Posts Tagged ‘case manager’

HINfographic: Case Management Trends: Face-to-Face Patient Encounters Edge Out Telephonic

September 6th, 2017 by Melanie Matthews

As integrated care management takes hold, patients are much more likely to interact with a case manager at their healthcare provider’s office today than they were four years ago, say respondents to the 2017 Case Management Survey by the Healthcare Intelligence Network. The embedding or colocating of case managers within points of care rose from 54 percent in 2013 to 66 percent this year, the survey found.

A new infographic by HIN examines the top case manager-patient interactions, case management monthly caseloads, details on return on investment for case management programs and more case management trends.

At the point of care or behind the scenes, care coordination by healthcare case managers helps to elevate clinical, quality and financial outcomes in population health management and chronic care, the all-important hallmarks of value-based care.

2017 Healthcare Benchmarks: Case Management provides actionable information from 78 healthcare organizations on the role of case management in the healthcare continuum, from targeted populations and conditions to the advantages and challenges of embedded case management to CM hiring and evaluation standards. Assessment of case management ROI and impact on key care components are also provided.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

Infographic: How Certified Case Managers Navigate the Healthcare Landscape

March 17th, 2014 by Jackie Lyons

Board-certified case managers (CCMs) work in a variety of healthcare settings. The top three are hospitals (24 percent), worker’s compensation organizations (18 percent) and health plans (17 percent), according to a new infographic from the Commission for Case Management Certification (CCMC) and Health2 Resources.

This infographic also illustrates the roles of CCMs, the content and value of their knowledge, where CCMs are located in the United States and more.

You may also be interested in this related resource: 2013 Healthcare Benchmarks: Case Management. This 78-page resource provides actionable information from 118 healthcare organizations on the prominence, placement and responsibilities of case managers as well as case management-driven outcomes in healthcare utilization, cost and compliance.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

Have an infographic you’d like featured on our site? Click here for submission guidelines.

3 2014 Trends for Health Plans

January 21st, 2014 by Jessica Fornarotto

Influencing primary care, aggregating and mining data, and embracing bundled or episode-based payments are three trends that will influence health plans in 2014, predicts Catherine Sreckovich, managing director in the healthcare practice at Navigant Consulting.

HIN interviewed Sreckovich on these trends prior to her presentation during HIN’s tenth annual webinar on Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

HIN: Where will data analytics take health plans in the coming year, and how will this shape population health management offerings?

(Catherine Sreckovich): We’re certainly hearing a lot about big data, and it will be an integral approach to merging this practice’s or population’s health, the ability to aggregate and mine data is going to be an essential capability for health plans for their predictive models. And the outputs of these models are going to enable the health plans to identify and stratify their members or population health. Member and patient demographics can also inform consumer engagement strategies to support population health. And the analytics are going to inform the effectiveness of different care management interventions and consumer engagement strategies.

HIN: Health plan case managers embedded alongside providers has become almost a de facto model. How will payors influence primary care delivery in the year to come?

(Catherine Sreckovich): There is a number of approaches evolving right now and that will continue to evolve as payors attempt to influence primary care delivery. One is the use of patient-centered medical homes (PCMHs) and other integrated models to expand the payor’s role as the primary care case manager.

In addition to paying primary care providers to hire case managers and care coordinators, payors are pushing for shared savings arrangements with these primary care providers, such as within an accountable care organization (ACO), and to push them to manage the care for those with chronic conditions.

We’re also seeing payors paying for primary care physicians to become certified PCMHs and to implement electronic health records (EHRs), either by paying directly for the certification of the technology or by adding bonus payments to their FFS rates.

Payors are also paying for incentives for primary care physicians to offer wellness programs such as smoking cessation or weight loss programs and are trying very hard to influence where and to whom primary care physicians refer their patients by giving them information about the cost and quality of other provider types, such as specialists and hospitals.

And we will continue to see that payors will target the larger primary care physician practices with whom they have a critical mass of members to achieve enough savings to offset the added costs of incentives, bonuses and shared savings arrangements. As a result, we expect that some of the smaller primary care practices will likely not receive the same level of support and push from payors.

In another example, we see payors increasingly partnering with non-traditional providers, such as retail-based clinics and community health centers to offer easily accessible primary care at lower costs. And this will certainly be an opportunity to address some of the physician supply shortages that we anticipate seeing in the next year or so as more and more people have access to healthcare insurance and coverage.

Finally, another approach payors are using is to offer members access to virtual doctor visits via webcam, for example, and other telemedicine approaches that are giving individuals access to these primary care providers to increase access to convenient and low cost primary care for their patients.

HIN: CMS and top-performing Pioneer ACOs are heavily invested in bundled or episode-based payments. Will more private payors embrace this reimbursement method as well?

(Catherine Sreckovich): Definitely. The bundled or episodic-based payment approaches are here to stay. We’re starting to see this take off in a number of states. For example, there are state innovation grants that CMS has provided to states like Arkansas, Ohio, Delaware and others looking for opportunities to implement multi-payor bundled payment initiatives. Although these are not necessarily the traditional ACO model, they built off of that ACO model.

We also see that the large health plans in various states are starting to build and develop ACOs. Key to these are the shared savings arrangements that they’re implementing with these payment approaches. So whether they’re bundled or episodic-based payments or whether they look more like a traditional ACO, if there is such a thing, we’re starting to see takeoffs on those kinds of models as payors and health plans become more creative in the development of their alternatives.

Excerpted from: Healthcare Trends & Forecasts in 2014: Performance Expectations for the Healthcare Industry

Community ‘Feet on the Street,’ HRAs Improve Dual Eligibles’ Health

January 14th, 2014 by Jessica Fornarotto

A local approach — the integration of public health with managed care — is what a lot of states and CMS are starting to look for, explains Pamme Taylor, vice president of advocacy and community-based programs for WellCare Health Plans.

In HIN’s special report, Community Care Connections for Dual Eligibles: Closing Social Gaps to Improve Health Outcomes, Taylor describes some of WellCare’s efforts to connect its dually eligible population to health services, including making contact, identifying services for each member and assessing health status via health risk assessments (HRAs) that are part of these community services.

Question: What is WellCare’s strategy and practice for contacting dual eligible members and ensuring follow-through with recommended referrals to community support services?

Response: This question is two-fold; first, how do we reach the members and get them engaged? And second, how do we verify that services were rendered? For members, we have street teams that go out into the community investments. We also have community health workers on our interdisciplinary team. It’s their job to connect with our members on a face-to-face basis while also connecting them to community supports. It’s through that model that we heavily rely on engagement and connectivity, etc.

Our first line of outreach is through the phone; our second line is through the community health workers and the individuals that are ‘feet on the street.’ And then, how do we verify that services were rendered, and how is that data collected? We have a command center, which is the warehouse of all that information, and then the social service electronic health record (EHR), which bolts onto the member’s medical record. That process produces a provider roster that we then put into the hands of our field teams, who use that as part of relationship management, much like a provider relations representative would use in their engagement with the primary care physician (PCP). We meet with them on a regular basis to confirm that services were rendered, and review the successes.

The secondary piece to that is our case managers also reach out to the members that they have referred to services and activities. They verify through the members they received it and their level of satisfaction. So there’s two points of feedback: one from the provider themselves and one from the member.

Question: How do you identify community services to meet members’ needs?

Response: It’s similar to the United Way 2-1-1 directory. We did community health needs assessments, which identified a number of different needs. And using epidemiological information, we come at it in terms of identifying the need, and then determining the service model. Then we took it a step further and asked, ‘How do we define the services so it’s a blend between public health, social supports and managed care terminology?’

We use about 67 different categories of social supports. We turn that into research. We go ‘feet on the street’ to canvas the neighborhoods to make sure that we have all of the organizations represented. Then that’s put into a ‘pend’ status in our databases and it is vetted on a secondary level of review by our team of liaisons. Once it’s vetted and confirmed, it’s then put into the final database, which is used for searching by our case managers. It’s a combination of public health practice using both public health and managed care terminology.

There is no magic number of categories or organizations. No one’s ever systematically inventoried or catalogued the network of social services. That’s what we’re hoping to do — explain and quantify what organizations exist, then identify their service area, their reach, their service portfolio, and the volume of connectivity that the health plans have with these organizations for specific services. It’s an exciting time.

Question: What other components of the comprehensive health assessment are administered to the duals as they come on board?

Response: A number of different factors go into the HRA that’s completed. There are health factors, socioeconomic factors, living environment, and activities of daily living (ADL). What are their social needs, what are their social supports, etc.? There’s a whole number of different tiers of questions that we ask as part of the HRA. We use very specific tools that are either state-dictated or guidelines produced by the state or in partnership with CMS. It depends on which side of the equation that we’re being contracted for, and it depends on what’s already in existence.

Engaging Members in Health Management Post-Discharge with Case Managers, Outreach Calls

December 17th, 2013 by Jessica Fornarotto

“Member engagement is always the challenge, and it is no different for telephonic engagement,” states Jay Hale, director of quality improvement and clinical operations at Carolina Behavioral Health Alliance (CBHA), as he discusses how CBHA engages members in their telephonic case management program post-discharge. “We’ve found multiple venues to attract attention and begin the engagement process, including letters, outreach calls to members, and partnering with the discharging hospital. We want to be part of the discharge process, so telephonic case management is as much a part of the discharge plan as their visit with the doctor or therapist, medication regime, etc.

In HIN’s special report, Telephonic Case Management Protocols to Engage Vulnerable Populations, Jay Hale further describes the engagement process for CBHA’s telephonic case management program.

We are a small regional managed behavioral healthcare organization (MBHO), so our case managers also do utilization management. They identify the cases early and are able to talk to the utilization review (UR) people at the hospital and say, “This is someone that we have identified,” which helps with that discharge process. The earlier we can talk to members, the better. We want to talk to members as quickly after discharge as possible. Having the support of that hospital adds weight to what we do, so it is key that they do not receive a random call. We want it to be something that is related to their treatment process. That is why we want to be part of that discharging.

The next step is to call the member once they have been discharged. We obtain contact information from our records or from the hospital. Our records are based on what the person gave to human resources at some point along the line, so they may not always be updated. The hospital frequently has the most recent phone contact information.

We obtain the discharge recommendation, which is part of our UR process, including appointment times. I contact the member and engage them in the process to assure that they attend their appointments. We also call their providers to say that we want to make sure that the individual attends their appointment. We are the people who are authorizing the care, and these are in-network providers for us. Therefore, that is a relatively easy process. I feel comfortable with that because it is part of the treatment payment healthcare operations process. It also lets our providers know that we are doing this, so they should support us. It also lets them know we are not there just to plan, but also support what they do.

Once we get in contact with someone, we are going to describe this service in the way of how it can help him or her. “This is a service that helps you see how well you are doing.” Other phrases we use include, “We are here to support you in your recovery,” or “We are here to help you and your son/daughter.” We speak in a positive way, and we let them know that there is no cost to them for the program. This is part of their health plan, and we provide this service to help them see how well they are doing. That phrase works for them because it has a positive tone to it.

We also want to match case managers to the members as much as possible. As we manage care, we can see that individuals are more comfortable with a male or a female based on our UR information. They may be more comfortable with someone based on their issues, so we want to try to have the appropriate person do an outreach call to them. Because of that, we may learn about varying times of day to call.

We also found it is important for the case managers to know the therapeutic language that the member has learned. Specifically in substance abuse, we want people who are familiar with that language so that they can talk about supporting recovery, working a program, avoiding old playmates and playgrounds, working the steps, the big book and sponsors. There are certain words that are very specific to that language and to that program. If we can use that language comfortably, then that increases member engagement.

How Taconic IPA Embedded Case Managers Risk-Stratify High-Risk, High-Cost Patients

November 5th, 2013 by Jessica Fornarotto

Using a self-developed approach that combines elements of Geisinger’s Proven Health® Navigator, Johns Hopkins Guided Care Nursing and the Wagner Chronic Care Model, Taconic Professional Resources is assisting physician practices in the New York Hudson Valley to improve population health and care for their sickest patients through the use of embedded RN case managers.

During HIN’s webinar on Improving Population Health With Embedded Case Managers in an Open, Multi-Payor Community, Annette Watson, senior vice president of community transformation for Taconic, described how case managers identify high-risk, high-cost patients.

How does a case manager go in and identify who is high-risk or who is high-cost? You can do it a number of ways, and they can be formal and informal. You can use internal sources and when we do go in, that’s one of the baselines you have to understand. Who are the patients and what is the population? If they have not been using data or have not been in an Advanced Primary Care initiative, it’s highly unlikely that a practice has a quantitative method in place when we arrive.

We begin by asking the practice providers who are the sickest patients? We can then use data that’s available at the practice level, such as registries or reports, that can be run from the EHR. We also look at what kind of data they’re getting from external sources. Are they getting reports from payors that perhaps show some utilization activity?

One thing about many of those reports is that they may be somewhat aged. They’re not necessarily timely, which creates actionable questionability. But we’re finding more and more reports about recent ER use or discharges from payors that are more and more timely that allow the practices to look at data retrospectively in most cases, but much more quickly than they were getting in the past.

And when it comes to hospital admission and discharge information, many times in a primary care practice depending on the model, if they are not the admitting physician, whether it’s a specialist or a hospitalist or someone that comes through the ER, it’s not a given. People think they know about their patients being in the hospital. They don’t always, and that is a challenge and a workflow implementation that we often spend a lot of time on when we get into a practice — how to get the timely information about admissions and discharges.

We also implement new processes in the practice to formally assess the risk of patients using validated tools. In the Hudson Valley, the tool that was easily adopted and modified in a variety of EHR’s is from the American Academy of Family Physicians (AAFP). This tool allows for a quantifiable way to put a risk level on every patient in a practice who is seen, and it changes over time. It’s the kind of tool that when a case manager goes into a practice, we look at risk stratification as an important characteristic of identifying those patients and managing those patients over time.

Infographic: How Case Managers Help Patients Navigate the Healthcare Maze

October 8th, 2013 by Jackie Lyons

Case managers can help patients understand their health status, care and treatment options and the importance of such treatments.

Furthermore, 44 percent of board-certified case managers say helping patients navigate the healthcare system is an important role. This infographic also provides a look at the healthcare experience with and without a case manager, including how chronic disease care and preventable readmissions are affected.

Get the latest healthcare infographics delivered to your e-inbox with Eye on Infographics, a bi-weekly, e-newsletter digest of visual healthcare data. Click here to sign up today.

You may also be interested in this related resource: 2013 Healthcare Benchmarks: Case Management.

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.

The Changing Role of Case Managers in Emerging Care Delivery Models

March 7th, 2013 by Cheryl Miller

“I know some case managers who left on Friday with one title, and came in on Monday with a different title!”

So says Teresa Treiger in the recent webinar The Role of Case Managers in Emerging Care Delivery Models sponsored by the Healthcare Intelligence Network.

A lively speaker with more than 30 years of healthcare industry and 20 years of care management experience, Ms. Treiger discussed the evolution of the case manager in the changing healthcare landscape. With the continued expansion of patient-centered medical homes and accountable care organizations, case managers are taking on a more standardized, collaborative approach to care coordination, she said, creating the need for broadened responsibilities.

Included in the change is the case manager’s title, which seems to constantly be in flux. This stems from the wide ranging responsibilities of the case manager, and its ever changing job description.

The first step? “Case manager job titles need to be codified into a law so consumers know what they’re getting,” Ms. Treiger says, and there needs to be “a set of standards that defines them, what they do, and what their titles are.”

Titles aside, the evolution of the case manager has been an extensive one, transforming from primarily a utilization management role to one involving readmissions avoidance initiatives.

“…The core functions of case management have remained and are consistent, but what’s important is some are shifting because of the changing work environments, the newer settings of care and different employers that case managers can work in. And while the past may have included a significant utilization management component, today we’re more focused on quality, including readmission avoidance type of initiatives.”

Much of those initiatives include care transition programs, long a primary responsibility of case managers. Given the recent explosion of such programs, case managers have the opportunity to step up, and they should, because patient discharges are muddled by too many people, Ms. Treiger says.

Integrative care is another area where case managers need to be educated, so they can not only address the patient-centered stance much of the healthcare industry is taking, but so they can be more patient-focused. Case managers need to apply both clinical and psychological care to their patients in order to truly benefit them.

As case managers continue to expand in the healthcare industry, on and off-site, the use of case manager extenders will be a “tremendous resource,” she said, enabling case managers to focus on clinical issues.

But despite stepping up to more responsibility, case managers also need to realize that “There is no “I” in team.” And in some venues, embedded care environments for one, they are still the newer kids on the block. To solidify and maintain their stance in the industry, they need to “show tangible results, show potential organizations how they can benefit them.”