Each year, the BlueCross Pinnacle awards are presented to employees who shine as outstanding examples of our mission and our values.
This year, 93 employees were nominated by their colleagues, and our selection committee narrowed that list to 10 winners (including one team award). One winner was chosen from all the finalists for the highest honor, the 2018 Peace of Mind award.
Here’s who we recently recognized.
Deliver Best Medical Value award: Ian Morris
Ian’s impressive title – bio-statistical research scientist – is more than a designation.
In this claims analysis role, he helps prevent a very small number of providers from skirting medical guidelines and taking advantage of BlueCross while potentially putting members at risk. (An example would be a provider who unnecessarily tests every patient for influenza upon each visit.)
Ian’s background as a pharmacy technician and as an analyst with the Tennessee Department of Safety – interacting directly with patients and focusing on safety – prepared him well for paying attention to the details and spotting outliers.
“It seems like every time Ian reaches his hand into a haystack, he comes out with another needle,” says Charlie Steinhice, reporting and analytics manager. “But the real secret to Ian’s work is he recognizes the implications of that needle and gets the extra information to document what it is. And he engages the people who can do something about it by asking, ‘How do we fix this problem?’ So he takes part in the solution, as well.”
Drive Positive Change award: Mandi LeonhardtIn her efforts to help manage costs for our members, Mandi wouldn’t take no for an answer.
The commercial operations project manager worked tirelessly on our provider recovery initiative, which determined a unified approach to handling provider overpayments and automating some routine processes.
“When she was told this couldn’t happen, Mandi knocked down barriers and brought the right people to the table, from staff level to upper management,” says Cassi Burke, financial transaction manager. “Sometimes the operations and finance teams feel like they’re speaking different languages. Mandi has a way of opening doors for communication, making everyone feel valued and helping them realize we’re all working toward the same goal.”
Collaboration award: Will McCormick
At BlueCross, we strive to keep health care costs down and offer many health care funding arrangements. Shared Savings helps control costs for our commercial self-funded employer groups and the members they represent. We don’t charge any hidden administrative fees for overpayment recoveries – only a percentage of each actual transaction. And we are transparent about the percentage fees we collect – fees we don’t charge unless we obtain claims savings for the groups we partner with.
Will was recognized for his extensive work implementing this program throughout the company, huddling with our underwriting, legal, data management, sales and account management divisions (just to name a few) to identify cost-saving measures.
“Will’s ability to see the big picture is second to none,” says Marty Bonnington, associate product manager. “His vision for Shared Savings, along with his inclusion of different areas of the company, has made the program a huge success.”
Innovation and Agility award: Brandon Cosley
Working behind the scenes, Brandon, a bio-statistical research scientist in our information delivery division, developed a text analytics engine that drastically reduced manual review time for numerous divisions in BlueCross.
And when we say drastic, we mean what collectively took 20 eight-hour work days now takes mere minutes.
“As an example, a single nurse note from our care management data collection software requires several minutes to find and review,” says Leigh McCormack, also a principal bio-statistical research scientist. “If 2,000 notes are reviewed each year, this equates to more than 165 hours of manual review.”
“Brandon’s process allows our nurses to better serve more of our members in a timely fashion. He can bridge the gap between forward-thinking analytics and how it can be a solution for everyday business needs.”
Develop Our People award: Dalton Mook
As a social worker and care manager in the Total Health Management division, Dalton helps ensure members have talented BlueCross representatives working on their behalf.
“Last year, the disease management program was brought in-house, and Dalton realized that we had a large group of nurses who needed to take their case management certification exam in 2018,” says Elenir Hill, case management supervisor at BlueCross. “She’d just passed the exam herself, and being proactive and enjoying training others, saw the opportunity for an internal study group.”
Dalton assisted with the creation of the group and managed it by planning sessions, inviting speakers and gathering materials. As a result, the vast majority of the attendants successfully passed the exam on their first attempt. She continues to lead seven-week study-group periods three times a year.
Demonstrate Operational Excellence award: Lanna Suddeth
As a business analyst with 23 years of experience in our BlueCare Tennessee subsidiary, Lanna has learned how to identify efficiencies to better serve our members.
In 2017, Lanna created a series of reports for our Coordination of Benefits team that grouped many similar claims together.
These reports helped get more claims processed on first pass – we process around 84 percent of claims within a day by our electronic system and require no additional information – and meant that a member would only have to be called by a BlueCross representative one time.
“Lanna will do anything to help anybody, and that includes looking for process improvements that provide peace of mind for our members,” says Stephanie Evans, BlueCare systems supervisor. “She reviews our pending reports daily in order to move them to first pass as quickly as possible.”
This has led Lanna to become a mentor to peers on her team, as well as people in other areas, training them how to run more efficient queries.
Exceptional Service award: Loretta Moore-Moravian
As a transition care nurse, Loretta meets members in the hospital to assist in their discharge needs and collaborates with our partners to develop a safe discharge plan. She often works with individuals who are homeless, who have no family support or who don’t know where to turn to for services. Upon discharge, members often have continuation of case management with referrals to other population health case managers.For one such member in need, Loretta’s involvement resulted in a lifesaving experience.
“Loretta assisted with discharge planning for a member who required an urgent tracheostomy placement,” recalls Cheryl Murphy, director of clinical effectiveness. “The surgery was successful, but the member had limited support to assist with his post-op care. His caregiver was his 18-year-old daughter. Can you imagine your 18-year-old taking care of you after major surgery?”
Upon learning that the hospital was planning to discharge the member two days after surgery, Loretta contacted the hospital case manager and questioned if the member or his daughter had been trained on proper caregiving techniques and durable medical equipment. They had not.
“Loretta was able to delay the member’s discharge to ensure proper training,” Cheryl says. “She also made an urgent referral to have a respiratory therapist assess the member’s understanding of care and equipment.”
“Loretta’s tenacity and advocacy likely saved this man’s life, and helped him transition back home comfortably.”
Integrity and Trust Always award: Tabitha Miller
As many on the BlueCross behavioral health team will tell you, Tabitha, a clinical manager, not only talks the talk, she walks the walk.
An unfortunate reality of substance abuse is the presence of predatory treatment facilities. Tabitha was crucial in identifying out-of-state facilities that took advantage of some of our marginalized and often vulnerable members with substance abuse issues.
“Tabitha is passionate about our members and being a good steward of BlueCross resources,” says Adam Kilgore, case management supervisor. “She worked with other departments to identify several instances of members allegedly residing at the same vacant lot address. She then kept investigating and finding more and more potentially fraudulent behaviors. She has fought tirelessly for protections for BlueCross as well as our members.”
Team award: Brandon Cosley, Ashleigh Drain, Shannon Dunn, Dustin Knight, Jennifer Peggram, Patricia Reid
They call themselves the Gapbusters. Their mission? To reduce gaps in care – disparities between health care needs and medical services received – through the use of the MyBlueTN app. The app informs members of recommended preventive screenings and tests, prompts them to schedule screenings, and is refreshed monthly to keep track of received care.
The team – made up of employees from the Information Delivery and Quality and Performance Improvement divisions – used the Ghostbusters as their inspiration, pitching their project to BlueCross executives while wearing matching uniforms and proton packs.
“Each individual team member is very innovative, creative and forward thinking,” says Patty Howard, quality improvement manager. “At heart, each one is also driven by, ‘What can I do to make the member experience better?’ They found common ground in empowering our members to be proactive, close gaps in care and improve their health, resulting in a very effective tool.”
Peace of Mind award: Marie Lawson
While the opioid crisis continues to have a profound effect on Tennesseans – the state ranks third in the nation for prescribing and fourth for overdose deaths related to prescription opioids – Marie, a population health medical manager, tackled one aspect of the epidemic head-on.
Seeing the need for support for the large number of women in East Tennessee who become pregnant while addicted to opioids, she oversaw the development of family-centered coordinated services to optimize outcomes for babies born with neonatal abstinence syndrome (NAS). Her goal was to educate members taking opioids on how the drugs could impact the pregnancy.
“During the past year, Marie has been a champion of change for our members who are suffering from the opioid crisis,” says Cheryl Murphy. “She developed an intensive case management program using a multi-disciplinary, person-centered team approach for expectant mothers at risk for NAS delivery, during the postpartum period and throughout the first year of life.”
“Marie has a passion for getting these members the right care without having to contact multiple agencies.”
“She worked very closely with Governor Haslam’s Children’s Cabinet on this initiative. We have already seen favorable outcomes for members who are engaged in the program.”
These efforts just go to show Marie’s devotion to our members and our mission to provide peace of mind through better health. The result was recognition with our highest employee honor, the Peace of Mind award.
“Marie has demonstrated model leadership behavior as evidenced by her self-motivation, self-direction, initiative, accountability and innovative thinking,” Cheryl says. “She has an unrelenting desire for mutual success for our company and for our members.”