District CEO Darcy J. Davis shares compassion and commitment of Utilization Management team
Health Care District Chief Executive Officer Darcy J. Davis recently spent the day with Lola Lane, RN, Senior Nurse Reviewer in the District's Utilization Management department.
Lola and her team help the District's health coverage members gain access to health care services. As Darcy learned after connecting with this specialized team, the Utilization Management department works hard to strengthen the health care safety net in Palm Beach County.
Darcy shared her experience with Health Care District employees in the second issue of "Walk a Mile in Your Shoes."
Lola Lane, RN, Senior Nurse Reviewer, Utilization Management
Little did I know that when I named my outreach efforts “Walk a Mile in your Shoes,” that this concept would resonate with one of you more than others. When I showed up at Lola Lane’s workspace, the entire space (that wasn’t covered in Denzel Washington appreciation photos) was covered in shoes…shoe Christmas ornaments, shoe cards, shoe trinket boxes and shoes in just about every decorative form I could imagine. She was ready for me. After a few photo ops with her shoe collection, we went to work.
Finding the Team
When Lola took me to the 3rd floor of the District Headquarters where her team’s offices were, I knew I was entering sacred space. In our current location we work in very isolated silos. Once you go beyond certain doors, it is actually possible to stay there all day without interacting with others outside of the home department. Occasionally, one might run into someone on an elevator; but other than a casual “hello” and “boy, it’s hot outside” it is possible to work in the same building without ever meeting key individuals in the organization.
This was definitely the case for me. I was looking at a lot of friendly, but unfamiliar faces. Thank goodness they were immediately welcoming and seemed genuinely glad I was there.
Meeting the Players
FROM LEFT: YVES-ANNE JEREMIE, RN, CASE MANAGER; KRISTI NORRIS, RN, UTILIZATION REVIEWER; LIANNA STEVENSON, RN, CARE COORDINATION; LOLA LANE, RN, SENIOR NURSE REVIEWER; EILEEN NUGENT, RN, UTILIZATION REVIEWER AND MARY PARR, RN, CASE MANAGER. SEATED: DARCY J. DAVIS, CEO AND SAMANTHA NEDD, RN, UTILIZATION REVIEWER.
Roundtable
I got to witness first-hand the daily interactions of this highly functional team. The Utilization Management team helps the District’s health coverage members get access to network services in a cost-effective and timely manner.
Each of the nurses and case managers went around the table and brought to the group some of their more challenging cases, seeking input from the others. Often, the same patients were bouncing from team member to team member as the patient bounced from hospital facility to hospital facility.
The UM team also took the opportunity to tell me about a few of their most rewarding success stories. I tried not to disrupt this well-honed process, but I was immediately interested and couldn’t help but offer thoughts. Thoughts of appreciation, and some suggestions to help with their processes.
Saving Lives and Saving Money
The types of patients and cases that make their way to these ladies are not easy. It was obvious from the first case review that the folks who seek the assistance of the Health Care District are some of the poorest and the sickest. By the time they connect with our payer plans, the situations are dire and the patients are desperate.
Time is of the essence and the cost of care could be astounding. But the folks in Utilization Management understand their role very clearly. Save lives, and do it cost effectively.
A number of shoes to fill
A Success Story
A patient, let’s call him “John,” was diagnosed with cancer of the kidney. Not just a run of the mill cancer, but a rare sarcoma of the kidney. His particular case required a specialized surgeon.
Mary, our case manager, searched all of her known resources for a surgeon who specialized in this type of surgery. After looking across the state for a specialist, she was able to reach out to a Palm Beach County doctor who was credentialed for this very type of surgery. The doctor knows our patients well and was receptive to John’s needs.
Within days, John met the surgeon at a local hospital and had his kidney removed. His condition was acute and chronic, but with District Utilization Management intervention, he was connected with life-saving resources. His kidney was successfully removed and he is doing well.
Another patient, let’s call him “Peter,” was diagnosed with bladder cancer. Yves-Anne, our other case manager, worked with our eligibility team and financial counselors at the District’s C.L. Brumback Primary Care Clinics and succeeded in getting him retro-active Medicaid coverage. Peter’s medical bills were financially covered by Medicaid, not directly by the District.
Connecting the dots
Through discussion with the UM team, we identified a few opportunities to better utilize District resources.
Remember the silos? Well, through no one’s fault, but by simply talking through regular occurrences, we identified an opportunity to leverage the expertise of others across the District.
One common area that the UM team has found challenging is Wound Care. They have a number of cases where their patients may have diabetic ulcers or other wounds that need care beyond that which our C.L. Brumback clinics can currently provide.
But…at our long-term care facility, the Healey Center, we have certified wound care nurses. Also, at Lakeside Medical Center we have the surgical expertise of our Medical Director and General Surgeon, Dr. Dan Kairys.
So by connecting the dots, aka connecting our resources, we may be able to enhance our internal expertise and provide care to our beneficiaries through our own providers instead of paying to send them outside of our organization.
FROM LEFT: YVES-ANNE JEREMIE, RN, CASE MANAGER; LOLA LANE, RN, SENIOR NURSE REVIEWER; ELIZABET RIVERA, INTAKE SPECIALIST; MARY PARR, RN, CASE MANAGER; JANICE FRISCIA, AUTHORIZATION SUPERVISOR; LIANNA STEVENSON, RN, CARE COORDINATION; DARCY J. DAVIS, CEO; EILEEN NUGENT, RN, UTILIZATION REVIEWER; TRACEY EAMES, OFFICE ASSISTANT; SAMANTHA NEDD, RN, UTILIZATION REVIEWER; KRISTI NORRIS, RN, UTILIZATION REVIEWER; KATHY RANGE, INTAKE SPECIALIST AND SHEMERRIA BURGESS, INTAKE SPECIALIST.
The Human Factor
So, I need to be honest about this outreach opportunity. I really had no idea what to expect. I mean, in the back of my mind, I was actually thinking this was probably a lot of paper pushing and chart reading.
What I completely underestimated was the human aspect of the work. As I spoke with the nurses and case managers, their passion for their work was clear.
The emotion of some of these cases was raw. In fact, a couple of them broke down and choked up as they relayed the situations they faced. They treat each patient as they would a family member.
I was truly impressed by the compassion and commitment that permeated my morning. What an amazing group of women, providing such meaningful service to our patients.
This is a group of team members I am proud to get to know. We all benefit from their heart-felt efforts.
Lola Lane, RN
Lola’s leadership in Managed Care is exemplified through her mentoring and educating new Utilization Review nurses, problem solving of difficult cases and serving as a resource for other departments. Lola has 35 years of experience as a Registered Nurse.
She graduated with a Bachelor of Science in Nursing from the University of Miami and obtained a Master of Science in Health Management from St. Thomas University. Lola became a Licensed Healthcare Risk Manager in 1997 while working as the Performance Improvement Manager for a home health care agency. She later became the director of a home health care agency.
Lola joined the Health Care District in June of 2001. She holds a Certification in Health Care Management and is a Certified Professional Coder. Lola’s specialties of work include Critical Care, Medical-Surgical, Radiology, Open Heart Surgery, Home Health, Pediatrics and Neonatal Intensive Care Unit. Lola’s integrity and sincere desire to provide care to the underserved of Palm Beach County is recognized and appreciated.