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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