Posts Tagged ‘case managers’

Risk Assessment, Case Management Help to Improve Dual Eligibles’ Health

April 30th, 2013 by Jessica Fornarotto

“When you look at some of the characteristics of the dual eligibles, in the under 65 population, 66 percent have only a chronic condition and have no functional impairments. But as you move up to the older ages, there’s fewer frailty and a bit more of the chronic conditions,” according to Dr. Timothy Schwab, chief medical officer of SCAN Health Plan. SCAN has a strategic approach to serving the dual eligible market, and Dr. Schwab recently discussed how they get this population to complete health assessments as well as the role of case managers in deciding who needs nursing home services. He also discusses how case managers work with the most extreme health condition cases.

Question: SCAN-risk stratifies individuals to determine those at highest risk, using HRAs, claims data and other assessment tools. How does SCAN encourage or incent completion of HRAs and other assessments in what can sometimes be a transient or hard-to-reach population?

Response: Getting completion of the HRA instrument is a challenge in any population, but more so in a very diverse population like the dually eligible. We initially mail our HRA to all new members. Then we follow up with reminder postcards. If we still don’t receive a response, we have a shortened risk assessment form that we ask them to complete through telephonic interactive voice response (IVR). Even with that, we still probably have a 30 percent failure rate to get the HRA done in a timely fashion.

We try to supplement that with information from our physicians. On the first visit to the physician, we can gather information and ultimately supplement it with our claims data on both the medical side and importantly the pharmacy side. We get a lot of valuable information, which makes up for people who don’t complete the HRA.

There are two groups that usually don’t complete it. The first is the group in long term institutions, like nursing homes. There’s a low response rate there. We also have a lower response rate in populations with mild dementia who are living on their own. But we also have a fairly low response rate from very healthy individuals. It’s important to recognize in the dual population that there are a group of duals that are relatively healthy. The only reason they’re a dual is because of financial conditions qualifying them for that. They could be out and about and just not concerned about completing the HRA.

We do not currently provide incentives for the general population to complete the HRA. We have tried some minor incentives with subsets of the population; for example, years ago with our diabetic population we offered a small gift of a foot care program if they completed a mini risk assessment. But in general, we haven’t found it effective.

Question: What percentage of your dual eligibles require disability support and what particular challenges would a case manager working with this subset of beneficiaries encounter?

Response: For our over 65 dual population, about 40 percent are what we classify as nursing facility level of care, or individuals who live in the community but have deficiencies in usually three or more activities of daily living (ADLs). They are frequently getting services for some of those deficiencies and are at high risk of ending up in a nursing home for long-term care, unless interventions are placed.

Of that 40 percent, probably about half are getting some sort of home-based services that are non-Medicare covered; things like personal care, homemaking, bathing assistance, and transportation assistance. For our case managers to make these assessments, do the in-home visits, and develop a care plan, we focus on hiring social workers, geriatric social workers and geriatric nurse practitioners. We spend a lot of time training them, both in how to identify the needs in the home, and how to identify the needs when talking with the caregiver, who is frequently an important part of this conversation.

We also offer on the job training for working with the rest of the team when they present these cases at our team meetings and the interdisciplinary care team meetings.

Question: How can care managers work with the most extreme cases that have multiple physical health and behavioral health, chronic and acute conditions?

Response: Those are the tough ones to work with. The first step is to find the right care manager for that individual. For example, if the primary issue is behavioral health, choose a care manager that excels in behavioral healthcare. That care manager then works with others to resolve the other issues. These people will require more time. You may also need to engage the help of the personal care workers or those in the home, so that they become both the physician and the care manager’s eyes and ears there. Teach them ways to pick up very subtle changes or differences in that person so that you can quickly provide new interventions if the person starts to show signs of deterioration. It’s a classic example of ‘one size doesn’t fit all;’ if your model says we will contact an individual monthly, some may need weekly and some may need daily contact. You may need to figure out ways to get that contact in an easy, efficient way for that individual.

Healthcare Week in Review: Hospital Trends, Suggestions for Reducing Readmissions

April 22nd, 2013 by Cheryl Miller

Physicians have them; so do nurses, and even teachers. So why not case managers?

Aides, or extenders, could be one of several new key trends for case managers, says case manager Teri Treiger. Because they are often faced with large amounts of administrative work in addition to clinical assignments, aides can help take care of details and allow case managers to be much more efficient.

Efficiency and collaboration could help the widespread number of preventable hospital readmissions among Medicare beneficiaries, according to researchers at Penn State, the Weill Cornell Medical College and the University of Pennsylvania. But it will take time, more time than many healthcare professionals originally anticipated, time that is costing the nation nearly $18 billion annually, because of the lack of collaborative relationships among providers in different care settings, researchers say.

A majority of hospitals are in agreement that ACOs are key to remaining competitive. According to a new study from L.E.K. Consulting, over 80 percent of surveyed hospitals are making future plans to join or are already participating in an ACO.

Hospital executives also intend to invest significantly on information technology (IT) and facilities over the next five years in order to stay ahead, researchers found. Hospitals are investing in mechanisms that will help them improve quality metrics and outcomes and gain a competitive advantage in the marketplace, researchers note. Researchers also found that there will be major changes in purchasing dynamics, as we detail in our story here.

Nearly half of adult residents living in the metropolitan Texas area are uninsured, making it the highest area of uninsured adults in the metro United States for the second year in a row, according to the Gallup-Healthways Well-Being Index.

This is nearly three times the national average of 16.9 percent; a percentage which has remained the same since 2011, but jumped by two percent in 2008. Metropolitan areas in Vermont, Massachusetts and New Hampshire had the lowest uninsured rates. Geographically, these rates haven’t changed; and demographically, one group in particular, Hispanics, remains uninsured.

Researchers expect these figures to change, however, as healthcare reforms take effect.

And lastly, young adults under 26 insured on their parents’ health insurance plans due to federal mandate are more likely to be treated for depression, substance abuse and pregnancy, according to new research from the nonpartisan Employee Benefit Research Institute (EBRI). This report is the first to identify the major treatments the coverage is used for, researchers note.

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

March 4th, 2013 by Cheryl Miller

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

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

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

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

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

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

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

What kind of art do you do?

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

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

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

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

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

In brief, can you describe your organization?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Where did you grow up?

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

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

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

Are you married? Do you have children?

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

What is your favorite hobby?

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

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

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

Any additional comments?

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

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

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 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.

Lower Readmissions for Hospitals with Good Nursing Work Environment

January 14th, 2013 by Cheryl Miller

No one could argue that nurses do more than their fair share of work. But now a new study is documenting that work environments that are beneficial for nurses are also beneficial for hospitals in terms of readmissions rates.

Researchers at the University of Pennsylvania School of Nursing found that Medicare patients treated in hospitals with a good work environment for nurses had up to 10 percent lower odds of readmission than those treated in hospitals with a poor work environment.

Researchers suggest that improving nurses’ work environment and reducing their workloads are organization-wide reforms that could result in fewer readmissions. All hospitalized patients are exposed to bedside nursing throughout their stay and combining targeted transitional care, the coordination of healthcare during the transition from hospital to home, with high-quality inpatient nursing care will produce more positive outcomes for all patients, and help reduce overall healthcare costs. Preventable hospital readmissions cost the United States more than $15 billion annually, and Medicare is now penalizing hospitals with excessive rates of readmissions.

This study parallels another recent news story documenting nurses/case managers’ role in reducing readmissions by dispensing phone calls within 48 hours of discharge to high risk patients. The study, from Cigna, followed nearly 4,000 high-risk gastrointestinal, heart and lower respiratory patients and found that prioritized, telephonic outreach by health plan case managers after hospital discharge reduced future readmissions by 22 percent. This subject is currently a hot topic on our new LinkedIn forum, CaseTalk – a Forum for Care Coordinators. You can join in the discussion group here.

How to find the right nurse/case manager? Robert Fortini, vice president and chief clinical officer of Bon Secours Health System, tells us that they should posess both creativity and critical thinking skills, in our story excerpted from our new book, Profiting from Population Health Management: Applying Analytics in Accountable Care. Bon Secours’ nurse navigator program was so successful that they were planning on doubling their budget for them within 18 months.

And in other news, the increased use of EMRs and other related tools have failed to fulfill the financial promise of HIT, according to a new RAND Corporation analysis. One of the major reasons is that systems deployed are neither interconnected nor easy to use. Some changes to reverse this are documented in our story.

And don’t forget to take our new survey on Medication Adherence.

Top 10 Most Inspiring Reads from Healthcare Case Managers

December 18th, 2012 by Cheryl Miller

Shopping for that busy case manager in your life this holiday season? Then look no further than this top 10 list of their favorite, most inspiring books.

While most of them admitted that they didn’t have time to read, or if they did, they were spending it reading professional journals like CMSA Today, or their kids’ college essays, we got them to ‘fess up to their favorites. Here’s their list, ranging from the wildly popular Hunger Games trilogy to an old but not forgotten classic by Charles Dickens, A Tale of Two Cities.

Stacey B. Hodgman, MS, RN-BC, CCDS, CPUM, Senior Director of Case Management for Kindred Healthcare, Board of Directors for the Case Management Society of New England
I am currently reading Transforming Ourselves and the Relationships that Matter Most by Lisa Oz, wife of Dr. Mehmet Oz. I enjoy self-help books and always look for ways to better understand human behavior and relationships. As a case manager, it is imperative that we understand human behavior and how we can help influence patients to make lifestyle changes that they want to make while promoting optimal health. Relationships define us both personally and professionally and understanding how to make the best of each one can only lead to a happier, more fulfilling life.

Victoria Powell, RN, CCM, LNCC, CNLCP, CLCP, MSCC, CEAS II, Founder and President of VP Medical Consulting, LLC.
I usually read nonfiction, but new movie releases got me started on a few fiction pieces recently. I completed The Hunger Games series by Suzanne Collins and also The Help by Kathryn Stockett. As for my non-fiction I have just finished Dave Ramsey’s EntreLeadership. All were excellent and I give them five stars each.

Miriam Weiss, MSN, RN, CCM, Care Manager at Amerigroup Corporation, Care Manager Consultant, Per Diem, at CareManagers Inc.
Books by Danielle Steele, John Grisham, James Patterson, or Lisa Scottoline.

Hillary Calderon, RN, Senior Manager of Corporate Case Management for HCA
Last book I read was The Help. I am last at reading the trends. I am in the process of reading The Hunger Games.

Linda Van Dillen, RN, BA, CCM, Executive VP/Partner of S&H Medical Management Services, Inc.
I recently read The Hunger Games trilogy and saw movie number one. It was very interesting on so many levels. It made me think of how you can use power for good or for evil, and even when you are supposedly the “good guy” your actions can be used to either truly help others or to just promote your viewpoint.

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

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

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

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

Linda Conroy, RN, BSN, Clinical Integration Case Manager for Hartford Physician Hospital Organization (HPHO)
Still Alice, by Lisa Genova.

Time to Welcome Those in Need

December 17th, 2012 by Cheryl Miller


‘Tis the season to welcome those in need, and doctors’ offices are a good place to start.

Primary care physician offices need to be more accessible, because the majority of patients are finding their doors closed when they most need them, says a new report from the Center for Studying Health System Change

Of nearly 10,000 patients surveyed who have a usual source of primary care, more than half said their doctors did not provide care after hours and on the weekend. These patients were more likely to go to the ED as a result, or skip medical care completely, researchers said. At a time when reducing unnecessary ED visits totaling more than 136 million in 2009, according to the CDC is a major concern of healthcare experts, this could be a simple, potentially cost-effective solution.

Another reason to expand primary care access? Americans are living longer, given increasing medical advances, according to United Health Foundation’s 2012 America’s Health Rankings®. But they’re not necessarily healthier, because of increasingly unhealthy behaviors and diets, habits that unfortunately aren’t limited to the typically overindulging holiday season.

While rates of premature, cardiovascular and cancer deaths have declined since 1990 by 18 percent, 34.6 percent and 7.6 percent, respectively, preventable behaviors have increased: nearly a third of adults are obese, 10 percent of the population has diabetes, 31 percent has high blood pressure (BP) and 26 percent of adults are sedentary or do not exercise outside of work, resulting in increasing levels of diabetes and high BP.

There is another population that is living longer – former cancer victims who beat the odds but now have bodies weakened by cancer treatments. These ‘survivors” need a heavy dose of holiday cheer, in the form of a dedicated line of care, and today’s case managers can provide that care, says Sheryl Riley, managing partner at Clarion LLC. But they need to be trained not only to deal with the physical after-effects of their disease, but their emotional state and their families’ emotional state – as well.

And this could very well be a topic of discussion for our brand new LinkedIn forum: CaseTalk… a Forum for Care Coordinators, where case managers can talk about best practices, news and analysis, and network with others.

In our discussions with case managers over the years, we have found that they would appreciate an online meeting group where they can share ideas and concerns about their craft with the limited amount of time they have, all year round. We hope that CaseTalk becomes that go-to place for many of you, case managers and healthcare professionals alike.

Happy holidays!