DorlandHealth

Richard Scott

In this inaugural edition of The CM Insider section of Case In Point Weekly—a section that will bring readers face to face with thought leaders across case management settings—we sit down with Marcia Colone, Ph.D., ACM, the director of UCLA Health System’s Care Coordination Department, to talk about her department’s guiding principles and key concepts, including advancing the plan of care and escalation.

Richard Scott: First of all, congratulations on your new role with UCLA Health System. How has your transition been so far?

Marcia Colone: My new role as director of care coordination at UCLA Health System started in May 2008 when I crossed the threshold of the new hospital due to open in June. UCLA Health System is rated by World News and Report as third in the nation. Its reputation is well earned as a world class medical facility. The opening of the long-awaited new building heralded a new beginning for the organization and for me as I began my new role as director.

The Department of Care Coordination was formed in 2005 and experienced many changes in leadership and focus. With nearly 100 staff, comprised of RN case managers, social workers and discharge planners on two hospital campuses, the respective roles were clarified and the vision was renewed upon my arrival.

RS: I understand you have a guiding principle at your organization. Can you talk about this principle and what it means.

How an ED Countered Overuse

Three years ago Dr. Salvatore Vertaramo came up with an idea. As with most emergency departments, we had developed our own list of “frequent flyers.” Dr. Vertaramo, an ED physician, noticed there were in fact two lists of frequent flyers. The first were those who were very ill and frequented the ED related to their illness—for instance, those with congestive heart failure or cancer.

The second group frequented the ED for pain control. Realizing that an ED is not the most appropriate place for anyone to obtain pain control, Dr. Vertaramo came up with a plan to give this group a contract to lessen their narcotic use. Starting off by trying to convince fellow doctors and those in administration that this plan could work, he was met initially with a dose of skepticism. Even if the plan were effective, was it ethical? Was it even legal?

Dr. Vertaramo enlisted the help of our clinical information department to run a list of everyone who had visited the ED at least 10 times in the past year. He scoured every name and checked to see why they had come to the ED. He compared what medications had been administered both in the ED and by prescription for discharge. Equipped with this information, he took it to administration, where they decided that he could trial his idea for six months and see how it worked—provided it was greenlighted by our legal department, our patient advocates, and corporate compliance. The team identified the process for a contract, a referral list of pain and addiction centers, and options for chronic pain management. All contracts were individualized to target specific patients and their problems.