In February 2016, Heather Vega, a Financial Deposits and Receipts coordinator at BlueCross living with diabetes and focal segmental glomerulosclerosis (a chronic kidney disease), felt worse than normal.
Though she’d used an insulin pump since 2011, Heather’s blood sugar was higher than her meter could read, and she couldn’t make it through the work day. After visiting the BlueCross health clinic, she was sent to the emergency room and treated.
About a week after her trip to the ER, she received an unexpected phone call. It was Lee Warren, a clinical team expert and care manager at BlueCross. Heather did not know Lee, and admits to being a bit skeptical of the call.
“When care management called me, it was a little intimidating at first,” she remembers. “I thought, ‘Oh, I’m in trouble now.’ But Lee was very warm and friendly, and just started asking me questions. ‘Hey, Heather, what’s going on? We heard about your trip to the hospital and that you had really high blood sugar.’ He started talking me through my health issues.”
Though a BlueCross employee, Heather is also a BlueCross member. And like many members who are suddenly and unexpectedly hospitalized, she was contacted by a care manager to discuss how she was feeling, any immediate needs she might have, and next steps to help prevent another hospitalization.
“One thing Lee quickly identified was that I was dealing with high stress levels, and stress will affect your blood sugar negatively,” Heather says. “I was very busy at the time working on a major project, so I wasn’t making the best food choices. He started coaching me. ‘Heather, make sure you get enough rest. Here are some stress-reducing techniques,’ and ‘Heather, make sure you’re drinking enough water and eating the right foods.’ He even sent me documentation, and he started following up with me every two weeks.”
“I knew that in two weeks I was going to have another conversation with Lee. That helped me focus.”
A view from an ambulance
As a teenager in Connecticut, Lee watched most kids his age nervously try to score dates or buy their first car. But he had other things on his mind. At age 16, he became an EMT for the local ambulance service.
“We did not have enough adults in town to cover days, so high school students were allowed to man the ‘back of the box’ if we were properly trained,” Lee recalls. “After about a year of training, I had to get a passing score of a 90 or greater on the exam to be certified by the state. My mother was a registered nurse and my father volunteered on the local fire department, so you could say I was born to help others. ”
Now a registered nurse himself, Lee and his family moved to Chattanooga 12 years ago to help care for his mother-in-law, who had leukemia. He came to BlueCross first as a care manager in the BlueCare CHOICES program before moving over to serve members with commercial coverage, including BlueCross employees and their families.
One of the trickiest parts of Lee’s job is connecting with a person and building a sense of trust – all over the phone. Face-to-face discussions aren’t a typical part of Lee’s role.
“I spend a lot of time getting to know the individual and their unique needs,” Lee says. “If you’re reading off a checklist, you don’t get to know the person.”
“When we get started I let them know, this is a rollercoaster,” he adds. “You’re going to have your good days, your bad days, and you’re allowed that. We all have things we need to work on. I’m not going to judge you, I’m just here to help you. And if you don’t have some struggles, I’m going to be a bit worried about you.”
Lee understood Heather’s initial skepticism and hesitance to open up to a stranger on the phone, especially with something as personal as health struggles.
“One way I build trust is getting a lot of laughter, which I really remember with Heather,” he says. “We laughed a lot, and we had the most success by looking at everything with a sense of humor. We can’t all be serious all the time.”
Adds Heather, “Everything we discussed – whether it was dietary habits, timing meals, proper sleep habits, increasing activity, weight loss – was presented in a way that seemed obtainable. He kept giving me little tips, like, ‘Make sure you sync your Fitbit as soon as you get up.’ He had a true interest, and I felt like I had an accountability partner. ”
Though she had a committed support system in place, Heather felt she was stuck on a treadmill. No matter how much effort she made to improve her health, she wasn’t gaining ground.
Heather met with her nephrologist, who said her kidney disease was “life or death” and recommended bariatric surgery. As Heather was gathering information on gastric bypass, discussing her concerns with Lee and preparing herself for the possibility of changing the anatomy of her whole body, she received more bad news.
In November 2016, she learned that her kidneys were failing. Her doctor recommended a fistula – a surgical procedure in the arm that connects an artery to a vein in order to create an access point for dialysis. Heather was devastated.
“My eyes were welling up while the doctor was explaining this to me,” Heather recalls. “I hadn’t researched the actual process of dialysis. Lee called me soon after, and you could tell in his voice that he had received bad news himself.”
Heather went forward with the fistula, and was back to preparing for bariatric surgery. However, this time it would be to help her lose weight in order to accept a kidney, as she was too overweight to accept a kidney transplant. Frustrated and scared, she threw herself into work and stayed focused.
“I remember explaining to my co-workers, ‘When you guys have put in a hard day’s work, you go home, you’re tired and you’re ready to let that day go away – that’s how my day starts,’” she says.
Another ally in the corner
As Heather started preparing for her gastric bypass, Lee passed her case along to Raylene Bechen, a care manager who specializes in bariatric surgery. As Heather had done with Lee, she bonded quickly with Raylene due to a medical procedure that needed to happen quickly: the insertion of a heart catheter.
Heather’s cardiologist would not approve her bariatric surgery until she received the heart catheter, as people who have diabetes are at an increased risk for cardiovascular disease.
“I can’t have my bariatric surgery until I have this heart cath,” Heather says, recalling her frustration. “This heart cath is going to put me straight into dialysis. I’m trying to have the bariatric surgery to keep me from going into dialysis. It was a catch-22.”
Fortunately, Raylene explained that these steps were being taken for her safety and people with kidney disease even at Heather’s level regularly have successful heart catheters that don’t negatively affect the kidneys. She recommended Heather have her nephrologist speak with her cardiologist, ensuring her two doctors were in communication about a plan of care that addressed both her best interests and peace of mind.
“I truly was just a behind-the-scenes partner who provided education and support for Heather,” Raylene says. “In a small way, I empowered her to adapt to her new lifestyle. But the credit goes to her for her commitment and hard work. This was not a quick fix, but a journey. As a nurse it is rewarding to know she has achieved improved health and living her best life.”
A new way of life
Heather moved forward with the heart catheterization on May 29, 2017 and then had bariatric surgery on June 5, 2017. She has lost nearly 130 pounds, no longer requires the insulin pump and feels amazing. She is involved with a BlueCross bariatric support group and feels that dialysis is in her rear-view mirror – “four or five car lengths away,” she says.
She plans to take the graduate management admission test and apply to graduate school to obtain her masters of business administration. She credits her health success to the support she gets from her family – partner Raymond, son Marc, stepdaughter Rosie and rescue pooch Felix – as well as the support from extended family members Lee and Raylene. Her case has since closed.
“I don’t know what I would have done if I didn’t have their expertise, their knowledge, their caring and their sensitivity to my needs and concerns,” Heather says. “They were guardian angels, and they lived by our mission statement. Lee and Raylene truly gave me peace of mind, which put me on the path to better health.”
“There’s a stigma about care management, but no one needs to be intimidated. Care managers are here to help us.”
Heather keeps in touch with Lee and Raylene over email. She recently shared a photo that showed her remarkable weight loss. These success stories and continued relationships warm Lee’s heart.
“I actually hate closing cases down,” he admits. “Of course there’s somebody else who needs assistance, but as anybody who’s worked with me knows, you can always call me, even if the case is no longer open. If I can help you with something, give me a call.”
“I’m here for the person.”