Earlier this week, leaders from HealthPartners joined XSOLIS on a webinar covering their recent implementation of CORTEX and how their organization is bringing fresh perspective to utilization management. Bror Herrick, System Director of Utilization Management, and Melissa Seleski, Program Manager for UM, sat down with Cameron Bowman and Carol Schultz of XSOLIS to discuss recent changes and what they mean for their organization. The conversation covered three major themes:
Bringing a growth mindset to UM
Bror started his career both at HealthPartners and in UM in April: as he shared, “for me, the trend in hospital operations jobs, especially at the senior leadership level, has really changed from, you can be an executive at hospital, to leading a function across sites and an integrated system…I’m really grateful for that. Not just that I’m at Health Partners but had this opportunity to work in utilization management. Like I said, it’s really interesting to learn new stuff, but it’s also sort of a missing piece in my understanding of hospital operations and finance. That’s fun to be a part of.”
HealthPartners’ leadership saw tremendous value in utilization management and envisioned a new future. “Very few things change rapidly in health care, particularly hospitals. And so, beyond that, I think the vision for having a systemwide utilization program rather than how it was, say, six months ago within HealthPartners where each individual hospital within their care management teams were accountable. This vision for a hospital program has really taken over a year for this system to create and manage all the change management and get to a point where they were willing to hire a director and a leadership team to execute that vision. And so that’s, frankly, that’s exciting for me because a lot of the change management had happened,” shared Bror. “It dates way back to a small team figuring out what the vision for utilization management is, and now we’re finally able to execute.”
Getting your sea legs in a new role
With the growth mindset around what UM could be came the need to dig in and affect change. But before that, comes the actual learning. Bror shared that he was learning in “a lot of different ways and I am still learning. I literally have a textbook on utilization management in my bag that I take everywhere with me. And when I have some downtime, it’ll be open and I’ll read it a little bit…The first couple of weeks after starting, Melissa went in [CORTEX] to do some reviews, and I just watched her on our shared screen function remotely. I ask a lot of dumb questions, and everybody is very patient with me.
But when I interviewed for the job, and I said, ‘Hey, I don’t know anything about utilization management,’ everyone said don’t worry about that, ‘We’ve got a lot of people who know a lot about UM. That’s not what we’re looking for.’ Having that expectation, people were patient with me to ask questions and learn. And there’s no one way to learn, but again having a hospital operations background, [I had a] lot of familiarity with observation care modeling, CDI were patient flow, length of stay, that sort of thing. UM was the last piece that I didn’t really have. So, that connection has been really helpful in getting up to speed and learning.”’
Melissa Seleski has used her years of experience at HealthPartners and in utilization to help drive continued change. She also used relationships built last year at the annual XCHANGE conference to “network with some other hospital teams, members who had recently implemented Cortex or they were thinking about it…So when we did really get going with it and had some questions, I reached out to those people that I met and asked the kind of questions that maybe one you’re not really comfortable asking or, you know, where they were more of a peer… And it was really nice to talk with them candidly, about those issues or lack thereof really. But just understanding better of what they were, how they did it, and how they rolled it out, and how it was received. That was really helpful. Really under really being clear with our expectations and communications with, our team was huge.”
Shifting the perspective of UM
Moving into the role, Bror saw positive change ahead: “we were implementing Cortex because we wanted to improve our observation rate, have more confidence in the financial performance of our hospitals, that we weren’t leaving money on the table with denials and all that simple stuff. But also, we wanted to take utilization management and move it from just being this clinical thing that we did within care management that had massive financial implications to really being a financial [driver]; we want to live in the financial world and in the clinical world.”
To this end, Melissa has seen a stark difference after helping lead the organization through a CORTEX implementation: staff are “able to really understand the need, and the severity of the patient’s illness and the intensity of services that we’re providing for the patients. And be able to identify them without some clicking of a box. And so, the team really adapted well to that change with CORTEX, and using their clinical knowledge has been super helpful,” said Melissa.
Bror continues, “It is such a shift from checking boxes to going back to drawing from your clinical knowledge, allowing staff to dig into what they know, and that gut feeling. ‘I know this patient needs to be here, but I can’t find a way to prove it,’ so to speak. And so, CORTEX is so different in how that information is delivered and extracted from the clinical chart and it really empowers the nurses in a way that they’ve never seen before… it might be scary to change but trust the process.”