Posts Tagged ‘Case Management’

9 Things to Know About Palliative Care

June 12th, 2014 by Cheryl Miller

With an aging population that is living longer—an estimated 10,000 baby boomers become eligible for Medicare each day — and a shortage of specialists trained for the field, palliative care is no longer taking a back seat to more traditional healthcare. The majority of respondents to the Healthcare Intelligence Network’s first annual Palliative Care survey in February 2014 said they have a palliative care program in place, and of those that don’t, more than half said they planned to launch a program within 12 months.

Here are nine benchmarks gleaned from the 2014 Palliative Care survey:

  • Timely referrals of patients to palliative care are one of the biggest challenges to implementing a program, according to 89 percent of respondents.
  • Frailty is a key characteristic of their palliative patient/member population, say 48 percent of respondents; other traits include impaired cognitive capacity (34 percent) and disabilities (15 percent).
  • „„Candidates for palliative care are primarily identified by physician referrals (78 percent).
  • More than half (60 percent) of respondents said that case management assessments were important tools for identifying palliative care candidates.
  • While the majority of respondents (68 percent) administer palliative care on an inpatient basis, more than half (54 percent) say care is conducted on home visits and just under a third offer palliative care at extended care facilities.
  • About 88 percent of respondents with palliative care programs reported an increase in patient satisfaction levels among Medicare participants, while 89 percent saw more satisfaction among caregivers.
  • Overall, the presence of palliative care helped to curb healthcare utilization costs for 70 percent of respondents.
  • Seventy-one percent of respondents with palliative care programs in place reported an uptick in hospice election by Medicare patients.
  • Nearly 20 percent of respondents said it was too early to tell what ROI their palliative care program generated.

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Excerpted from 2014 Healthcare Benchmarks: Palliative Care

Transferring Telephonic Skills to Face-to-Face, Embedded Case Management

May 1st, 2014 by Cheryl Miller

Because many case managers come from telephonic backgrounds, embedding them in physician practices—an essentially new role—requires the right mix of qualifications and characteristics to handle face-to-face interactions, says Annette Watson, senior vice president of community transformation for Taconic Professional Resources. Case managers that are change agents, who are enthusiastic and welcome collaboration and have registered nurse experience, are part of the mix of qualifications and qualities that have proved successful for this role.

Question: What qualities and qualifications does Taconic seek in its embedded case managers?

Response (Annette Watson): We’re looking for our case managers to be registered nurses in the State of New York with unrestricted licenses to practice. Part of that background is that nurses have a wide ranging education that makes them generally able to care for chronically and complexly ill patients. In the physician’s practice setting, that qualification is really what we look at as a baseline for entry into this field. We then, at Taconic, look for them to have a certification as a case manager prior to their coming to us. That would either be a certified case manager (CCM) designation, or a registered nurse (RN) with a case manager (CM) designation from the American Nurses Credentialing Center, or an RN CM.

Both of those represent an experientially based qualification. That means that we don’t have to teach them from the baseline what case management is. But what we’re doing is refining skills for this new setting.

We also look for experience relative to case management work in a setting that has them working in a collaborative environment with physicians and patients prior to getting there that would create a transferable skill set.

Many times case managers have been deployed in settings where they’re telephonically based or don’t have direct contact with either physicians in practice or with patients in a telephonic model. We find that that’s a transition from one setting to the other that doesn’t always work without a lot of ability to overcome obstacles and create an environment where face to face interactions go well. So those are just some of the things that we’re looking for in background.

Lastly, in terms of qualities, we’re really looking at what we call ‘the right stuff.’ A personality type where people are enthusiastic about the work, are positive about the type of new groundbreaking work that they’re going to be doing in these new settings, often which is they’re often new to a practice and new to a role, so they’re very much an ambassador of what case management is. Those kinds of personality traits that make them change agents and collaborative and enthusiastic in the setting are all part of that mix of the qualifications and qualities that we look for.

Excerpted from Advancing Primary Care with Embedded Case Management: Lessons from the Taconic IPA Pilot

4 Pillars of SNF/Hospital Partnerships

March 13th, 2014 by Cheryl Miller

Maintaining contact with patients long after the 30-day discharge period when the penalty phase ends for hospitals is one of the four pillars of Torrance Memorial Health System’s post-acute network philosophy, says Josh Luke, Ph.D., FACHE, vice president post-acute services at Torrance Memorial Health System and founder of the California Readmission Prevention Collaborative and the National Readmission Prevention. This can be done telephonically or in-person, and is usually conducted by an ambulatory case manager.

The main component of our post-acute network is to go into each of the seven SNFS once a week and meet with them for a half hour at the most, covering four tactics. The first is to review a list of all of the patients that have been sent from the hospital over to the SNF, specifically focussing on which ones are discharging that week.

The second tactic is to discuss their discharge disposition, and see if they’re going to a home health agency, and if so, if it’s one that we own, or another one in the community. We distinguish this so we can do what’s called ambulatory case management of the patient, which means we want to case manage them once they go home. We don’t just want to forget about them. We want to keep an eye on them and check in on them, whether it’s telephonically or in person, making sure that they continue to do well, not just through the end of the 30-day episode after discharging from the hospital when the penalty phase ends for hospitals, but also for their long term well-being.

The third tactic is to encourage each of our patients going home from the hospital and SNF to make an appointment at our post-acute clinic (CCC) with the physician who does medication reconciliation. She asks the patients to bring in all the medications they were on before they went to the hospital and all those they were prescribed at the hospital. They then sit and have a 45 minute conversation, including guidelines on what their medication plans are moving forward, which ones they should be taking, and which ones they shouldn’t, and making sure, with teach back methodology, that the patient has a clear understanding of what is expected from them in terms of consuming medication once they return home later that day. Those appointments normally take place within the last 72 hours.

The fourth tactic is to review what we call the ‘return to emergency room’ log. In the industry the common term is ‘return to acute’. We don’t allow our SNFs to use that term because we feel they’re responsible for the ‘return to the emergency department (ED)’. What we mean by that is we’re challenging our SNFs to say, “Take charge of what you can control. And what you can control is making sure that patient doesn’t leave your SNF unnecessarily.” We’re not here to say, “Did the patient get admitted or not to the hospital?” We’re here to ask the SNFs if they followed the guidelines that several organizations nationwide have provided that help avoid unnecessary transfers out to the hospital.

Excerpted from 5 Best Practice Prevention Protocols for Reducing Readmissions.

New Rule for Patient Care Collaborations: There’s No ‘I’ in ‘Team’

March 6th, 2014 by Cheryl Miller

“Take your provider hat off and put on your patient hat for a moment. Do you feel as though you’re at the center of your own healthcare team, or that your mother or child has a healthcare team around them? Do you even feel as though there is a healthcare team?” asks Teresa M. Treiger, RN-BC, MA, CHCQM-CM/TOC, CCM, CCP, president of Ascent Care Management. Here, she lists the elements necessary to build an effective patient care team.

I always use the phrase, “There is no ‘I’ in the word ‘team,’” and it’s really true. True teams are precious; high functioning teams are a real rarity. I know there are organizations that deliver excellent team-based collaborative care, but it’s not a common occurrence because the concepts of teamwork are not necessarily covered in everyone’s curriculum or training. Nurses, social workers and allied health all come up within the perspective of being part of a team, but that is not codified into the curriculum at every institution.

Then we have to consider the patient. Supposedly the patient is at the center of the care team, but right now the center, I think, is a convenient place for the patient to be because then everyone can get their hands on them, so to speak. However, the patients that I speak to across the country are not feeling the love. They’re not feeling like they’re at the center of anything.

To demonstrate this, take your provider hat off and put your patient hat on for a moment. You’re all patients at some level, or your loved ones are. Do you feel as though you’re at the center of your own healthcare team, or that your mother or your child has a healthcare team around them? Do you even feel as though there is a healthcare team? If you can shift your perspective there, you can see where patients are not feeling that love necessarily.

Team building takes a tremendous amount of the time. It takes collaboration, it takes everyone at the table being accountable, and it takes everyone at the table being able to trust the other people sitting across from them. It’s not something that you can just decide to have — “Well, let’s have a great team.” It takes time. If anyone has worked in an emergency room, when you have a group of people working together on a shift that just clicks, when you know you can count on those people, that’s the kind of energy and positive interchange that I’m talking about when I talk about teams. That takes time; it didn’t just happen on day one. Trust is something that builds over time; similar to the interest on your bank account.

Excerpted from Case Management in Value-Based Healthcare: Trends, Team-Building and Technology.

6 Strategies Help Stem Hospital Readmissions, Streamline Processes and Care Transitions

February 27th, 2014 by Cheryl Miller

Development of post-acute partnerships with home health, skilled nursing facilities (SNFs) and hospice is emerging as a key strategy to stem hospital readmissions, according to new market data from the fourth annual Healthcare Intelligence Network (HIN) Reducing Hospital Readmissions Survey.

More than half of survey respondents participate in post-acute partnerships, with home health collaborations the most common (79 percent). These partnerships serve to streamline processes and care transitions, educate and align staff, and implement changes of value to patients, respondents say.

Looking at more conventional approaches, medication reconciliation and telephonic monitoring of patients post-discharge emerged as frontrunner strategies to curb readmissions. Moreover, the 2013 survey revealed significant upticks in the use of each tactic over 2012 levels: medication reconciliation is now conducted by 73 percent of respondents, versus 54 percent in 2012, while the use of telephonic monitoring jumped from 48 to 71 percent over the same 12-month period.

In other new data, almost half of respondents — 47 percent — aim programs at individuals already assessed at high risk for readmission as well as traditional Medicare (53 percent), Medicaid (28 percent) and high utilizer (23 percent).

Other key findings include the following:

  • Two-thirds of respondents to HIN’s December 2013 Readmissions e-survey have a program to reduce readmissions.
  • In a new metric from the 2013 survey, more than half — 52 percent — aim readmission reduction efforts at individuals with diabetes.
  • Case management is the most successful approach to curbing rehospitalizations, say 27 percent. The case manager retains chief responsibility for reducing readmissions, say 34 percent of respondents.
  • Heart failure remains the top condition targeted by programs, although a fifth already track readmissions for hip and knee replacements, a metric the Centers for Medicare and Medicaid Services (CMS) will examine more closely in 2015.

Excerpted from 2014 Healthcare Benchmarks: Reducing Hospital Readmissions.

3 Reasons Home Visits Critical During Care Transitions

February 20th, 2014 by Cheryl Miller

As far back as 2010, home visits were a vital component of the Durham Community Health Network (DCHN), a primary care case management program for Medicaid recipients who live in Durham County, NC, explains Jessica Simo, program manager with Durham Community Health Network (DCHN) for the Duke Division of Community Health. Conducted in three-month increments, and designed initially to better address Medicaid recipients’ needs and link them to their medical homes, the face-to-face visits helped establish a level of trust between case manager and patient, eventually leading patients to better outcomes, including improving medication reconciliation.

Why are home visits so important? Number one, it is very challenging to observe problems that individual patients may have with adhering to their medication regimens if providers can’t see the medicines in the bottle in the patient’s home. You need to be available to count the medicines and ascertain definitively that they are not missing. Trying to do medication reconciliation over the phone is nowhere near as effective as being in a patient’s home.

Another reason home visits are more effective is that you can physically see what activities of daily living (ADL) or instrumental activities of daily living (IADL) deficits the patient may be experiencing in their natural environment. This is something you can’t directly observe within the confines of an exam room.

The engagement of family or other support persons is also important. Home visits are an excellent way to see somebody in their natural environment, find out who the support people are for the patient, have a comfortable discussion in their home about an individual plan of care and get the people who can assist with that on board.

For all of the previous reasons, home visits were critical to the DCHN pilot. It’s especially important in a medically complex patient population where there are frequent transitions, whether they be from the acute care setting, from any emergency department (ED) visit or back into the home from an assisted living facility.

Excerpted from 2013 Healthcare Benchmarks: Home Visits.

Award-Winning Protocol Puts Readmission Prevention Manager in ER to Reduce Rehospitalization Rates

February 13th, 2014 by Cheryl Miller


Call it a bouncer of sorts for the emergency room: the readmissions prevention manager, or RPM for short, has helped Torrance Memorial Health System reduce all cause readmissions by nearly 5 percent, and earn its hospital system kudos from the industry, says Josh Luke, Ph.D., FACHE, vice president of post acute services at Torrance Memorial Health System and founder of the California Readmission Prevention Collaborative and the National Readmission Prevention Collaborative.

Designed to determine whether newly admitted high-risk patients are ready for the emergency room (ER), or could be placed elsewhere, the RPM is an integral part of a strategy implemented in 2013 for Total Wellness Torrance (TWT) to reduce preventable readmissions, Luke said during Award Winning Readmission Prevention Protocols: Navigating Care Transitions with Preferred SNF and Home Health Providers , a 45-minute webinar on January 8th, 2014, now available for replay.

He shared the key features of this program, which was recognized by California Association of Healthcare Facilities as a Program of Excellence in 2013. At the time, the 401-bed not-for-profit hospital was achieving readmissions rates that were in step with national averages, generally within 18 to 20 percent, and some quarters exceeding that. Torrance felt it could do better, approaching the problem from an all-cause, rather than disease-specific perspective, Luke says.

Creating the RPM was the first step in the process, he says. This person would function as the leader of the hospital readmission prevention team, making sure only patients who meet criteria and need to be hospitalized are admitted either to the observation floor or to the inpatient unit.

As Luke explains: the RPM gets a real-time email alert any time a patient comes to the ER and their social security number is entered into the hospital’s electronic system. Their number one priority is then to go right to the ED to meet the patient and work with the attending doctor, case manager and nursing team in the ER to see if this patient can be cared for at a lower level of care.

That’s essentially what the Affordable Care Act has encouraged us to do and incentivized us to do and penalized us when we don’t do that efficiently, which is not to admit patients to the hospital that don’t need to be here. We are very encouraged by the success of that program in its initial six months.

The RPM then follows those patients who were not admitted to the ED to a post-acute network facility, at all times keeping in mind patient choice. TWT includes a post-acute network of eight skilled nursing facilities (SNFs), all within five miles of the hospital, and a home health agency. Along with a home health department navigator, the RPM goes to each SNF once a week to follow up on patients, determining discharge plans and employing an ambulatory case manager if the patient goes to a home health agency outside the Torrance network, and keeps tabs on them long after the 30-day readmission period is over.

Collaboration and communication with the post-acute network (PAN) is key to success, Luke says. “Whenever I’m asked if I could name three basic things to prevent readmissions, the first thing I always refer to is telling your skilled nursing facilities to invest in predictive software because it doesn’t cost you as a hospital anything. It enables you to share data with the SNFs.”

That, and always be a champion of choice for your patients, Luke adds, even when they’re being bounced out of the ER.

4 Trends for Healthcare Providers in 2014

January 30th, 2014 by Jessica Fornarotto

Dual-track medical homes, e-visits, retooled patient handoffs and more post-acute care are predicted provider trends for 2014, according to Steven Valentine, president of The Camden Group. HIN interviewed Valentine prior to his presentation during an October webinar on Healthcare Trends & Forecasts in 2014: A Strategic Planning Session.

HIN: What is the physician practice going to look like in 2014? How has the primary care team evolved to meet the Triple Aim values inherent in the PCMH and accountable care models?

(Steven Valentine): We should expect to continue to see consolidation amongst the medical groups. The independent practice associations will begin to assimilate together because they need to put more money into their infrastructure. And many of the organizations have underperformed, in all honesty.

The primary care team is still critical. We’ve benefitted by keeping many primary care doctors around because they were negatively hurt with their net worth in the recession in 2008-2010. But it’s slowly coming back and we’re starting to see those physicians thinking about retirement again. The reality is, we’re never going to replace all of these primary care doctors as they wind down their practice. We need to do a better job of getting telehealth going and utilizing e-visits. We’re seeing the health plans starting to pay for those e-visits, as well as having the consumer who uses them use a credit card and pay at that time, just like a visit.

We’re going to have to look at different models. Obviously, the nurse practitioner is getting more involved with the primary care. And yes, they’re still pursuing the Triple Aim. We know that quality scores, satisfaction scores and trying to manage cost per unit is still a critical focus of the triple aim moving forward with population health.

Lastly, with a PCMH in accountable care, while some of the pioneer accountable care organizations (ACOs) reduce themselves out of pioneer into the Medicare Shared Savings Program (MSSP), we still have a number of organizations and it’s growing. The commercial ACOs have been very successful in California.

We fully expect accountable care to continue. We think the PCMH will evolve into two tracks. The first track is a primary care PCMH. The spinoff is a chronic care medical home that has the multidisciplinary team organized around a chronic disease. This is a model developed by CareMore years ago in Southern California and it’s been expanded across the country. As I travel the country, I run into organizations that have set up these chronic care centers around the chronic disease.

HIN: Regarding the Pioneer ACO program, one of the top performers in the CMS pioneer program, Monarch HealthCare, told us that it’s going to be working to engage specialists in care coordination roles in year two and year three. What’s ahead for specialists in terms of quality and performance improvement as well as shouldering perhaps more care coordination duties, especially for Medicare patients?

(Steven Valentine): The specialists are going to be a critical piece to this whole solution. They have been a tremendous asset in the area of bundled payments, where you have the facility fee and physician fee combined into one payment. That works for both the Medicare as well as the commercial side. You’re beginning to see more of the bundled payments within an ACO.

The ACO manages what we call ‘frequency’ — in other words, the number of procedures to be done. Specialists are involved in satisfaction, quality scores, and resource consumption once the decision is made that the procedure needs to be done.

We expect the specialists to be involved with quality and performance. Everybody is putting in incentive programs to help drive higher quality, better performance, and a lower cost.

HIN: Hospitals have tightened the patient discharge process as a means of shoring up care transitions. But what other work needs to be done in terms of collaborations, perhaps with skilled nursing facilities (SNFs), long-term care and home health, for example, to improve patient handoffs and reduce hospital readmissions?

(Steven Valentine): Handoffs have probably been one of the areas where we’ve seen the most disappointment or underperformance within many ACOs. They have not effectively involved the hospitalists and the care/case managers who are typically embedded within the medical group that would oversee the patient throughout the care continuum. Or if it’s a health system, emanate centralized care/case management function where they manage all of the transitions from pre-acute, acute to post-acute. We think this will get better. As the doctors are more at risk, they will get more engaged with the care/case managers to manage these transitions and handoffs.

We also know that, while not in 2014 but the trend will start, we’ll see lower acute care utilization, pushing more patients to post-acute care. This means, in any given area, acute care hospitals will begin to convert excess capacity to post-acute care services like skilled nursing, long-term care, palliative care, hospice care, home care and rehab care. You will begin to see a closer proximity. The care managers will be able to work more effectively with the doctors and hospitals to manage the patient through the continuum, smooth out these transitions and have a better patient experience with better satisfaction scores at a lower cost.

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

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

January 17th, 2014 by Cheryl Miller


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

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

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

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

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

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

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

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

In brief, describe your organization.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Where did you grow up?

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

What college did you attend? I attended Seattle University.

Is there a moment from that time that stands out?

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

Are you married?

Yes, for 25 years to Gregg.

Do you have children?

Two children, Ben and Rachael.

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

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

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

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

Any additional comments?

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

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

January 2nd, 2014 by Cheryl Miller

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

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

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

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

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

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

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

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

In brief, describe your organization.

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

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

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

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

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

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

What is the most satisfying part of your job?

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

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

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

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

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

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

Where did you grow up?

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

What colleges did you attend?

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

Are you married?

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

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

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

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

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

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