management. I am certified in case management by the Commission for Case Manager Certification, and also completed the legal nurse consultant certification program in 2000.

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

With great pride, upon graduation from nursing school, I entered into active duty as an RN in the United States Air Force (USAF). I served active duty during Desert Storm, from 1988 to 1991. Thereafter, I remained in Indefinite Ready Reserve, until I was honorably discharged from the USAF in 2005.

Like most nurses, I acquired a variety of nursing experiences before transitioning into case management. My initial case management experience began as a perinatal case manager in the home health industry in 1996, when I transitioned from the labor and delivery unit of a university-based hospital system to their home health division; I was an integral part of the creation of their first perinatal home health program, PerinatalConnection. Due to the need for more flexible hours to care for my family and an elderly parent, I returned to the trauma ER for a nursing agency, until I began working for Aetna as a RN case manager in October 2006.

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

I have had many defining moments in my career, all of which support my reasons for going into the healthcare field: the desire to help others. One of my first defining moments was while in nursing school, picking glass from a 20-something year old man’s head and face, while he lay in his ICU bed after his auto accident. He looked at me and said, “You are a Christian, aren’t you? I can tell that you care just by the way you treat me.” I thought to myself, “Wow…actions do speak louder than words,” and I knew I had chosen the field that was for me.

In brief, describe your organization.

Aetna is one of the nation’s leaders in healthcare, dental, pharmacy, group life, disability insurance, and employee benefits. Dedicated to helping people achieve health and financial security, Aetna puts information and helpful resources to work for its members to help them make better informed decisions about their healthcare. I am very proud to work for Aetna, and on a daily basis, embrace and connect with patients in their situations, and empower them with the knowledge to make educated decisions regarding their healthcare needs.

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

First, I truly believe in treating people as you would like to be treated, embracing people as though they were your own family.
Secondly, I firmly believe that people can make better healthcare decisions when they have the appropriate knowledge. As a case manager, I ensure patients understand their medical benefits, as well as their medications and physician’s treatment plan.

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

It is no surprise that healthcare needs to be more affordable for everyone. We need to advocate solutions that will support and motivate patients to be in charge of their own health. I know that for myself, I really think about what an ER visit will cost, versus waiting to see my primary care physician (PCP). This helps me to decide “is it really all that urgent?” As a case manager, I know that reduction of ER visits and avoidable hospital readmissions are one small part of decreasing healthcare costs. Having worked in ER departments, I have seen patients use the ER as their PCP, despite encouragement to select a PCP or follow up with their PCP. Patients many times use the ER because it is more convenient or accessible for them. Motivating patients to be more proactive with their health means promoting more cost effective ways that enable accessible and appropriate healthcare services.

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

It is all about the opportunity to connect with a patient and make a difference in their life. Sometimes, it is educating a patient about a medical benefit they did not know they had. Other times it is outreaching to the physician to make sure he/she understands their patient’s current situation, or assisting with the transfer of a member from a facility in one state to a facility in another state.

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

Promoting self change in our members. It is obvious that someone who is obese should lose weight, someone who smokes should quit. Use of motivational interviewing techniques improves communication with patients to promote self change, where the patient identifies the agenda and goals.

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

Motivational Interviewing (MI). Using MI techniques makes Aetna’s care management program different by encouraging engagement of the member when exploring the root cause of their health issues or concerns. MI is successful in guiding members to transition from unwillingness to discussing their issues to seriously considering self change. MI helps case managers improve health behaviors and outcomes, increase member engagement in Aetna programs, and improve member satisfaction.

Where did you grow up?

That is a loaded question! My father was a Methodist minister, so I moved a great deal; however, the majority of my childhood was in various towns in Tennessee. Cumulatively over my lifespan, I have lived in eight different states: Ga., Fla., Tenn., Colo., N.C., Ark., Ill., Ohio.

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

I received my Liberal Arts degree from Martin Methodist College in Pulaski, TN, then received my BSN from Tennessee Technological University in Cookeville, TN. In 2000, I completed the first Legal Nurse Consultant certificate program that was offered by Cuyahoga County Community College in Parma, OH.

I must admit nursing school was a tough and competitive program, sometimes feeling like it was a weeding out process of the strong versus the weak. Therefore, it was a huge accomplishment to complete nursing school as well as pass my state nursing boards. When I returned to college in 1999 for the Legal Nurse Consultant program, I found it to be a different level of learning for me. I did not feel it was a forced to learn situation; rather, I had the strong desire to learn something new and incorporate my nursing experience into the legal arena.

Are you married? Do you have children?

I have been married to my best friend, Michael Tipton, since 2003. We share a blended family of boys, ages 17 to 26.

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

Sewing, which I learned from my mother. At a very young age, I was making my own Barbie doll clothes, then my own clothes once I became a teenager. I enjoy the creativity and usually can’t wait to see the final product!!

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

The movie, “The Pursuit of Happyness.” I love Will Smith as an actor, and appreciated the challenges his character faced and overcame. It showed what desire, perseverance and integrity can achieve.

Any additional comments?

As I mentioned before, I am very proud to work for Aetna, and be part of their focus toward solutions for improved, affordable, and accessible healthcare systems. It is also rewarding for me to help our members realize that we, as case managers, are genuinely here to help them. It makes my day when I hear “Wow, you really do care….I guess the bad name that insurance companies have out there is not always true.” Every day, I strive to provide the core values of Aetna: integrity, caring, excellence, and inspiration.

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

Meet Healthcare Case Manager JoAnne Vanett – Patient Advocacy, Education, Communication Keys to Success

November 20th, 2012 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.

JoAnne Vanett, BSN, MA, CCM, CEN, Specialty Case Manager in Readmissions Risk Reductions for Aetna

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

JoAnne Vanett: I have been a BSN for 40 years. After graduating in 1972, I began my career as a pediatric nurse. I tried various fields throughout my early years but always came back to pediatrics, and particularly pediatric oncology and children with cystic fibrosis, who at that time had a very limited life expectancy. I also pursued art as a major in high school, but dropped it once in college, since we began working in clinical (hospital experience) in sophomore year.

Once I began full-time nursing I started taking courses at the Corcoran School of Art in Washington, D.C., which is where I first heard about art therapy. I graduated with a master’s in it from George Washington University, hoping to work with terminally ill patients, and was one of the first students in the art therapy program to work with medical patients using art. I continued to work full-time as a nurse during grad school and transferred to the ED so I could work nights. There I fell in love with emergency/trauma. I worked at the first pediatric trauma center in the United States, and found I could use art at work to explain things to children and realized I had been doing that for years with all my patients. However, life takes us to strange places and becoming a single parent kept me a nurse rather than furthering my career in art therapy. I became a certified emergency nurse (CEN), taught advanced cardiac life support (ACLS) and pediatric advanced life support (PALS) and trauma courses.

After a back injury, I worked as a worker’s compensation case manager. Then I made my way back to the ED until I felt it was time for a change. Eight years ago I became a case manager for Aetna and became a certified case manager (CCM). It was one of the best moves I have ever made.

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

My first job out of college, and where I spent a significant amount of years, was at Children’s National Medical Center in Washington, D.C. Truthfully, a piece of my heart is still there. After more than 30 years in clinical nursing I was ready for a change and one interview at Aetna told me this was the place I wanted to be. I met with three supervisors and their enthusiasm, positivity and excitement overwhelmed me! I never expected that I would ever work for an insurance company. What impressed me so was the respect and autonomy the nurses were given. What I learned was that Aetna approached case management as advocacy for the members; promoting education as well as finding ways for members to maximize their benefits, and it just spoke to all I believe in. I was so very impressed with the nurses who worked there, and love that case management resembles the excitement of the ER in the way you never know what the next case will bring.

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

I have always wanted to be a nurse. The most valuable moments for me are when I know I have done something well for a patient and a family. If I have contributed to saving a life; made someone feel safe and not alone; sat with a dying patient; helped to prepare a patient and a family for death or cope with a devastating illness; or resolved a problem for which no one else has been able to find a solution, then I am satisfied. There is no way to quantify nursing. It is the relationship that develops between the nurse and the patient, no matter what field of nursing, whether face-to-face or over the telephone.

In brief, describe your organization.

While Aetna may be an insurance company it prides itself on the expertise of all its nurses who function in a great many roles throughout the organization, not just as case managers. Aetna is always looking for new and innovative ways to engage our members to personalize care and improve outcomes by prevention and education as well as advocacy. There has been a new focus on the mind-body connection and ways to support all of the employees to decrease stress and encourage a good work-life balance. Aetna listens to what the employees have to say and is responsive. For me, personally, I have found a number of great mentors in the supervisors and managers I have worked with over the last eight years. There is even a formal mentoring program. In addition, the medical directors welcome our input and are great resources for education and collaboration. It is very much a team approach. As many of us telework, there is a large telework network and many special employee resource groups that are available for participation. There are many ways to volunteer and Aetna promotes a giving atmosphere. There is also a focus on education. I think that as much as Aetna strives to provide excellence for its members, it strives to provide excellence in the workplace.

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

  • First, listen to your patient. Find out what is most important to them and attempt to resolve it.
  • Second, help your patient/member be a better educated healthcare consumer, and know how to navigate the medical care system. No one should have to be ill and get lost in the process. People pay for their benefits and they are entitled to use them to the fullest extent but in the most cost-effective way.
  • Most importantly, be an advocate for your patient/ member. You are the voice of someone who may not be able to speak for himself.

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

Venturing into technology for its members. There are apps for the phone as well as a Web site with tools to use to manage care. Aetna is always looking for ways to educate its members. The organization is committed to doing the “right thing for the right reason” with a high standard of excellence, and aims to treat everyone with compassion and caring.

Do you see a trend or path that you have to lock onto for 2012? 2013?

I am very interested in case managers who are embedded within physician practices. I think that collaborating with them along with facility providers to offer a team approach to support patient care and education are the wave of the future.

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

For me, the most satisfying thing about my job is hearing someone say, “I could never have gone through this without you.” It’s being able to accomplish something: find a solution, solve a problem, locate a resource, get something authorized, help someone change their life for the better, or prepare and then ease a family through a death. And best of all, it is the relationships I develop in the process.

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

I think the greatest challenge of case management is time and communication. There are so many people we could help if we could reach them. But the difficulty is communicating with the facilities or the providers and the time it takes to do so. It is taking the time to make a connection and build a relationship in the first few minutes of a phone call. Once that connection is made then a relationship can be built. You have to convey in the first few moments of a phone call your willingness to collaborate and build a good working relationship. It is the willingness of a facility or a provider to take the time to work with an insurance case manager and understand what we can offer. We all have to work as a team and collaborate. Once the relationships are established we have so much more to offer and to improve healthcare for people.

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

The most effective workflow we are currently using is our Readmission Risk Reduction program. As a specialty case manager, I work as part of a team to do intensive proactive discharge planning and collaboration with facilities, home care agencies, and physicians to assist and educate patients with the goal of preventing repeat admissions. We then follow the member with intensive communication and support and then transition to a long term case manager if needs continue past a month. While I miss the long term relationship with the patients, I like the intensive interactions and problem solving and the success we can achieve with this program.

Where did you grow up?

I grew up in Philadelphia, Penn., attended college and graduate school in Washington, D.C., and lived in the D.C. metropolitan area for a number of years afterward.

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

I attended The American University for nursing school, took art classes at the Corcoran School of Art, attended grad school at George Washington University in Washington, D.C. The time that most stands out while in college were the anti-war I demonstrations. Because our campus was private and essentially enclosed the police could not come on campus, but they shot tear gas over the buildings onto the quad. I worked as a volunteer for the Medical Committee for Human Rights during the demonstrations and was a first aid volunteer on campus and went out with a team to provide first aid in downtown D.C. and also worked in a free clinic in Georgetown.

Are you married? Do you have children?

I was married in Maryland, my son was born there, and we then returned to Pennsylvania after my divorce when he was small. My parents were involved in his care and I am now the caretaker for my 94-year-old father. My 30-year-old son is a senior software developer and architect for a technology company outside Annapolis, Md. Somehow I seem to have spent my life on the I-95 corridor!

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

While I would not call it a hobby, I am very involved with Mindfulness Meditation. I began with the Foundation Program at the Penn Program for Mindfulness several years ago, as a way to decrease stress. Since then I have progressed to having a daily meditation practice and continue to study with an ongoing group at the University of Pennsylvania. I still dabble in painting and drawing.

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

I would recommend the book we used for my foundation program at Penn, Jon Kabat-Zinn’s “Full Catastrophe Living.” We do not recognize how great a role stress plays in our lives and that we have the opportunity to take the time to appreciate each moment while it lasts. No one ever knows what the future holds so it is most important to be aware of the present moment.

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Meet Healthcare Case Manager Sheryl Riley: Survivorship Critical Next Challenge for Care Managers

October 1st, 2012 by Cheryl Miller


This month we provide an inside look at a healthcare case management manager, the choices she made on the road to success, and the challenges ahead.

Sheryl Riley, RN, OCN, CMCN, Managing Partner, Clarion LLC

HIN: You’ve spent nearly a decade working in the field of oncology as a case/care manager. Can you briefly describe your work history?

Sheryl Riley: I started my career as an LPN and then in 1985 got my RN degree as well as a degree in business. At that time I was not involved in oncology but in cardiac disease, intensive care unit (ICU,) critical care unit (CCU,) step-down unit. Approximately five years into my career, I was approached by a group of physicians who asked me to help them build an intravenous (IV) infusion company. This opportunity is where it all started. I learned how businesses are run, how case management can work in case or care management in so many different areas, not just telephonically but in the home as well.

For example, we were called by a health plan to assist a patient who needed chemotherapy in the home, which was extremely progressive in late ’80s, early ’90s. We were doing IV antibiotics, partial parenteral nutrition (PPN) and enteral therapy, which were simply routine therapies, however, I soon realized there was more to it. Thus began a quest to build care management with an IV infusion component. During the 10 years that I worked in IV infusion companies I really attempted to spread the idea of care management, which enabled me to put together a new type of IV infusion nurse program. I had a great time with the last company that I ran; we opened up offices all over the country and built a model not only in the home but in some acute facilities. It really created some exciting opportunities to do some innovative care management around IV infusion therapy and things like dopamine therapy. We were able to take it out of the hospital ICU and translate it into sub-acute facilities because we had the ability to start the lines and manage the critical cases. Though their cases were complicated they were no longer critical cases and they were able to return home. We didn’t want them to have the cost of the hospitalization, so we managed them in sub-acute facilities for about a quarter of the price.

But the real breakaway came with the building of the first care management oncology program ever in the early ’90s here in New Jersey with an entrepreneur. We built our own computer system to go with it and we had nurses on the ground in other parts of the country. I would go in and visit with oncologists and speak with them regarding the concept and how the program operated as well as show them the value of our oncology nurses. At that point Humana and United were on board and we were in negotiations with Aetna. We were working in the Florida, Pennsylvania and New Jersey markets.

It was very, very exciting, because we created care paths based not just on diagnosis but nutrition, exercise and side effects management, in addition to end of life issues. If need be we also addressed respite care, babysitting, and pre-emptive issues for those that were younger with cancer such as sperm banking and egg banking. We created pathways based on disease process and trajectory of disease and it wasn’t your standard pathway. I worked with a team of highly skilled and trained oncology masters prepared nurses. When we sat down we not only created a pathway for the nurses to follow but a patient pathway as well, taking into account the National Comprehensive Cancer Care Network (NCCN) guidelines. We were focused on making them patient-centric even before it was a popular notion. It was also important that the program be on a computer system that either could be accessed easily by the patient and nurse as well as have a printable form.

So we kept building on my care management. Today they call it care coordination, which is the model inside the ACO. Currently the American Nurse Associations (ANA) and three other groups have put out white papers on care coordination models utilizing RNs. It is really care management as we know it, but they’re calling it care coordination because I think some people get confused with case versus care. About ten years ago I wrote an article on the difference between the two which was pretty progressive back then because case was really based on non-clinical aspects. It was simply considered moving somebody from a high level of care to a lower level of care around cost and service, with minimal regard for the clinical aspects of what they did. It wasn’t only clinical people doing that.

The crux of care management is making patients feel secure and empowered about the decisions that they’re making, with your help. One of the biggest changes in my career came when I realized that patient education wasn’t about me telling them what to do, it was them telling me what their goals were and then me trying to help them find a way to help them achieve those goals. That was my most exciting revelation: really understanding how to change behavior, how to reach that person who could never be reached before. That to me was probably one of the most exciting things.

HIN: What are some of the challenges in working with this population?

The biggest challenge is that people don’t know how to define care management. I have to tell some of my private patients, I’m not here to deny you care. I’m not here to disallow you anything. I’m here to expand your knowledge and work with you to find the best resources and the best opportunity for care for you or your family member.

The other challenge that we all face in oncology is that eventually, many of our patients will succumb to their disease and that is one thing that you cannot change. You’re going to cheat it occasionally and you’re going to help them hopefully experience the best quality of life humanly possible that they can achieve with your guidance. Yet it is hard every single day knowing that 50 percent of your population won’t make it. It’s not like dealing with a surgical patient that’s going to get better or even a diabetic, because they probably have a longer life expectancy. That aspect of my job I have learned to accept and embrace, because we learn so much from our patients at every stage of their care.

Given the many strides we’ve seen in the treatment of cancer, we are now seeing an upswing in survivorship, which is fantastic, but it opens the door to a new aspect of oncology care management, care of the survivors, not just immediately but 10 to 12 years down the road when the effects of the treatment can be seen on their vital organs.

We now have over 50 percent of the population surviving. The question that remains is how to best manage their needs. You’re dealing with drugs that have ravaged the body to kill cancer, but have also had deleterious effects including weakened bone, bone marrow and organs, particularly the heart and the lungs. Now these patients face cardiac anomalies, lung problems, bone problems, bone marrow problems and possibly down the road a lymphoma or something of that nature. So survivorship is the next big challenge that we face with this population. And with survivorship, there also is a level of emotional instability, because a quarter of the time, patients may lose their spouse. The spouse will divorce them or walk away from them. So what I see many times, when a person survives, the family is so excited about their survival that they’re just overwhelmed. But the patient feels like they survived for a reason and they want to give back. They want to get involved with others so that they can help them survive. And the families sometimes say: “I’m done with cancer. You’re done with cancer. Walk away!” And many of the survivors feel like they’ve been given a gift and they want to share that gift, however there are some family members who can’t deal with that so they will face those issues as well. Though there is much challenge dealing with the death, the dying, the helping with the decision making, the next big challenge for us as care managers is survivorship. And how are we going to help the patients manage this process as well as the family.

HIN: Will care managers need particular training for this sort of thing, for survivorship?

Yes. I think that we have spent our careers dealing with death and dying, and now we need to begin to educate ourselves on survivorship. I’m not going as far as saying there should be certification for it, but it’s definitely another line of education that we need to look at. And it’s out there. The Oncology Nursing Society (ONS), the NCCN and the National Cancer Institute (NCI) are starting to come out with survivorship programs.

But not a lot of care managers are taking advantage of them, given their lack of time. It’s disheartening because the real collaboration between oncology care managers really isn’t there. The majority of the 29,000 oncology nurses that belong to ONS are still working within hospitals and doctors’ offices, and haven’t truly embraced the care management mantra and what it stands for. They’re giving chemo. They’re trying to manage the patient there at the chair side or the bedside or wherever. But they’re not really out in the community. They’re not out in the patient’s home. They’re not taking a lot of phone calls after hours. They’re dealing with it all through a 9 to 5 job, Monday through Friday at a hospital or in a private office. For those of us that deal with our patients on a telephonic basis or a home basis, or go to the doctor’s office with the patient and get involved from the care management perspective, we feel that there’s a need for us to talk and learn from each other.

I learn so much from all other care managers. Listening to what they do, how they do it, when they do it, how they intervene, things they say, for me that’s the best part of the experience. If we could break down the barriers between nurses and become a truly collaborative group, we would have the largest voice and the best opportunity to change process anywhere in the country.

HIN: What do your chronically ill patients value most? And how can we align those goals for case management in the healthcare industry?

Chronically ill patients need education and resources. And the care manager is pivotal in finding those sorts of things. When I look at a patient who says: “I can’t afford this,” or “I can’t afford that,” regardless of disease, it’s my job to understand their financial situation and try to find drug assistance or services for them, community services from local organizations, and national organizations when necessary. These are things they can’t find on their own. Another role that we play is being there to help them organize their visits. If they’re seeing five different doctors, find out why. If they’re on a generic brand of one medication and a name brand of another, make sure their doctors are aware and work it out with them. It is quite possible that they don’t need to see five doctors. For example in the 65 and older population they may just need to see a gerontologist instead.

Care managers add a unique value to the chronically ill patient because healthcare is an ever changing venue and they need assistance when it comes to understanding plan benefits and when those have been exhausted where the patient must go to find appropriate resources. Especially for chronically ill Medicare patients, we need to help them find resources. We need to find churches and community services, national organizations and friend, family and relatives and whatever necessary to pull it all together. It is important to consider their caregiver as well. If you’ve got a chronically ill 85 year old who is taking care of a chronically ill 90 year old, you’ve got issues. We help them deal with all of that. I personally think if you take care management away and the chronically ill will fall prey to so many more issues. There is a disturbing trend going with the chronically ill population but if these patients needs can be recognized early on then more can be done to utilize our healthcare dollars more effectively. The people that are 55 right now, that are teetering on diabetes, hypertension, teetering on being chronically ill, in 10 more years they may be chronically ill. More than likely they are already on some medication. Their diet is terrible. So dealing with chronically ill patients is easier because they know they need your help, they know they need some resources and they’re willing to listen to what you have to say. It’s the population that’s growing into chronic care where we have the biggest problem, because they’re still working, active everyday, and somehow you need to change their behavior. And that’s got to come from somebody. And I really think that care management can make a difference there.

Years ago I had set up programs for employer groups where you would go to the site. If they had warehouses, we would send a nurse in to do a little health fair and take blood pressures and cholesterol screenings, have them answer all these questions. You would get 90 percent of your risk assessments done at these screenings. It was great because now you could begin to focus on those people that really needed it. This environment was also perfect for group programs. Many times you would find that in this plan you had a high incidence of hypertension and diabetes. This presented an opportunity for people to learn in larger groups and identify with other with the same condition. It’s better when people learn together, especially at that age. Because it’s like:
“Oh, Joe, you have the same problem I have. I like that Mexican food, or I like that Italian food. Or I like my beer.”
Okay, let’s design programs so that you can have some of those things without depriving yourself of everything. You need somebody who understands chronic illness, understands care management, understands resources. And that’s why I think the care manager has the advantage. They know all of those things. They can act a little bit like a social worker, a little bit like a physical therapist, a little bit like a nurse, a little bit like a case manager from the health plan, and they can pull it all together for a patient. I don’t think any other entity can do that except for a care manager.

HIN: Where do you see case management going in the next five years?

If you’re going to take 40 million Americans and throw them in Medicaid you’re going to totally blow up the system. I think that will have a negative effect on our Medicare population as well as what care managers can and cannot do. Instead I hope to see more of the larger clinics and larger facilities take on care managers. There is a slight problem with that plan, as I said earlier; there is a whole trend of moving from the word care management to care coordination. When situations are in a state of flux even with the support of whitepapers supporting RNs as the care coordinator, you see if you change the word to coordination you’re really eliminating medical management, any medical aspects, because what they’re thinking that you’re only going to do is coordinate their services. Most of the general public do not believe that you need an RN to coordinate services. If you look at the way the new models are set up for care coordination, they are RN models. There’s an RN and a social worker in a non-clinical model. The RN model allows for all the aspects of care management. Leaving the question as to why are they changing the title to care coordination. I personally don’t understand it and don’t like it. I have to teach it. I have to try to explain it to clients and to nurses, but I truly don’t understand except that they’re trying to diminish the role of the nurse and put non clinical people in these roles so that they don’t have to pay the rate of a highly trained nurse or care manager. And that is frightening. That is scary. I really don’t want to see that happen. We’ve come such a long way.

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Meet Healthcare Case Management Manager Teresa Treiger: Helping Clients Bridge Gaps To Self-Advocacy, Self-Management

September 14th, 2012 by Cheryl Miller

This month we provide an inside look at a healthcare case management manager, the choices she made on the road to success, and the challenges ahead.

Teresa M. Treiger, RN-BC, MA, CHCQM-CM, CCM, Founder of Ascent Care Management, LLC

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

Teresa Treiger: My given name is Teresa, but most people know me as Teri. I am a registered nurse although my educational background also includes degrees in healthcare administration and business. I have over 30 years of cumulative experience in the healthcare industry with more than 20 of those devoted to care coordination and care management. I am certified in case management by the American Board of Quality Assurance and Utilization Review Physicians (ABQAURP,) the Commission for Case Manager Certification (CCMC,) and the American Nurses Association (ANA.) I am also certified as a chronic care professional by the Health Sciences Institute (HSI.)

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

As so many of us did, I started off with bedside nursing on a general medical-surgical floor before moving to neurosurgery, orthopedics, respiratory intensive care, and urgent/emergent care. When it was time for a change of pace, I shifted to the business side of healthcare for a couple reasons:

  • I did not believe that the business of healthcare was enough of a concern for the people who worked within the sector. It was far too easy to not consider the financial implications of care when all I had to do was take a sticker off of a piece of equipment and place it on a patient’s supply charge sheet. I’ll expand on that more in a bit, and
  • I did not feel as though I was making an impact on the bigger picture of healthcare; bedside nursing was and is a wonderful experience but I knew I needed to make a different kind of impact. Subsequently, I worked in case management in a variety of settings – managed care, acute hospital, rehabilitation and long term care settings eventually focusing on care coordination program design/implementation and education.

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

This is an interesting question because my defining moment was not necessarily what got me into case management but rather what validated the choice I made as being perfect.

I was at a crossroads, having just undergone a corporate restructuring which left me unemployed. I attended a Case Management Society of New England (CMSNE) chapter conference on leadership and it literally changed the trajectory of my career path, but not because it was case management-focused. It validated that the business of healthcare delivery was in dire need of a focus point. With all due respect to clinician providers, their job is not to coordinate how the care is delivered – and they aren’t all that good at it. By and large, they are great at diagnosing and providing the blueprint of an individual’s care, but how that all gets accomplished — not so much.

In brief, describe your organization.

I am a case management consultant and have my own company, Ascent Care Management, LLC. I work with individuals who desire their own case manager, but the bulk of my business is focused on business clients who want to revamp their case management departments in one way or another. Frequently, I help organizations through process flow redesign, documentation, case management IT projects, and accreditation preparation. I also enjoy public speaking on a variety of healthcare and care management topics.

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

  • Don’t ever lose sight of the fact that behind every number is a patient.
  • Treat others with the courtesy and respect with which you hope to be treated.
  • How you are perceived as a case manager will be a reflection on every other person who refers to themselves as a case manager, so I make it a good experience for the client.

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

I have a case management boot camp that has been well received. Often what I have found is that individuals transition into case management because of the work hours or other reason rather than actually wanting to make case management a professional adventure. Training is so vastly different from one organization to another that there is really very little actual training aside from the information system and day to day work flow process. The boot camp focuses on the actual steps of the case management process through interaction and exercises to help individuals to have a better framework for working with clients toward measurable and achievable goals. The way I see it, the case manager should be considered to be a bridge to self-advocacy and self-management of their own healthcare rather than a crutch.

Do you see a trend or path that you have to lock onto for 2012? 2013?

I see a few things…

  • Many PPACA provisions kick in during 2012 to 13. Knowing what is coming up for implementation will help case managers ramp up for what they need to understand.
  • Many health systems are implementing their own brand of case management and unfortunately it simply requires a change in an individual’s job title rather than an evaluation of skill sets and provision of training and development opportunities in order for that person to be successful. These types of programs are going to be running aground and a need for knowledgeable case management consultants will bloom as the C-suite opts to address these less-than-successful programs.
  • The home care sector needs for case management are going to blossom as transition of care programs begin to engage more services to avoid readmissions.

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

Having an impact.

Some days it might be a very small thing, but to the individual I have worked with, whether mentoring a newer case manager or working with a client, it is something of great importance. I like that what I do is a positive contribution rather than a negative detraction. It is too easy to whine about this or that. Then I look around at the challenges others are facing and realize how fortunate I am to be able to help improve the lives of others. That is a gift.

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

The biggest challenge is that of complacency. I wrote about this in a recent blog post and summed up with the following… “Health care is always changing… consumer expectations are on the rise… and case managers are being viewed by many as a critical factor of successful patient-centered care coordination. I believe that an overwhelming number of case managers are up to the challenge being placed before them. The essential element that we must remain mindful of is to never fall into the pit of thinking that we know it all or that do not need to consistently and continuously improve the quality of the service we bring to the health care team.”

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

This is a great question for which I do not know an answer exists. Because case managers work in so many different settings of care, a tool or process that is great in one setting may not work in the next. However, with that said, I think that technology has the greatest potential for being the most effective tool… but it depends on the case manager and his/her ability to use it effectively and efficiently.

Where did you grow up?

I was born in Boston, Massachusetts and lived there for the first few years before moving to Hawaii for three years. We returned to live just south of Boston for the rest of my childhood and adolescence.

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

I have an ongoing love of learning so my education has progressed through a number of institutions: Laboure College, Stonehill College, Boston University, University of Phoenix. Currently, I am considering a return to school to earn my Doctor of Nursing Practice degree.

Are you married? Do you have children?

Yes, I am married to Dave Treiger. We will celebrate our 10th anniversary in August 2013. I have two furry children, cats whose names are Tang and Skooch.

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

I enjoy photography. It was something I used to do with my Dad that started when I was in high school. I still have both of our old SLR cameras… but now I primarily use a digital Nikon SLR.

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

It’s a classic but it remains my favorite book of all times, A Tale of Two Cities by Charles Dickens. I can’t tell you how many times I have read it since high school. As for a movie, I hate to sound so down on them but the quality of movies that have been made in the past 5 to 10 years has been less than overwhelming. Nothing really stands out that I would risk recommending to a friend.

Any additional comments?

Case management has changed my life and afforded me opportunities to travel around the world to share my experiences and learn about how case management is done in other healthcare systems.

I think that the case managers of today (and tomorrow) have to find ways in which to be proud and passionate about what they do and the critical part that they play in the healthcare delivery system. Our opportunities are endless so if a job isn’t working out to your expectations, find another one. Don’t allow complacency and resignation to direct your career choices. Envision your goals and then make them happen.

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

Meet Healthcare Case Manager Kerry Stutzman: It’s All About the Relationship

July 13th, 2012 by Cheryl Miller

This month we provide an inside look at a healthcare case management manager, the choices she made on the road to success, and the challenges ahead.

Kerry Stutzman, RN, MS, CCM, Care/Case Manager

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

Kerry Stutzman: I have my CCM; I was among the very first group to take the first CCM exam and obtain the title. I am a member of Sigma Theta Tau International, the honor society of nursing. I have an A.S. degree in nursing, a B.S. in applied social work, a BSN and a master’s degree in nursing.

I am a fourth generation Arizonian. My folks were both teachers; my Dad was an English professor at Northern Arizona University (NAU) and my Mom taught in the public schools. I have a brother and sister. I grew up in a beautiful small town, Flagstaff, AZ. It’s not so small anymore but back in the 1960’s it was. I was admitted to the NAU nursing program right out of high school, which was a huge honor; there were only two or three of us in this situation. I was so fortunate to have had such great teachers there who influenced me so much. I had similar experiences at the University of Phoenix and at Arizona State University (ASU). I met my husband in Flagstaff; I bought his roommate’s car. We moved to Phoenix in 1979 and were married in 1981. I have worked a variety of jobs: Visiting Nurse Service, as a home care nurse, I was director of nursing for Olsten Home Health Care, I was a patient care coordinator, a discharge planning coordinator, a discharge program developer. I worked as a floor nurse in a variety of areas: recovery room, orthopedics, spinal cord/head injury/stroke, arthritis/rheumatology, mental health (pediatrics and adult), trauma, surgical, pre-op, renal, neurology, oncology, general surgical, and gynecology/obstetrics. I have worked in field case management for the last 21 years.

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

I first went to work at Good Samaritan Hospital in Phoenix, AZ. At that time, back in 1979, it was one of the largest hospitals in the Phoenix metro area. I went to work on R5, a head injury and stroke rehab floor.

My first job in case management was as an in-patient care coordinator with CIGNA. My next job was starting a new discharge planning program at Phoenix Children’s Hospital. This job honed my discharge planning, home care and case management skills further. From this job, I went to work for Intracorp, which, at the time, was a major player in the case management arena. We primarily handled workers’ compensation cases smattered with some auto liability, catastrophic cases and other case management cases. Since leaving Intracorp, I worked for two other case management companies before starting Health Care Consultants of Arizona in 2009.

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

There wasn’t really one particular moment. Prior to working at Intracorp, I moved around from job to job every few years because I would get bored and need more of a challenge. I stayed at Intracorp for 13 years before moving on to another case management job. So, it was obvious that I enjoyed working in case management as it provided me with a variety of cases to work on that kept me challenged. I also loved working independently.

In brief, describe your organization.

I started Health Care Consultants of Arizona (HCCAZ) because the opportunity presented itself and I had wanted to start my own company for several years. I have a social work degree as well as a master’s in nursing with a specialty in mental health and I wanted an opportunity to more fully utilize all my skills. HCCAZ provides case management services in Phoenix and some of the surrounding cities such as Tucson, Prescott, Casa Grande, Florence and Apache Junction. We are an Arizona company, we are not national. We provide personal service and treat our clients and their families as we ourselves would want to be treated. If we can’t directly meet a client’s need, we will assist with locating a person or service that can. Everything is about the relationship. As the saying goes “People may not remember exactly what you did, or what you said, but they will always remember how you made them feel” – Dr. Thomas L. Garthwaite, Under Secretary for Health. We strive to make our clients feel well cared for.

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

  • Treat others as you would like to be treated; the Golden Rule.
  • Always have the patient’s best interest at heart.
  • Take the time to really listen, you’d be surprised what you hear.

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

Meeting the needs of the clients served.

Do you see a trend or path that you have to lock onto for 2012?

Do more with less. Be creative. Be flexible.

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

Working independently and all that that entails. In my case, working for myself means being able to spend more time with patients, working pro bono if needed, being selective on referral clientele, and having control over my work product.

Where did you grow up?

I moved around quite a bit but always within Arizona. I spent most of my childhood in Flagstaff, AZ.

What college did you attend?

I initially attended Northern Arizona University in Flagstaff for my associate in nursing degree and my B.S. in applied Social Work; I went to the University of Phoenix for my BSN; and ASU for my master’s degree.

Is there a moment from that time that stands out?

Graduations!

Are you married? Do you have children?

Yes, I am married and I have a 24-year-old son.

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

Working in the yard is my de-stressor. As far back as I can recall, I have always loved planting things and watching them grow. In sixth grade I converted the aquarium we used to house lizards and such into a mini garden to grow corn plants. My classmates and I were fascinated by watching the plants grow.

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

The Sunflower: On the Possibilities and Limits of Forgiveness. At the Lemberg Concentration Camp in 1943, Simon Wiesenthal (author) is summoned to the bedside of the dying Nazi soldier Karl Seidl. The soldier tells him he is seeking “a Jew’s” (Wiesenthal’s) forgiveness for a crime that has haunted him (Seidl) his entire life. The man confesses to having destroyed, by fire and armaments, a house full of 300 Jews. He states that as the Jews tried to leap out of windows to escape the burning building, he gunned them down. After Seidl finishes his story, he asks Wiesenthal to forgive him. Weisenthal records his and other’s responses and poses the dilemma to the reader.

Any additional comments?

You have to be a bit of a loner in this work area because you do work alone, independently, so much of the time, especially if you work from your home as I have done for the last 20 plus years doing this. I referred a friend of mine while I was working at Intracorp. She and I had worked on an orthopedic floor several years prior. She quit after about a year because she did not like working alone most of the time, she preferred the camaraderie of working on a floor in a hospital. It is very important for this reason, that as a case manager you keep yourself involved by attending groups, networking, attending educational workshops and having friends in the business to meet for lunch and to talk care issues over with. Keep yourself immersed.

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Meet Case Management Manager Helen Schreiber: Dispelling the Notion of “Nurse Police”

June 29th, 2012 by Cheryl Miller

Helen Schreiber RN, BS, CCM, Executive Vice President of S&H Medical Management Services, Inc.

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

Helen Schreiber: I attended nursing school after getting married and having two kids. I took all of my science classes at the junior college level while I was working part-time at a deli. I knew I was going to attend a diploma program because I couldn’t afford to go to a four-year university. Unfortunately, at that time, hospital programs would only accept you if you were single. I had faith and sure enough, after being told in 1979 and 1980 that I could not be married and attend, in 1981 I was told that I could attend if I lived in the dorm, and then Ravenswood Hospital School of Nursing finally accepted me in 1982 and allowed me to commute. There were 88 students in my class and more than half of them were married with kids. I graduated from there in 1985. I then received my bachelor of science in health arts (BSHA) from St. Francis in 1991. I am currently a certified case manager (CCM). Prior to that I was a Mobile Intensive Care Nurse (MICN), a Certified Emergency Nurse (CEN) and a Trauma Nurse Specialist (TNS).

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

I worked nights on an ortho unit (22 patients on my team) and then moved on to my dream job in the ER. I loved working nights there. When my kids got older I knew I needed to work days and I found an ad for a case manager.

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

I was truly in my element in the ER. I loved the fact that you could never predict how your shift would end. I love the chaos…and case management fills the same needs for me. Plan but be prepared for any eventuality.

In brief, describe your organization.

S&H Medical Management Services, Inc. is an independent, regional, women’s owned medical and vocational case management firm. We are completely virtual! I am most proud of the fact that we have 12 S&H babies. By that I mean, kids that were not in child care because of our at home positions with flex hours.

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

  • First and foremost, be honest.
  • The second most important thing is realizing that the availability of healthcare is a gift. It is there for the patient to accept. You can wrap it up and make it as attractive as you can but you cannot make a person open the gift. That is very difficult for some people to accept.

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

    We have the best vocational department in Illinois. At a time when jobs are being lost, our vocational staff continues to produce a product that rocks. We have doubled the size of our vocational department during the past two years and it is due to great outcomes and special people.

    Do you see a trend or path that you have to lock onto for 2012?

    The economy continues to impact this industry. I believe creative marketing is key at this time.

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

    I truly feel humbled to have people allow us into their lives and share the details with us at such a stressful time. That is the best thing about being a nurse.

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

    Involving the injured worker into the process and making certain that the case manager is honest with him is what is most beneficial to the process. Many times the case manager is perceived as the ‘nurse police’. Those words were spoken to me by an injured worker…..

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

    At S&H I believe our proprietary software for case management documentation has made our staff more effective. S&H has also adapted the CMSA adherence tools and we utilize these tools to assist with adherence assessments.

    Where did you grow up?

    I was born in Austria. My family immigrated to the United States when I was 18 months old. I grew up in Chicago and became a U.S. citizen in the early 60’s. I attended Good Counsel high achool.

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

    I am a child of the 70’s when not everyone went to college – at least not right away. I will never forget how overwhelmed I was when I first went to register at Wright Junior College in Chicago for my very first college course. The hardest thing to do is to go back to school. I remember telling my boss that I would be 33 by the time I finished school. He said you will be 33 in five years anyway.

    Are you married? Do you have children?

    I have been married to Roland Schreiber for 35 years. It is a second marriage for both of us. We have two kids: Erik is 38 and a cop in Chicago. Monika is a teacher, married to Pat and they are the parents of my two terrific grandchildren, Elizabeth and Olivia, who all live in Texas. We spend winters there in order to spend more time with the girls. While my daughter is certified as a teacher she now works for S&H and has since college. This has allowed her to work from home.

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

    Sewing when I have the time. My current project is new drapes. And I am absolutely crazy about dogs. We currently have three, Gretchen the golden retriever, Schatzi, the rescue (a German Shepherd mix) and Tinker, another rescue (a Shitzu).

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

    The Total Money Makeover by Dave Ramsey is a great book. It helps people learn to live debt-free and have more control of their lives.

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

  • Meet Healthcare Case Manager Sonia Morrison: Respect and Kindness Key to End of Life Care

    June 15th, 2012 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.

    Sonia Morrison, RN, CM, BSN, RN case manager at Salinas Valley Memorial Healthcare System (SVMHCS), Nurse Assessment Consultant and Educator for veterans at Visiting Angels of Santa Cruz

    HIN:Tell us a little about yourself.

    I am certified as a nurse case manager in oncology, and have worked in oncology for 21 years. I also worked in hospice for 11 years, was a certified nursing assistant (CNA) for three years, and a licensed vocational nurse (LVN) for one year.

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

    I was in a junior college career ladder program, so I worked nights as a CNA in med-surg acute care and then in a licensed vocational nursing (LVN) registry, mostly in ob/gyn, prior to graduation. My first job was as an RN in the oncology med-surg unit at Salinas Valley Memorial Hospital (now Health Care System) or the SVMHCS, and I am still there.

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

    I thought I wanted to be a midwife when I started my nursing education, however, I did not like assisting births in the hospital with strangers. In my last year of working toward my associate degree in nursing (ADN), I met an amazing oncology instructor. At the same time, my best friend was dying of cancer, thus I became an oncology case manager.

    More recently, I taught a CNA program for several years. In mid 2011 I attended a life directions seminar and was able to harness all of my passions and focus them around caregiving.

    In brief, describe your organization.

    SVMHCS is an acute care hospital with an average census of 166.

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

  • The keys to successful utilization review and discharge planning and collaboration are communication, including written documentation and collaboration with the full team, including the patient, family, doctor, nursing staff and other providers.
  • Patients are assessed and educated within the first 24 to 48 hours of admissions.
  • Balanced self-care allows me to serve my team the best.
  • What is the single most successful thing that your organization is doing now?

    Expanding the role of case management to include p.m. shifts.

    Do you see a trend or path that you have to lock onto for 2012?

    Money talks and reimbursement has been the biggest challenge.

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

    Treating patients and families with respect and kindness, especially at the end of life.

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

    Finding services for obese or no pay source patients. SVMHCS case managers are working with management for creative sponsoring of needed services.

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

    Extended Care Information Network and executive health referrals.

    Where did you grow up?

    I was born in Los Angeles, CA, one of five girls and two surviving boys.

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

    I attended Cabrillo Community College, Santa Cruz, CA for an advanced degree in nursing and a bachelor degree in public health nursing (PHN) at California State University at Dominguez Hills, CA. I enjoyed being of creative service in the community during my PHN clinicals; I used bilingual teaching tools to explain lab results, diet choices and I created new curriculum to introduce teens to human health by relating what they knew to horse health, disease, symptoms and interventions.

    Are you married? Do you have children?

    I have a husband of twelve years, a forty year old son and a six year old granddaughter.

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

    The very first profession I fell in love with was a veterinarian, but my parents told me I was not smart enough to be a vet. So then I wanted to be a dancer, but my parents told me I couldn’t do that because if I broke my leg, I couldn’t support myself. So, now, I am a dancing nurse with six dogs!

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

    A book I wrote: The Heart of Caregiving, A Guide to Joyful Caring.

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