September 18, 2023 • 46 mins
In this Rebroadcast episode, ADJUSTED welcomes Mollie Kallen, President and CEO of MKCM National Case Management. Mollie shares her insights about the differences between good case management and great case management!
Season 6 is brought to you by Berkley Industrial Comp. This episode is hosted by Greg Hamlin and guest co-host Paloma Duncan, Senior Catastrophic RESOLUTION specialist at Berkley Industrial Comp.
Visit the Berkley Industrial Comp blog for more!
Got questions? Send them to marketing@berkindcomp.com
For music inquiries, contact Cameron Runyan at camrunyan9@gmail.com
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Greg Hamlin (00:12):
Hello everybody and welcome to adjusted. I am your
host Greg Hanlon coming at youfrom beautiful Birmingham,
Alabama, and Berkley industrialcalm and I'm excited to share
with you this rebroadcast wherewe talk about Nurse Case
Management with my good friendMolly Kaelin one of the things
that is so impactful for claimsis having boots on the ground.
(00:35):
And having done an adjuster, Ican remember how much I relied
on strong Nurse Case Management.
And so in this episode, we spentsome time exploring what that
looks like what the role lookslike, how that coordinates with
the adjuster and what reallymakes for an effective Nurse
Case Management Program. So Ihope that you'll enjoy this one
(00:56):
as much as I have. And again,just thank Molly for her time
and spending it with me on thisepisode. Enjoy. Welcome
everybody to adjusted a workerscompensation claims podcast. I'm
your host Greg Hamlin coming atyou from beautiful Birmingham,
(01:38):
Alabama and Berkeley industrialcomp. And with me is my special
co host for the day. Hello,Paloma Duncan.
Mollie Kallen (02:05):
I will talk about my journey a little bit, but
I'll just share with you now. Somy company is MK cm, as Greg
mentioned, and we're a nationalcase manager coming over 500
case managers across thecountry. And I have a passion
(02:27):
for what I do. I have a passionfor a lot of different issues
that are going on in ourindustry that we'll talk further
about, and my backgrounds ineducation. So I love these kinds
of formats and talking to peopleand also learning from others.
So thanks so much for thisopportunity, Greg?
Greg Hamlin (02:44):
Well, we are certainly glad to have you. The
topic for today is effectiveNurse Case Management. And so
that's one of the reasons wewant to have Molly here and why
I want to plomo to co host withme today because it's a huge
piece of what we do in workerscompensation in helping our
injured workers return to workand get back to where they were
prior to the injury. But Molly,the question I always like to
(03:06):
start with is when did you knowthat workers compensation was
going to be your colleague youjokingly said when I was five I
knew. So I want to know thetruth is that is that is that
when the light bulb momenthappened, you're like, Yes, this
is my thing. Oh, yeah, no,
Mollie Kallen (03:21):
totally not. And I was joking. So what I always
tell people when I speak acrossthe country is nobody graduates
high school or college and says,I'm gonna go into workers comp,
that is never usually thejourney, the journey usually is
very indirectly, you go into onearea, and you're pulled into
workers comp, from a variety ofdifferent areas. So same kind of
thing for me. I didn't know whata case manager is, or was a lot
(03:45):
of people still don't know whatcase managers are what we do. We
were kind of like the unsungheroes, sometimes of this
industry. When I was out theredoing appointments, people would
stop me and say, Are you apharmaceutical? Rep. Are you an
attorney? You know, I mean,nobody really understands this,
and that's one of my beefs isthat I think, really, in nursing
school, and rehab, casemanagement or rehab programs, we
(04:06):
really need to be talking aboutalternative careers. Whenever I
see nurses in the hospitaloutpatient, I've always talked
to them and educating them,because I think a lot of people
don't even know what this is.
But just to kind of back it up.
For me. My bachelor's was anelementary ed. So in another
lifetime, I was an elementaryschool teacher, and I loved it.
I was making $18,000 a year witha master's degree. And I was
(04:27):
kind of like, you know, I lovekids. But I can't survive this
way. And what happened was, Igot into counseling, my Master's
in Counseling. I wanted to be aschool psychologist, but then I
realized that schoolpsychologists are not really
doing counseling, they're doinga lot of testing, which was not
what I want. I want moreclinical peace, right. So then
what happened was I got a job ina psych practice doing
(04:49):
counseling for injured workers.
So that was kind of my firstexposure to this population. And
I really enjoyed that. And thenI saw an ad in a paper and
ironically as a case manager orI mean, as a vocational person,
I always would tell people, younever get jobs through the
paper, you know, it's alwaysthrough talking to people, PS I
kind of kind of started in thiscareer from an ad in the paper.
Right? Right. So I answered anad in the paper from Infracore
(05:13):
Inchicore. It was the very firstcase management company was
owned by Cigna. And they werethe very first ones to ever come
up with this career and paypeople. They were the first ones
to use computers. I was rockinga car, Greg, blue Mercury Topaz
that they go, Wow. And I thoughtI was like the bomb, I was
(05:35):
driving through, you know, Ohio,where I'm from. And this car by
gas was paid for. I'm like, thisis a great gig. I love this. And
I didn't even know what it was.
And I just found my passion. Ilove talking to doctors, injured
workers, adjusters and kind ofbeing that middle person. So to
answer your question, I fellinto this position, which is
(05:56):
like what a lot of people do inour industry, and I just really
loved it. And everything justkind of grew. In fact, owning a
company was not even in theplan. I had worked for all the
big companies, I worked forInchicore. Then I worked at core
bow, and then Gen X. And then Istarted my company, it was never
a grand design to like have abig case management company,
people would offer me positions,ironically, to be a supervisor
(06:19):
of case managers. And I waslike, why would I do that case
managers are just kind ofstrange people. You know, they
they are just not the easiestpeople sometimes to do. So why
would I want to supervise themPS again, here I am supervising
500 people. So life takes youand very strange twists and
turns. But I'm just so happythat it took me here. It clearly
(06:40):
wasn't a design at all.
Greg Hamlin (06:41):
That's awesome.
Well, I can totally relate towhat you were saying about
education, you know, and in thatsmall check, you wanted to help
people. You know, I, you saidyou love kids. I love kids.
Obviously, we have six. But Istarted not for profit, too. So
well. It was a little differentthan education, but not for
profit fundraising. And Irealized pretty quickly that
(07:03):
that wasn't going to work if Iwanted to have the amount of
children that I have now. Sohere we are. But I think most
people fall into this industryas well. Paloma, I assume that's
the same for you.
Paloma Duncan (07:17):
Yes, yes, it was for sure. It was that job fair.
And same thing that youexperienced at Indiana
University where you were justwalking around not knowing what
you were going to do. And thenthere was Liberty Mutual and
name? Yeah, I started.
Mollie Kallen (07:30):
Yeah, I think it's something that is just so
common in our industry. But Ithink we need to do a bit of a
better job. Because especiallynow with what's going on with
COVID. And everything, we haveto really work at not just
attracting the best people inour industry. But really
retaining them is a big issuefor me as well, too. We can talk
more about it later.
Greg Hamlin (07:50):
So for you, you talked a little bit about
starting your own company, whatmotivated you to start your own
company? That's obviously a hugerisk. Scary Thing for lots of
people, right? I'm sure it'salso very rewarding in other
ways. But talk to us a littlebit about like, how did you
decide that? Okay, I'm gonna dothis.
Mollie Kallen (08:10):
Yeah. And again, it wasn't kind of a design, it
was just what happened was Iafter working for all the big
three companies, I decided Ikind of wanted to get on my own
for a couple different reasons.
I wanted to kind of bypass allthat political layers,
incentivizing case managers toBill, you know, doing things all
about billing, you know, I wasso not about that. It's about
really just providing a qualityservice, cutting out that
(08:30):
middleman, and just really doinggood work. So I was gonna go on
my own, which I did, and I wasout of my home office, just me,
myself and I, and working. Andthen what would happen was is
companies were like, well, yeah,we really like you. Is there
another version of you in Ohio?
Or is there another version ofyou in Texas? And what did I do,
(08:52):
I would Google and connected andI grew a network, again, very
organically, a network of casemanagers. And I decided that I
wanted to differentiate mycompany from others. And the
main differentiator is that Ionly use veteran case managers.
So I went to people who werelike myself, who have a minimum
seven to 10 years of experience.
And actually our average is 20years and company, because I
(09:14):
wanted people had a footprint. Ifeel that it really makes a
difference. Listen, I was agreen case manager. I made great
mistakes. My favorite one was Icomplained to a doctor, people
let me go for about 10 minutesabout the office manager. Oh,
she's horrible. She neverreturns my phone call. She never
returns my emails. Oh, my God,man, like went on for 10
minutes. And who was she? Hiswife? Yeah, well. Insert foot,
(09:35):
right. Yeah. So I mean, I'vemade all the green mistakes. And
yes, and it's important. We allmake mistakes. I still make
mistakes. But I wanted peoplewho were beyond that. I wanted
people who know what they'redoing. They have relationships
because it's really all aboutwho you know, in life in
general. So that's how we getgood results. We don't keep out
(09:56):
so So again, it was kind of anorgan And next thing, I started
to amass this list ofexperienced case managers, and I
just kind of grew. So again, itwasn't like a purposeful thing,
it just kind of grew and grew.
And, and I just love what I do,I love working with these case
managers are very much apartner, you know, and I think
(10:16):
they lose out in other companiestoo, because they usually have
somebody who's supervising themwho's never walked the walk or
talk the talk. And I've beenthere, I've been in an office
with a doctor who was grouchyand was just nasty, you know,
I've been with a belligerent,you know, injured worker, so I
get it, I get how hard our jobis, it's really hard job. It's
all about boundaries, you know,we get pulled in lots of
(10:38):
different directions. So thatfuels me every day and making a
difference in people's lives.
And I think we forget that, thatwe really do make a difference.
People are at a very vulnerablepoint when we're working with
them, right? I mean, they'redealing with injuries, they're
dealing with their their lives,economic loss, pain, you know,
not understanding the medicalsystem, you know, not
understanding what the doctorjust said to them, you know, so
(10:59):
our job is to really break allthat down and educate them and
really help them through. Soit's been a real gratifying
journey. That's for sure.
Greg Hamlin (11:08):
That's awesome. So one of the things that I wanted
to know a little bit more aboutwas, you know, you've been doing
this for a long time, you talkedabout the importance of
experience and havingexperienced nurses, maybe for
those who haven't had as muchexposure to what a case manager
or nurse case manager can do.
Talk to us a little bit aboutwhat their role is, if you're
(11:30):
having an onsite nurse casemanager in a workers
compensation injury?
Mollie Kallen (11:36):
Yeah, absolutely.
I do. One of my talks is casemanagement one on one again,
because a lot of people don'tknow, I have whole slide about
what we can do what we can't do.
And so the way I describe itinitially, is remember those
Venn diagrams we had in school,you know, we're I use the Venn
diagrams to kind of describe allthe different players on the
team members, right? You've gotgestures, you've got risk
managers, you've got providers,you've got attorneys, you know,
(11:59):
all those people. And then inthe middle of the wheel, you've
got the injured worker, they'rethe most crucial team member.
And lots of times we lose sightof that, you know, it's so
important that you have empathythat you have trust, that you
have that education piece, sothey feel empowered. So our job
is a case manager, if you stillvisualize that circle that I was
(12:19):
talking about, we are kind oflike the person that intersects
between all those different teammembers, between the injured
worker, the doctor, you know,the providers, the physical
therapists, the MRI, you know,all those people, the attorneys,
everybody who's on that team,the risk manager, we are the
connector, because many timesyou guys know, being in the
(12:39):
business, the right hand is notthe left hands doing. You see
that a lot with the physicians,especially if it's multiple
providers, you know, you got aphysiatrist you gotta pay
management, you got an ortho?
Well, these doctors, it stillboggles my mind, they don't
communicate, they don'tcommunicate on any level, they
don't communicate on medication,they don't communicate on
treatment, therapies, all thatstuff, DME, you know, so our job
(13:00):
is to make sure that everybody'saware of what's going on. And
that the case is moving in apositive direction, that the
injured worker is getting whatthey need, that they're, you
know, getting the best care,that we're also trying to
contain the client, not lettingit bleed out unnecessarily to
providers as a need to go to,for example, doctors tend to
(13:21):
always, you know, refer out youryour ortho, I tell them, you
know, they want to cut you, butthey don't want to cut you. And
if I don't want to cut you, I'mgonna send you to pain
management. Well, there might beother things to do, why go to
these steps. So our job is casemanagers to present alternatives
respectfully to the physicians,and to update everybody, all the
stakeholders about what's goingon, to help move the claim to a
(13:42):
positive resolution. That's mydefinition.
Greg Hamlin (13:47):
That's fantastic.
So Paloma, I know you've had alot of experience when it comes
to handling difficult claims.
Talk to us a little bit abouthow nurses have helped you and
what you're doing on your moredifficult claims.
Paloma Duncan (14:01):
Sure. So it's always nice to have eyes and
ears on somebody that you speakto you read the medical reports,
but you don't really pick up onthose nonverbal mannerisms and
things that you might see. Sothat information is always
crucial for us, when we'reseeing somebody that's not
recovering, maybe they are stillsmoking and they you know,
(14:21):
record that they're not smoking,those simple things that they
can pick up on that we can't wedon't see them. That is crucial
for us, along with kind of justgetting that judgment feeling of
you know, I have concerns thatthis, you know, maybe a
malingering patient or you know,I'm really concerned with the
treatment plan here. The doctorsnot looking at what I'm telling
(14:42):
him is concerning maybe we needto redirect care. So those
situations I feel are veryhelpful to have an an on site
nurse attend the appointmentsand like you said, educate the
patients and give themreassurance on what they're to
be doing once they leave thedoctor's office, right because a
lot of times you The doctor justwrites the note and doesn't
maybe verbalize, you should notbe doing this, that or the
(15:04):
other. And this is what you needto do. But the instructions and
language barriers, I'm bilingualin Spanish. And so I know you
have a lot of bilingual nurses,that is amazing. You can see a
huge impact on any file that hasa bilingual nurse, because the
communication barrier can behuge, not only language,
education, culture, all of thosethings make a huge difference if
(15:26):
you understand where they'recoming from and what kind of
guidance they might need. So
Mollie Kallen (15:30):
I can piggyback to Greg I mean, everything a
plumber said, I agree there'sdifferent types of case
management for those of thepeople are listening might not
be as sophisticated. No, there'stelephonic case management,
where we're just kind ofcoordinating everything on the
case telephonically. And thenthere's field that Paloma
mentioned, obviously, she'shandling catastrophic cases, do
case management usually startsvery early on, we get a call.
And what we're doing is like, assoon as we hang up the phone,
(15:52):
we're calling the hospitals,either even their teeth of going
into surgery, I'm verytransparent, and how we operate
our business. So we're all aboutcost containment and ROI for our
customers. So if someone's goinginto surgery, right, pull them
out, you're not going to want tostay out of the hospital, just
hanging out in the hallway.
Medical for you, right and getyou information. By the way, we
still get medicals, but 80% ofthe time, we still are able to
get medicals on the phone stillboggles my mind. But we do. And
(16:14):
then we go out. And we're youknow, that's where it's a really
key role. And we take it veryseriously because we represent
the employer and the insurancecompany to a family who is
dealing with a catastrophicsituation. Understand the
medical, they don't understandwhat's going to happen to their
lives, their loved one is maybethey're on event or who knows
and ICU. And we come in therephysically to do a couple
(16:38):
things, one to kind of reviewthe medicals and send you guys
over medical as we can to tokind of triage the case with the
providers and see how long thisis workers going to be there for
diagnosis prognosis, are theygoing to rehab? Are they going
home? Do we need dem ease andthree, which is really key,
which Paula mentioned wasemotional support. Ya know,
people care about you, you're ina system that you might not
(16:59):
understand. Let us help younavigate through that system.
And we're going to be with youthrough this process to make
sure you get the best care andcoordinate everything for you.
And that's really, reallyimportant because that trust
building that I talked aboutstarts right then because these
people are mistrusting, theydon't understand what's going
on. They're confused, they'reafraid. And we got to come in
(17:20):
there and kind of help that. Socatastrophic case management,
again, once we're out of thehospital, that's a really
different kind of a skill. Ialways call it like the plate
spinners. You know, you gottaYeah, it's a catastrophic case
manager. It's a whole differentlevel than regular case manager,
because you have got to bedealing with like 10 spinning
plates at the same time, becauseyou're dealing with vendors for
(17:41):
tmes, and home modifications,and physiatrist orthopedist, and
neurosurgeons and you'recoordinating all that care,
transportation, home health. Sothat's a whole different thing.
But like you mentioned, for thefew case management, eyes and
ears, right, we see how theinter Walker walks in, we see
how they walk out, we see whenthe doctor bends over, the
doctor is rolling his eyes.
(18:03):
That's really huge information.
That's not going to be an email,you know, that's a
Greg Hamlin (18:08):
it's not going to be in the medical report.
Mollie Kallen (18:10):
Yeah, no way. I rolled my eyes when Johnny bent
over Oh, my God, not this depo.
Here we come, you know. But alsolooking at the job. You know,
we'd love to get jobdescriptions and review those
with the doctors and injuredworkers. That's key making each
Yep. Well, I
Greg Hamlin (18:26):
can't tell you how many times I've had an injured
worker when I was an adjuster.
They go to the doctor'sappointment. If there's nobody
there, they'd say, Well, isthere modified duty? And that
guy would say no, there's nomodified duty. But there was
right? No one ever was there tosay, Well, wait a minute, what
are his restrictions? And whatcan he do? And can we work with
the employer and let me helpcoordinate that so that he's not
just sitting on the sidelines?
(18:47):
And I think that's a huge thingthat nurses can do that adds so
much value? Absolutely. Theother thing I've seen is
sometimes the doctors, they areso busy, they have so many
things going on, they're goingfrom thing to thing to thing. So
Paloma might write the doctor aletter, but he might not look at
it for a week. Oh, my God, no,do weeks, you know, and they
(19:08):
might be really good questionsor information we want him to
discuss. But we don't have a wayto have that dialogue. Because
if we call we're not going toget them on the phone most of
the time. There's a couple ofdoctors who will do that. But
most do not. But sometimes thenurses can have those
discussions.
Mollie Kallen (19:23):
Yeah. And you just brought to a really good
point that was going to read mymind. So one of the key things
that we do as case managers andI think it's the most
efficacious is Doctorconferences, one on one sitting
across the table from a doctorwith those questions that maybe
Paloma had with the injuredworker not being there. And we
have the undivided attention ofthe doctor. And we could bring
(19:44):
old medicals or whatever and sitacross the table from him and
have him respond and payattention to what we're doing.
And again, that experience comesinto play. I'm an experienced
case manager. I can pull Dr.
Smith aside say Dr. Smith,really, don't you think it's
about time then, you know, theJohnny kind of go back to work.
So you can have those kinds ofconversations informally, that
really impact a case. But if youweren't experienced and had a
(20:07):
relationship with that, doctor,there's no way that you could do
that.
Greg Hamlin (20:11):
That's an excellent point. So Paloma, maybe I want
to ask you this and then havemaybe Molly chime in, out of
curiosity. So when you've hadnurses on files, you've been
doing this for 15 years plussomething like that. So when
you've had nurses on files,there's good ones, and there's
great ones, what's thedifference for you? When you
say, Well, that was a goodnurse? Or that nurse was
(20:33):
amazing? What's the difference?
Paloma Duncan (20:35):
Yeah, relationships are everything
right? I feel like once youestablish that relationship and
trust with an injured worker,you see things move smoothly,
and resolve and have a goodresult because they trust that
you are guiding them in theright direction. So I think just
establishing those goodrelationships early on, and
communication are definitely twoof the big things that I've
(20:56):
noticed with nurse casemanagers, and then coming to me
and making sure that what theirplan is, is what I'm thinking as
well. So that we work togetherand establish a goal that
results in a return to work, youknow, maximum improvement, those
goals that we have, and in thetimeframes that we're looking
at. And if they're not there,then addressing the setbacks
together, I think is veryimportant for an amazing nurse
(21:18):
case manager or, you know,having those conversations like
Molly had mentioned with thedoctor having those conferences,
saying, you know, maybe we needto check some blood work or have
some of this done that he's thathealing, you know, aren't you
concerned that there might besomething else going on here?
Those those things that they canpick up on and communicate with
the doctor, effectively and withmyself, I find to be very
(21:38):
amazing nurse case managers thatdo that.
Mollie Kallen (21:41):
I'll jump in.
Yeah, go for it. You know, I'mshy. I'm writing notes furiously
as well as talking. So beingproactive versus reactive. II,
anticipating things like me, asa case manager, I would call
that adjuster and employer afterdocument said, Hey, Dr. Smith's
talking about pain management,if things don't get better,
let's see what we can do aboutthis. So looking ahead, thinking
outside of the box, I had a caseonce were there keeping somebody
(22:06):
in the hospital over the weekendfor a knee Walker, because they
couldn't find a knee Walker,what did I do? I googled one 800
Knee Walker found somebody gotthe knee Walker got him out
again, thinking outside the boxwith the approval of the
employer. Next thing we alwaysdo a lot in our company. I think
we've lost the art of phonecalling in our industry and a
lot of industries. Emails aregreat. Gotta love. However,
(22:27):
nothing makes me crazier, right?
Because it's encrypted emailsgoing back and forth about the
same issue a, b, we everything'sdiscoverable. So if there's
something sensitive, it shouldnot be in an email. So we're,
we're big believers in roundtabling cases, you know, we'll
suggest it or a casserolesuggested, hey, you know what,
we think we need to geteverybody on the call for five
(22:48):
minutes, 10 minutes, and reallykind of look at this case, come
up with a plan, and then goforward. So that
Greg Hamlin (22:55):
I love that Molly.
And I say I just had one comeacross my desk this morning,
where there was an ad, this isnot on the nurse case manager
side. But there was an agent andinsured that had been sending
emails back and forth with anadjuster. And then they felt
like they weren't gettinganswers. And I finally just
talked to the adjusters that,hey, we just need to make a
phone call pick up the phone.
Let's have a phone call here.
Because I think this can all getsorted out in five minutes. If
(23:17):
we just talk to each other 100%Do you think this is going to be
a new challenge? I do think thisisn't going away. Because I look
at my kids and the most recentcollege hires, and they do this
I can't people can't stop ifyou're just on their phones
texting all the time. They donot call their friends they text
their friends. Yeah. And so arethey snap their friends or
(23:38):
whatever the word, you know,whatever the the cool kids are
doing now, but it's not it's notcolleague. And so I remember
when I onboard a new adjuster,it's probably been four or five
years ago, they had sent threeemails sent to faxes, and it had
been a month and they hadn'tgotten an answer. And I said,
did you have you? Have you triedcalling? And they're like, Well,
no, it makes me insane. Yeah.
(23:59):
But they're kind of petrified topick up the phone. So that's
something that I've had to workon with with some of them. And
they come with different skillsets that are wonderful in other
ways. But that is a spot thathas changed. And I think you're
right, especially when you'retalking about doctors who may be
in their 50s and 60s. They'renot doing that. Yep.
Mollie Kallen (24:17):
Well, I we task our case managers when they
first get a case, not just toreach out to all the
stakeholders by email, butthey've got to do it by phone.
And I hold them to that, youknow, did you call Susie Did you
call you know, because again,emails are great, but you know,
maybe that adjuster found out akernel of information on this
injured worker that they don'twant to put in writing, but it's
important for us to know as casemanagers so Oh, totally agree
(24:39):
with you. I totally agree. Andthen the other thing is I was
gonna mention too is good mediaupdate. That's what I got
distinguishes a good case here.
Like look, you guys can all readdoctor's notes. We can all read
plenty notes. We do not need toregurgitate information for you
guys, right? You want to knowsubjective objective barriers
return to work, you know, MMIand we work really hard our
company And we've come up with atemplate that we're starting to
(25:01):
roll out about standardizingupdates, because God bless all
my case managers, they all writethese long. I'm sure you've seen
the right paragraph, and I lookat them and already my eyes
start to glaze over, like, Oh,God, how can I read this? Give
me the meat, potatoes, you knowwhat's going on? So we're
constantly talking to ournurses, but they're in our case
managers, but they're so used tocharting and hospitals, right,
(25:22):
and they can just write whateverand a lot of times, so we're
trying to streamline thatinformation. And then also
responsiveness is key, like yousaid, communicating. If you guys
ask a question, we give them 24hours to answer they got an
appointment, they have 24 hoursto update. You know, if we treat
telephonic just like field, Idon't care if you're handling
how telephonically they went toa doctor's appointment within 24
(25:44):
hours, you call that doctor,that injured worker you get as
much as you can. So I have neverunderstood how this should just
be normal. You know, I mean, Idon't understand there's a lot
of companies out there that'slike, oh, yeah, you know, a
nurse didn't show up. What doyou mean, a nurse didn't show
up? You know,
Greg Hamlin (25:59):
that's a huge deal.
And it's yeah, it can be a hugedeal if you're counting on it,
if we're counting on it, becauseyou know, we can't be there. So
when you think about some of thechallenges that you have in
Nurse Case, management,obviously, there's probably some
unique ones involved. I canthink of a few. But I figure you
have you have your list as well.
I know that one challenge. Imean, this just comes to the top
(26:21):
of my mind is epic. There's somany states and every state has
their own rules on what you canand can't do. And I imagine
that's something that you got tojuggle on your end, what are
some of the other things thatyou see?
Mollie Kallen (26:31):
Yeah, and that's a challenge, because rulings and
laws are always changing, youknow, so we always try to stay
on top of that, that'sdefinitely challenging
boundaries is an issue. It'svery hard as a case manager, and
I kind of alluded to it before,we feel like sometimes we're
pushed and pulled in lots ofdifferent directions, octagon
about that circle, all thedifferent stakeholders, well,
(26:51):
they might not all have the samegoal, you know, the injured
workers goal might be to stayout of work, but nobody else's
goal is to get them back, orvice versa. Our job is to kind
of do what's ethically correctfor everybody, but also kind of
like manage the claim. So we'regetting good outcomes. So lots
of times you feel you're beingpushed and pulled and our case
managers sometimes because theyespecially with the cat cases
(27:12):
that Paloma handles, you getvery connected to these injured
workers and their families. Soyou have to walk a fine line and
not become overly connected,that you have to maintain that
objectivity. Because we at theend of the day, we're
professionals, we have a job todo, and we can't be pushed and
pulled by even the familymembers, you know, we want to do
(27:33):
what's best. But you know, yourfamily member might want a hot
tub being built in their home.
And that might not be medicallynecessary or right now
financially efficacious foranybody to do. So you know, you
have to kind of walk that fineline. And we're we're very
careful about that. We'relooking at emails, we're looking
at reports. And you can kind ofsee when it starts to veer. And
we that's when we kind ofintercede again, being proactive
(27:54):
versus reactive. If there's aproblem, you just jump on it.
And if we have to transfer file,we will we hate to do that.
Sometimes it's the converse,sometimes the personalities
don't get along at all, whetherit's a case manager, an injured
worker, the case manager, thedoctor, case manager and the
adjuster, you know, so we'redealing with people and I always
tell customers and potentialcustomers that we're going to
make mistakes, we're humanthings are gonna happen, but
(28:16):
we're going to own it and try tofix it and learn from it. So
boundaries is a big deal. Likefor example, like I said,
They'll ask us sometimes to takevideo to doctors, we can't get
involved in surveillancesurveillance issues, we can't
have an email, we can verbalizeto a doctor, Hey, did you see
that video that Paloma sent onmy blog. But we can't get
involved with that we haveethics that we have to maintain
(28:38):
as case managers. We can't getinvolved in anything that's
adjusting or surveillance wise,or any of that kind of stuff
either, like, Hey, I didn't getmy check paid. You know, help me
with that. I'm always tellingcase managers, that's not our
job, you need to start to theadjuster.
Greg Hamlin (28:53):
Know, and those are fantastic points. I think, you
know, there's a real move rightnow to claims advocacy, which I
love the concept behind it. Andwe've kind of done our own twist
on that calling an empatheticresolution model. And the main
reason for that my big concernwith the word advocacy is who
are you advocating for? Right?
There are a lot of peopleinvolved in this. There's the
(29:13):
insured the actual employer whopaid a premium to the carrier.
There's, you know, thestakeholders of the carrier,
there's the injured worker whoneeds the right treatment.
There, you know, the list isreally long of all the people
involved. So if I'm advocatingfor the injured worker without
thinking about how it connectsto everything else, going back
(29:34):
to your thing about boundaries,that's challenging. So trying to
find that balance, I think ishard. woma Have you have you
noticed that some in yourexperience on the claim side?
Paloma Duncan (29:46):
Yes, yes, most definitely. And you know,
there's a saying that, you know,a nurse, a nurse has heart so
they have a lot of compassion.
And so I can see how that can bechallenging. So once you're
meeting with these peopleregularly, they have multiple
appointments throughout theweek, then The wife is there you
see their children like youdevelop a bond. But then again,
you kind of have to step back.
(30:07):
And remember, what am I here forwhat are you know, objectively,
you can have that relationshipwith them, which I think is
crucial for them to be able totrust. And you know, that is
all, you know, empathetic. I'mall about that, I believe in
that strongly. But then also,like Greg said, remind remember
the stakeholders and everybodyinvolved and what the big
picture is, overall.
Mollie Kallen (30:27):
Yeah, I talk a lot about social determinants of
health. And I think it's andagain, that's like echoing what
Greg said, the movement in ourindustry right now is empathy,
holistic approach to claims andto injured workers. I think
that's really important, too.
And when you do that, itdefinitely affects the bottom
line. Oh, yeah. We all have tobe aware of the bottom line, we
get that. And I think, though,you know, we've lived in a world
where we've kind of like been inpods in our industry, you know,
(30:48):
you get the adjuster pod, yougot the we're all a family.
We're all right, as we all are ateam and that injured worker
cannot be forgotten. Everybody,you know, thinks, oh, they're
malingering when the statistics10% or less is really, you know,
but that 10% takes up 90% ofyour time we get that. But you
know, not everyone's a player,and most people aren't. And
(31:09):
you're right, yeah, it's to lookat the most Listen, as we were
brought up as case managers,I've talked about this before,
we were told, Don't ever askquestions about their family
life, don't ever ask questionsabout how they're feeling. Stay
out of all that somebody that isthe way we were raised in
industry. So a lot of your casemanagers they know to stay out
of there, they don't want to godown that road, well, we need to
go down that road, because thatroad, affects pain, affects
(31:32):
recovery, affects return towork, you know, affects
compliance, going to therapy,going to doctor's appointments.
So we as case managers need tokind of open our view, and
realize, you know, what, we haveto help them find resources in
their community that could helpthem What if they're having
trouble with food, you know, inthe house, or childcare, to
(31:52):
enable them to go to therapy ora doctor's appointment? So we
need to kind of open our horizona little bit and realize that,
you know, we really do need tokind of address those things.
And it's not dangerous, doingthose things, is dangerous, not
doing those things. It's a wholedifferent paradigm shift than
what we've been taught before.
Greg Hamlin (32:09):
Yeah, I think you're right, I think it's
thinking about the big picture.
And then communication, what yousaid earlier, communicate,
communicate, communicate, we'vegot to be talking to come up
with solutions will ultimatelythe best, the best result is
they get healthy, they get backto work, and the employer has
some back on their workforce,and everybody gets to move
forward. But you know, if wedon't address all the reasons
(32:30):
and obstacles that could bethere, and we might find
ourselves right, fighting oversomething that in the end puts
us in a much worse spot?
Mollie Kallen (32:39):
Absolutely.
Nobody, you know, you want todecrease legal, you want to
decrease psych, you want todecrease pain management, you
know, medications. So how do youdo that? By keeping that
connection with your injuredworker and making them feel
empowered? You know, people feeldisenfranchised, that's when
they're like, oh, you know, Idon't really know, how many
times do we hear from injuredworkers? I never hear from my
employer. They don't care aboutme, you know, so that it's the
(33:01):
littlest thing, right? Thatmotivates somebody to be non
compliant or to hire anattorney. And once you go down
that slope, that's, it's veryhard to relocate
Greg Hamlin (33:13):
spectrum. Trust is hard to rebuild once you lose
it. 100%. And that's kind ofgoes for all parts of life. I
think. So. Yeah. So we've talkeda little bit about empathy. And
we've talked a lot about yourcompany. I know you mentioned
that. One of the big differencesfor your company opposed to some
of the others that are out thereis the seven to 10 years of
(33:36):
experience, what do you feellike are some of the other
differentiators when you decidedI'm going to create my own
company? I wanted to look likethis because I think I have that
with my team. Like, when Ibecame a vice president of a
Claims Department. Those werethe things in my mind, like,
what did I want this to looklike? Why are we going to be
different than our competitors?
And how is that going to besomething that's an advantage as
(33:56):
we're competing in themarketplace?
Mollie Kallen (34:00):
Yeah, three, three main things. So one of the
experiences, we talked abouthaving the footprint, that's
huge. That's, to me, the keydifferentiator enabled us to you
know, not keep files open aslong and by the way, we don't
incentivize case managersdevelop, like in the companies I
was brought up, you know, dowhat you do. And I'm when I'm
onboarding customers, I tellthem right away, okay, I don't
care where are you from, butthis is the way it rolls here.
(34:22):
So the experience makes a bigdifference number one, number
two, is our QA our qualityassurance. So I have a
department made up of allexperienced case managers or
adjusters, you know, people inthe industry, and every case
manager is assigned onecounselor, and this QA
counselor, and we're copied onevery email, and we read it or
whole QA team is on that, youknow, email. So we're reading
(34:45):
the email. So we have a companycalendar, it's voluminous ly
detailed and nobody does thisbecause it's so detail oriented.
We track every milestone ofevery case, doctor's
appointment, Mr. If ce que meall that stuff. up, and we're
tracking when you guys ask aquestion, you need to make sure
that answers in 24 hours, we'retracking after a doctor's
(35:06):
appointment, you know, all thisstuff is being tracked, to give
us all that quality and our casemanagers, even though their
experience, that's the level Iexpect them to be at, you know,
if they get a question and youdon't respond, you get a case,
you need to respond within 24hours, you got an appointment,
and you respond within 24 hours.
So our QA, I've never seen acompany that does it. Usually,
again, we're proactive versusreactive. The only time I see
(35:28):
other companies and Iexperienced this, get involved
is after the problems happened.
And by then you're playing catchup, you know, in life, in
general, when you're behind theeight ball, you're not going to
do as well as when you're 48.
Alright, so the QA is huge. Andthen the third difference, I
think, is our transparency. LikeI said, we're going to take
ownership, we don't pass thebuck, If a mistake is made, and
it's our mistake, we're going toeat time or whatever, and then
(35:52):
learn from it, I do my duediligence, I know there's five
sides to every story. Because Ihave a story of the case manager
to you know, the injured workersays this, The doctor says this,
he just said, you know, I My jobis to kind of drill down and see
what I really feel is real, andthen to learn from it and to
take ownership. So, again, thattransparency travels to other
issues like referrals, you know,I turned down referrals, which
(36:14):
is unheard of in this industry,right? Why would you ever turn
down a referral, you know,because if I don't have the best
case manager to handle it, I'mnot gonna just throw a body on a
firewall, you're not gonna getgood ROI. And I care about my
customers and my customersrespect that. You know, I,
Greg Hamlin (36:32):
I appreciate them all. Because you've done that to
us before where we called you onsomething and you said, Why
could but the travel time justdoesn't make sense. It wouldn't
make sense. And I think you canfind somebody closer who can do
the right thing for you. And Ireally appreciated that instead
of you just saying, Well, I cansolve your problem. And then we
get a bill for, you know, threehours or two hours of travel
time. That doesn't make sense.
Yeah. No, I don't believe
Mollie Kallen (36:53):
in that. Yeah. I mean, I think that, again, being
honest, and treating people likethe way you want to be treated,
you know, I mean, honesty isalways the best policy, I always
tell that to my team, I tell itto my case managers, you know,
if something happened, you know,document it and confess off to
it, you don't want to hide. So Ireally am happy to hear that,
Greg, because you know, and lotsof times, I'll offer, Hey, can I
(37:16):
eat some of the travel time andthe mileage? If I feel I have a
good case manager who knows thedoctor who could do a good job
for you? And if that's the onlystumbling block, then I'll help
out. But I'm always honest, youknow, and I'm very proud of my
team that the same way, becausethat's how our customers trust
us. We talked about trust.
That's huge right here. I mean,a trust with customers.
Greg Hamlin (37:35):
And absolutely, yes. So what's your favorite
part, Molly, of being in thisbusiness?
Mollie Kallen (37:43):
It depends on days. I feel like I wear a
firefighter hat. And I'm puttingout I'm sure you guys feel this
way too, right? Yes, fires allday long. Usually, it's a full
moon. I can't do thecorrelation. There's a full moon
and everybody's blacking out.
Yeah. But what I really love ismaking a difference in people's
lives, no matter how small orlarge. And I was at a partners
meeting with a customer of oursand a guy who was involved in a
(38:06):
catastrophic case, surprise me,it was there and talked about
what a difference casemanagement meant in his life. He
was unconscious, and his wifewas dealing with the case
manager. And he was talkingabout what a difference it made
in his recovery. And I wasstarting to cry, because I
didn't, you know, again, we doour job. And you know, we're
used to doing our job, we kindof forget, but we really do make
(38:27):
a difference, we really doimpact people. So that's the
most rewarding. Another thingthat's rewarding to me is when
you have somebody beingdischarged from the hospital,
they got injured in one place,and they live in another. And I
love it. I call it like asymphony when it works, because
we have one case manager who'sworking with the hospital and
another case manager where theylive. And then the case managers
(38:49):
are talking to each other. Sothat way, when that injured
worker comes home, they're notwaiting two weeks for an
appointment of a robot. So Ilove that kind of synergy that
happens, you know, when you'vegot multiple case managers
working a file together andhelping each other. I just
really enjoy what I do. No, no,two days are the same. Right?
You know, and the day flies byand then it's like three
(39:12):
o'clock, like, oh my god, whathappened? But no, I really
enjoyed I love working with thecase managers, because I know
what their job is and how hardit can be, especially when COVID
happened. You know, I alwaystell my caseworkers to do not do
anything that you're notcomfortable with. Don't put
yourself in the situation, werolled out telehealth that was
great, you know, to have as atool in our toolbox. So I really
respect our case managers are onthe front lines, they do the
(39:35):
hard job, you know, my job isnothing compared to what they
do. So I love all aspects. Ithink of the business and the
vocational case management, allthat other kinds of stuff and do
life care plans. You know, it'skind of need to see like the
whole I stay in my lane. Youknow, people come to me and
said, Hey, do DMEM dotransportation? Yeah, that's
what I do. stay in my lane anddo a good job.
Greg Hamlin (40:00):
Oh, that's fantastic. I couldn't agree more
with you, Molly, my, I wasinterviewing a candidate
yesterday for a position in ourcompany. And he was asking me
like, what, what keeps me going?
He asked me that same question.
And I said the same thing. It'speople, it's a feeling like I
can make a difference. Yeah.
Either the injured workers thatwe work with, or the staff who
worked for me, I felt likethere's opportunities to
(40:20):
hopefully some people's livesare better, because what I'm
doing all day long, and that'sthe goal anyway, and so I can
completely relate to that. Iwant to throw you both a
curveball here to end it out. Soone of the things I feel like
and maybe it's just always beenthis way, but it seems like
there's a lot of yelling andshouting at each other and anger
(40:41):
back and forth when you turn onthe TV of who's right, who's
wrong. And it's created anenvironment that sometimes it
feels like, the only thingsgoing on are really negative.
And I really believe there'sbeautiful things going on. And
so one of the things I decidedto do this season is I wanted
people that we interviewed toshare a memory of a time that
they were truly happy. What werethey doing and what Who were you
(41:05):
with, and it doesn't have to bework related. But I just want to
show people who are listening tohuman side of everybody, because
I think we get so caught up inthe negativity. And I really
believe that there's beauty outthere if we just take time to
acknowledge it. So maybe I'llthrow it to Paloma first and
then have Molly jump in andshare her her memory.
Unknown (41:27):
Sure, sure. So
Paloma Duncan (41:29):
me and my family, we love to travel. And I would
have to say within the pastyear, we've resorted to
traveling to a lot of nationalparks. And one of the happiest
days was when we were at ZionNational Park. And me and my
boys and my husband climbedAngel's Landing out of the way
to the top. But I was proud ofhow far we made it. And just the
journey up there. You know, Ihave a 11 year old, an eight
(41:51):
year old and they're troopers.
But you still heard thecomplaining, you know, hey,
well, how much longer was it?
You know, I'm thirsty, do youhave some Twizzlers? You know,
all those things. But then, youknow, on the way, we also met
very interesting people that we,you know, made relationships
with and connected with. Andonce we got to where we were,
you know, they look down, andthey're like, Wow, we made it
this far. And they didn't thinkthat they could do it. And I
(42:13):
think that was in itselfrewarding. It's obviously a
beautiful park and in apeaceful, you know, situation in
itself. So I think overall, thatjust kind of made my heart very
happy to see that we were alltogether in you know, nature and
with the children, and they wereable to do it. And they thought
they couldn't do it. And we allaccomplish something together.
(42:34):
And I think that was rewardingconsidering everything that we
went through with COVID. And,you know, online schooling and
all of that. It was justsomething we all did together,
and everyone was happy in theend after it was somewhat of a
struggle to get up there.
Greg Hamlin (42:46):
I love that forum.
I bet designs is beautiful. Soif you haven't been people
should go check that out becauseit is definitely one of those
inspiring places. But I think myfavorite thing about what you
shared is that your joy camethrough seeing others and your
family push and do somethingthey didn't know that they could
do, which I think just says alot about who you are promo. So
thanks for sharing that. Molly,what's yours?
Mollie Kallen (43:09):
Oh, I have to convince you to Yeah. It's so
hard to narrow it down. So we'reclose. I'm gonna travel. It's
like, oh, yeah, I have one daywhen I love England, I think in
a previous lifetime if youbelieve in this stuff. Because
I'm walking around London, andpeople stop and ask me for
directions. I feel reallycomfortable there. I feel like
I've been there before. I justadore London. And we finally
(43:31):
have our trip. My family. Myhusband and my son have never
been abroad. So I'm taking themwe were supposed to go two years
ago and then COVID andeverything happens. So we're
going Hey, so I'm very excited.
But it's very different to gotravel like you mentioned and
you guys both know the kids andgoing by yourself. Yeah, you
know, so this is a wholedifferent trip. But anyway, my
favorite time is I was in HydePark. I love staying in the
Kensington area when I'm there.
(43:53):
And I was in Hyde Park on mybirthday just walking through
the park by myself and justreally liking Wow, I'm in
London. I'm in my favorite placein the world. I'm here on my
birthday. You know, it'speaceful. It's relaxing. I'm
looking around all the peopleand just very grateful. You
know, I agree with Palomatraveling, I think it's the best
education. If more of us travelthere'd be less prejudice. More
(44:14):
appreciation for our lives inUnited States. I'm telling you,
I love travel. But gosh, we havea really good here compared to
other countries. So and travelis just key. So that's my first
one I love, you know, being inEngland and stuff. And the
second one is we were inCharlotte over this past
Thanksgiving and again, travelshave taken a whole new meaning
guys, right since we weren'table to do it. I think we're
(44:35):
savoring it more now because wedidn't have the opportunity to
do it. Greg will never have theopportunity to travel. So many
kids, but anyway, but we were inCharlotte, you rented a lake
house and my son had never seenlike fall leaves like he's a
Florida guy and we live in SouthFlorida. Oh yeah. It was
hysterical to watch. He raked apile of leaves. And I said just
(44:57):
jump in. And he's like, WellWhat do you mean? Mom? You know,
he goes, Do I fall back? Do Isit? Do I lean into it? I mean,
there's like a whole bigdiscussion about because I grew
up north, I'm like, do you justjump in God and I jumped in, and
it was just so nice to see. Andyou live through your kids,
right? You lived through theireyes. And for him to kind of
(45:19):
experience Paul, and he neverexperienced it before. It was
just really kind of cool. Sothat was really a happy moment
too.
Greg Hamlin (45:25):
I love that. I love both those thoughts. I I think
for me, I can really relate toyour discussion that your your
your memory in Hyde Park andthat for me, I think some of the
best moments I've had are thosequiet moments where you're
really pondering and you justyou can feel at peace and you'll
like can see where things areclear for a minute and yes, and
not so busy and obviously withwith six kids. There's there's
(45:48):
lots of leaf jumping andcraziness that happens. I could
write a book on crazy Hamlinstories for sure. They're great.
Well, Molly, I've so enjoyedhaving you with us today. I seem
for you Paloma. It's a joy towork with both of you in
different capacities and want tothank all our listeners for
joining us for this episode, andwould remind you to do right
(46:11):
think differently and don'tforget to care. That's it guys.
Hope you join us next time.
Hello everybody and welcome to adjusted. I am your
host Greg Hanlon coming at youfrom beautiful Birmingham,
Alabama, and Berkley industrialcalm and I'm excited to share
with you this rebroadcast wherewe talk about Nurse Case
Management with my good friendMolly Kaelin one of the things
that is so impactful for claimsis having boots on the ground.
(00:35):
And having done an adjuster, Ican remember how much I relied
on strong Nurse Case Management.
And so in this episode, we spentsome time exploring what that
looks like what the role lookslike, how that coordinates with
the adjuster and what reallymakes for an effective Nurse
Case Management Program. So Ihope that you'll enjoy this one
(00:56):
as much as I have. And again,just thank Molly for her time
and spending it with me on thisepisode. Enjoy. Welcome
everybody to adjusted a workerscompensation claims podcast. I'm
your host Greg Hamlin coming atyou from beautiful Birmingham,
(01:38):
Alabama and Berkeley industrialcomp. And with me is my special
co host for the day. Hello,Paloma Duncan.
Mollie Kallen (02:05):
I will talk about my journey a little bit, but
I'll just share with you now. Somy company is MK cm, as Greg
mentioned, and we're a nationalcase manager coming over 500
case managers across thecountry. And I have a passion
(02:27):
for what I do. I have a passionfor a lot of different issues
that are going on in ourindustry that we'll talk further
about, and my backgrounds ineducation. So I love these kinds
of formats and talking to peopleand also learning from others.
So thanks so much for thisopportunity, Greg?
Greg Hamlin (02:44):
Well, we are certainly glad to have you. The
topic for today is effectiveNurse Case Management. And so
that's one of the reasons wewant to have Molly here and why
I want to plomo to co host withme today because it's a huge
piece of what we do in workerscompensation in helping our
injured workers return to workand get back to where they were
prior to the injury. But Molly,the question I always like to
(03:06):
start with is when did you knowthat workers compensation was
going to be your colleague youjokingly said when I was five I
knew. So I want to know thetruth is that is that is that
when the light bulb momenthappened, you're like, Yes, this
is my thing. Oh, yeah, no,
Mollie Kallen (03:21):
totally not. And I was joking. So what I always
tell people when I speak acrossthe country is nobody graduates
high school or college and says,I'm gonna go into workers comp,
that is never usually thejourney, the journey usually is
very indirectly, you go into onearea, and you're pulled into
workers comp, from a variety ofdifferent areas. So same kind of
thing for me. I didn't know whata case manager is, or was a lot
(03:45):
of people still don't know whatcase managers are what we do. We
were kind of like the unsungheroes, sometimes of this
industry. When I was out theredoing appointments, people would
stop me and say, Are you apharmaceutical? Rep. Are you an
attorney? You know, I mean,nobody really understands this,
and that's one of my beefs isthat I think, really, in nursing
school, and rehab, casemanagement or rehab programs, we
(04:06):
really need to be talking aboutalternative careers. Whenever I
see nurses in the hospitaloutpatient, I've always talked
to them and educating them,because I think a lot of people
don't even know what this is.
But just to kind of back it up.
For me. My bachelor's was anelementary ed. So in another
lifetime, I was an elementaryschool teacher, and I loved it.
I was making $18,000 a year witha master's degree. And I was
(04:27):
kind of like, you know, I lovekids. But I can't survive this
way. And what happened was, Igot into counseling, my Master's
in Counseling. I wanted to be aschool psychologist, but then I
realized that schoolpsychologists are not really
doing counseling, they're doinga lot of testing, which was not
what I want. I want moreclinical peace, right. So then
what happened was I got a job ina psych practice doing
(04:49):
counseling for injured workers.
So that was kind of my firstexposure to this population. And
I really enjoyed that. And thenI saw an ad in a paper and
ironically as a case manager orI mean, as a vocational person,
I always would tell people, younever get jobs through the
paper, you know, it's alwaysthrough talking to people, PS I
kind of kind of started in thiscareer from an ad in the paper.
Right? Right. So I answered anad in the paper from Infracore
(05:13):
Inchicore. It was the very firstcase management company was
owned by Cigna. And they werethe very first ones to ever come
up with this career and paypeople. They were the first ones
to use computers. I was rockinga car, Greg, blue Mercury Topaz
that they go, Wow. And I thoughtI was like the bomb, I was
(05:35):
driving through, you know, Ohio,where I'm from. And this car by
gas was paid for. I'm like, thisis a great gig. I love this. And
I didn't even know what it was.
And I just found my passion. Ilove talking to doctors, injured
workers, adjusters and kind ofbeing that middle person. So to
answer your question, I fellinto this position, which is
(05:56):
like what a lot of people do inour industry, and I just really
loved it. And everything justkind of grew. In fact, owning a
company was not even in theplan. I had worked for all the
big companies, I worked forInchicore. Then I worked at core
bow, and then Gen X. And then Istarted my company, it was never
a grand design to like have abig case management company,
people would offer me positions,ironically, to be a supervisor
(06:19):
of case managers. And I waslike, why would I do that case
managers are just kind ofstrange people. You know, they
they are just not the easiestpeople sometimes to do. So why
would I want to supervise themPS again, here I am supervising
500 people. So life takes youand very strange twists and
turns. But I'm just so happythat it took me here. It clearly
(06:40):
wasn't a design at all.
Greg Hamlin (06:41):
That's awesome.
Well, I can totally relate towhat you were saying about
education, you know, and in thatsmall check, you wanted to help
people. You know, I, you saidyou love kids. I love kids.
Obviously, we have six. But Istarted not for profit, too. So
well. It was a little differentthan education, but not for
profit fundraising. And Irealized pretty quickly that
(07:03):
that wasn't going to work if Iwanted to have the amount of
children that I have now. Sohere we are. But I think most
people fall into this industryas well. Paloma, I assume that's
the same for you.
Paloma Duncan (07:17):
Yes, yes, it was for sure. It was that job fair.
And same thing that youexperienced at Indiana
University where you were justwalking around not knowing what
you were going to do. And thenthere was Liberty Mutual and
name? Yeah, I started.
Mollie Kallen (07:30):
Yeah, I think it's something that is just so
common in our industry. But Ithink we need to do a bit of a
better job. Because especiallynow with what's going on with
COVID. And everything, we haveto really work at not just
attracting the best people inour industry. But really
retaining them is a big issuefor me as well, too. We can talk
more about it later.
Greg Hamlin (07:50):
So for you, you talked a little bit about
starting your own company, whatmotivated you to start your own
company? That's obviously a hugerisk. Scary Thing for lots of
people, right? I'm sure it'salso very rewarding in other
ways. But talk to us a littlebit about like, how did you
decide that? Okay, I'm gonna dothis.
Mollie Kallen (08:10):
Yeah. And again, it wasn't kind of a design, it
was just what happened was Iafter working for all the big
three companies, I decided Ikind of wanted to get on my own
for a couple different reasons.
I wanted to kind of bypass allthat political layers,
incentivizing case managers toBill, you know, doing things all
about billing, you know, I wasso not about that. It's about
really just providing a qualityservice, cutting out that
(08:30):
middleman, and just really doinggood work. So I was gonna go on
my own, which I did, and I wasout of my home office, just me,
myself and I, and working. Andthen what would happen was is
companies were like, well, yeah,we really like you. Is there
another version of you in Ohio?
Or is there another version ofyou in Texas? And what did I do,
(08:52):
I would Google and connected andI grew a network, again, very
organically, a network of casemanagers. And I decided that I
wanted to differentiate mycompany from others. And the
main differentiator is that Ionly use veteran case managers.
So I went to people who werelike myself, who have a minimum
seven to 10 years of experience.
And actually our average is 20years and company, because I
(09:14):
wanted people had a footprint. Ifeel that it really makes a
difference. Listen, I was agreen case manager. I made great
mistakes. My favorite one was Icomplained to a doctor, people
let me go for about 10 minutesabout the office manager. Oh,
she's horrible. She neverreturns my phone call. She never
returns my emails. Oh, my God,man, like went on for 10
minutes. And who was she? Hiswife? Yeah, well. Insert foot,
(09:35):
right. Yeah. So I mean, I'vemade all the green mistakes. And
yes, and it's important. We allmake mistakes. I still make
mistakes. But I wanted peoplewho were beyond that. I wanted
people who know what they'redoing. They have relationships
because it's really all aboutwho you know, in life in
general. So that's how we getgood results. We don't keep out
(09:56):
so So again, it was kind of anorgan And next thing, I started
to amass this list ofexperienced case managers, and I
just kind of grew. So again, itwasn't like a purposeful thing,
it just kind of grew and grew.
And, and I just love what I do,I love working with these case
managers are very much apartner, you know, and I think
(10:16):
they lose out in other companiestoo, because they usually have
somebody who's supervising themwho's never walked the walk or
talk the talk. And I've beenthere, I've been in an office
with a doctor who was grouchyand was just nasty, you know,
I've been with a belligerent,you know, injured worker, so I
get it, I get how hard our jobis, it's really hard job. It's
all about boundaries, you know,we get pulled in lots of
(10:38):
different directions. So thatfuels me every day and making a
difference in people's lives.
And I think we forget that, thatwe really do make a difference.
People are at a very vulnerablepoint when we're working with
them, right? I mean, they'redealing with injuries, they're
dealing with their their lives,economic loss, pain, you know,
not understanding the medicalsystem, you know, not
understanding what the doctorjust said to them, you know, so
(10:59):
our job is to really break allthat down and educate them and
really help them through. Soit's been a real gratifying
journey. That's for sure.
Greg Hamlin (11:08):
That's awesome. So one of the things that I wanted
to know a little bit more aboutwas, you know, you've been doing
this for a long time, you talkedabout the importance of
experience and havingexperienced nurses, maybe for
those who haven't had as muchexposure to what a case manager
or nurse case manager can do.
Talk to us a little bit aboutwhat their role is, if you're
(11:30):
having an onsite nurse casemanager in a workers
compensation injury?
Mollie Kallen (11:36):
Yeah, absolutely.
I do. One of my talks is casemanagement one on one again,
because a lot of people don'tknow, I have whole slide about
what we can do what we can't do.
And so the way I describe itinitially, is remember those
Venn diagrams we had in school,you know, we're I use the Venn
diagrams to kind of describe allthe different players on the
team members, right? You've gotgestures, you've got risk
managers, you've got providers,you've got attorneys, you know,
(11:59):
all those people. And then inthe middle of the wheel, you've
got the injured worker, they'rethe most crucial team member.
And lots of times we lose sightof that, you know, it's so
important that you have empathythat you have trust, that you
have that education piece, sothey feel empowered. So our job
is a case manager, if you stillvisualize that circle that I was
(12:19):
talking about, we are kind oflike the person that intersects
between all those different teammembers, between the injured
worker, the doctor, you know,the providers, the physical
therapists, the MRI, you know,all those people, the attorneys,
everybody who's on that team,the risk manager, we are the
connector, because many timesyou guys know, being in the
(12:39):
business, the right hand is notthe left hands doing. You see
that a lot with the physicians,especially if it's multiple
providers, you know, you got aphysiatrist you gotta pay
management, you got an ortho?
Well, these doctors, it stillboggles my mind, they don't
communicate, they don'tcommunicate on any level, they
don't communicate on medication,they don't communicate on
treatment, therapies, all thatstuff, DME, you know, so our job
(13:00):
is to make sure that everybody'saware of what's going on. And
that the case is moving in apositive direction, that the
injured worker is getting whatthey need, that they're, you
know, getting the best care,that we're also trying to
contain the client, not lettingit bleed out unnecessarily to
providers as a need to go to,for example, doctors tend to
(13:21):
always, you know, refer out youryour ortho, I tell them, you
know, they want to cut you, butthey don't want to cut you. And
if I don't want to cut you, I'mgonna send you to pain
management. Well, there might beother things to do, why go to
these steps. So our job is casemanagers to present alternatives
respectfully to the physicians,and to update everybody, all the
stakeholders about what's goingon, to help move the claim to a
(13:42):
positive resolution. That's mydefinition.
Greg Hamlin (13:47):
That's fantastic.
So Paloma, I know you've had alot of experience when it comes
to handling difficult claims.
Talk to us a little bit abouthow nurses have helped you and
what you're doing on your moredifficult claims.
Paloma Duncan (14:01):
Sure. So it's always nice to have eyes and
ears on somebody that you speakto you read the medical reports,
but you don't really pick up onthose nonverbal mannerisms and
things that you might see. Sothat information is always
crucial for us, when we'reseeing somebody that's not
recovering, maybe they are stillsmoking and they you know,
(14:21):
record that they're not smoking,those simple things that they
can pick up on that we can't wedon't see them. That is crucial
for us, along with kind of justgetting that judgment feeling of
you know, I have concerns thatthis, you know, maybe a
malingering patient or you know,I'm really concerned with the
treatment plan here. The doctorsnot looking at what I'm telling
(14:42):
him is concerning maybe we needto redirect care. So those
situations I feel are veryhelpful to have an an on site
nurse attend the appointmentsand like you said, educate the
patients and give themreassurance on what they're to
be doing once they leave thedoctor's office, right because a
lot of times you The doctor justwrites the note and doesn't
maybe verbalize, you should notbe doing this, that or the
(15:04):
other. And this is what you needto do. But the instructions and
language barriers, I'm bilingualin Spanish. And so I know you
have a lot of bilingual nurses,that is amazing. You can see a
huge impact on any file that hasa bilingual nurse, because the
communication barrier can behuge, not only language,
education, culture, all of thosethings make a huge difference if
(15:26):
you understand where they'recoming from and what kind of
guidance they might need. So
Mollie Kallen (15:30):
I can piggyback to Greg I mean, everything a
plumber said, I agree there'sdifferent types of case
management for those of thepeople are listening might not
be as sophisticated. No, there'stelephonic case management,
where we're just kind ofcoordinating everything on the
case telephonically. And thenthere's field that Paloma
mentioned, obviously, she'shandling catastrophic cases, do
case management usually startsvery early on, we get a call.
And what we're doing is like, assoon as we hang up the phone,
(15:52):
we're calling the hospitals,either even their teeth of going
into surgery, I'm verytransparent, and how we operate
our business. So we're all aboutcost containment and ROI for our
customers. So if someone's goinginto surgery, right, pull them
out, you're not going to want tostay out of the hospital, just
hanging out in the hallway.
Medical for you, right and getyou information. By the way, we
still get medicals, but 80% ofthe time, we still are able to
get medicals on the phone stillboggles my mind. But we do. And
(16:14):
then we go out. And we're youknow, that's where it's a really
key role. And we take it veryseriously because we represent
the employer and the insurancecompany to a family who is
dealing with a catastrophicsituation. Understand the
medical, they don't understandwhat's going to happen to their
lives, their loved one is maybethey're on event or who knows
and ICU. And we come in therephysically to do a couple
(16:38):
things, one to kind of reviewthe medicals and send you guys
over medical as we can to tokind of triage the case with the
providers and see how long thisis workers going to be there for
diagnosis prognosis, are theygoing to rehab? Are they going
home? Do we need dem ease andthree, which is really key,
which Paula mentioned wasemotional support. Ya know,
people care about you, you're ina system that you might not
(16:59):
understand. Let us help younavigate through that system.
And we're going to be with youthrough this process to make
sure you get the best care andcoordinate everything for you.
And that's really, reallyimportant because that trust
building that I talked aboutstarts right then because these
people are mistrusting, theydon't understand what's going
on. They're confused, they'reafraid. And we got to come in
(17:20):
there and kind of help that. Socatastrophic case management,
again, once we're out of thehospital, that's a really
different kind of a skill. Ialways call it like the plate
spinners. You know, you gottaYeah, it's a catastrophic case
manager. It's a whole differentlevel than regular case manager,
because you have got to bedealing with like 10 spinning
plates at the same time, becauseyou're dealing with vendors for
(17:41):
tmes, and home modifications,and physiatrist orthopedist, and
neurosurgeons and you'recoordinating all that care,
transportation, home health. Sothat's a whole different thing.
But like you mentioned, for thefew case management, eyes and
ears, right, we see how theinter Walker walks in, we see
how they walk out, we see whenthe doctor bends over, the
doctor is rolling his eyes.
(18:03):
That's really huge information.
That's not going to be an email,you know, that's a
Greg Hamlin (18:08):
it's not going to be in the medical report.
Mollie Kallen (18:10):
Yeah, no way. I rolled my eyes when Johnny bent
over Oh, my God, not this depo.
Here we come, you know. But alsolooking at the job. You know,
we'd love to get jobdescriptions and review those
with the doctors and injuredworkers. That's key making each
Yep. Well, I
Greg Hamlin (18:26):
can't tell you how many times I've had an injured
worker when I was an adjuster.
They go to the doctor'sappointment. If there's nobody
there, they'd say, Well, isthere modified duty? And that
guy would say no, there's nomodified duty. But there was
right? No one ever was there tosay, Well, wait a minute, what
are his restrictions? And whatcan he do? And can we work with
the employer and let me helpcoordinate that so that he's not
just sitting on the sidelines?
(18:47):
And I think that's a huge thingthat nurses can do that adds so
much value? Absolutely. Theother thing I've seen is
sometimes the doctors, they areso busy, they have so many
things going on, they're goingfrom thing to thing to thing. So
Paloma might write the doctor aletter, but he might not look at
it for a week. Oh, my God, no,do weeks, you know, and they
(19:08):
might be really good questionsor information we want him to
discuss. But we don't have a wayto have that dialogue. Because
if we call we're not going toget them on the phone most of
the time. There's a couple ofdoctors who will do that. But
most do not. But sometimes thenurses can have those
discussions.
Mollie Kallen (19:23):
Yeah. And you just brought to a really good
point that was going to read mymind. So one of the key things
that we do as case managers andI think it's the most
efficacious is Doctorconferences, one on one sitting
across the table from a doctorwith those questions that maybe
Paloma had with the injuredworker not being there. And we
have the undivided attention ofthe doctor. And we could bring
(19:44):
old medicals or whatever and sitacross the table from him and
have him respond and payattention to what we're doing.
And again, that experience comesinto play. I'm an experienced
case manager. I can pull Dr.
Smith aside say Dr. Smith,really, don't you think it's
about time then, you know, theJohnny kind of go back to work.
So you can have those kinds ofconversations informally, that
really impact a case. But if youweren't experienced and had a
(20:07):
relationship with that, doctor,there's no way that you could do
that.
Greg Hamlin (20:11):
That's an excellent point. So Paloma, maybe I want
to ask you this and then havemaybe Molly chime in, out of
curiosity. So when you've hadnurses on files, you've been
doing this for 15 years plussomething like that. So when
you've had nurses on files,there's good ones, and there's
great ones, what's thedifference for you? When you
say, Well, that was a goodnurse? Or that nurse was
(20:33):
amazing? What's the difference?
Paloma Duncan (20:35):
Yeah, relationships are everything
right? I feel like once youestablish that relationship and
trust with an injured worker,you see things move smoothly,
and resolve and have a goodresult because they trust that
you are guiding them in theright direction. So I think just
establishing those goodrelationships early on, and
communication are definitely twoof the big things that I've
(20:56):
noticed with nurse casemanagers, and then coming to me
and making sure that what theirplan is, is what I'm thinking as
well. So that we work togetherand establish a goal that
results in a return to work, youknow, maximum improvement, those
goals that we have, and in thetimeframes that we're looking
at. And if they're not there,then addressing the setbacks
together, I think is veryimportant for an amazing nurse
(21:18):
case manager or, you know,having those conversations like
Molly had mentioned with thedoctor having those conferences,
saying, you know, maybe we needto check some blood work or have
some of this done that he's thathealing, you know, aren't you
concerned that there might besomething else going on here?
Those those things that they canpick up on and communicate with
the doctor, effectively and withmyself, I find to be very
(21:38):
amazing nurse case managers thatdo that.
Mollie Kallen (21:41):
I'll jump in.
Yeah, go for it. You know, I'mshy. I'm writing notes furiously
as well as talking. So beingproactive versus reactive. II,
anticipating things like me, asa case manager, I would call
that adjuster and employer afterdocument said, Hey, Dr. Smith's
talking about pain management,if things don't get better,
let's see what we can do aboutthis. So looking ahead, thinking
outside of the box, I had a caseonce were there keeping somebody
(22:06):
in the hospital over the weekendfor a knee Walker, because they
couldn't find a knee Walker,what did I do? I googled one 800
Knee Walker found somebody gotthe knee Walker got him out
again, thinking outside the boxwith the approval of the
employer. Next thing we alwaysdo a lot in our company. I think
we've lost the art of phonecalling in our industry and a
lot of industries. Emails aregreat. Gotta love. However,
(22:27):
nothing makes me crazier, right?
Because it's encrypted emailsgoing back and forth about the
same issue a, b, we everything'sdiscoverable. So if there's
something sensitive, it shouldnot be in an email. So we're,
we're big believers in roundtabling cases, you know, we'll
suggest it or a casserolesuggested, hey, you know what,
we think we need to geteverybody on the call for five
(22:48):
minutes, 10 minutes, and reallykind of look at this case, come
up with a plan, and then goforward. So that
Greg Hamlin (22:55):
I love that Molly.
And I say I just had one comeacross my desk this morning,
where there was an ad, this isnot on the nurse case manager
side. But there was an agent andinsured that had been sending
emails back and forth with anadjuster. And then they felt
like they weren't gettinganswers. And I finally just
talked to the adjusters that,hey, we just need to make a
phone call pick up the phone.
Let's have a phone call here.
Because I think this can all getsorted out in five minutes. If
(23:17):
we just talk to each other 100%Do you think this is going to be
a new challenge? I do think thisisn't going away. Because I look
at my kids and the most recentcollege hires, and they do this
I can't people can't stop ifyou're just on their phones
texting all the time. They donot call their friends they text
their friends. Yeah. And so arethey snap their friends or
(23:38):
whatever the word, you know,whatever the the cool kids are
doing now, but it's not it's notcolleague. And so I remember
when I onboard a new adjuster,it's probably been four or five
years ago, they had sent threeemails sent to faxes, and it had
been a month and they hadn'tgotten an answer. And I said,
did you have you? Have you triedcalling? And they're like, Well,
no, it makes me insane. Yeah.
(23:59):
But they're kind of petrified topick up the phone. So that's
something that I've had to workon with with some of them. And
they come with different skillsets that are wonderful in other
ways. But that is a spot thathas changed. And I think you're
right, especially when you'retalking about doctors who may be
in their 50s and 60s. They'renot doing that. Yep.
Mollie Kallen (24:17):
Well, I we task our case managers when they
first get a case, not just toreach out to all the
stakeholders by email, butthey've got to do it by phone.
And I hold them to that, youknow, did you call Susie Did you
call you know, because again,emails are great, but you know,
maybe that adjuster found out akernel of information on this
injured worker that they don'twant to put in writing, but it's
important for us to know as casemanagers so Oh, totally agree
(24:39):
with you. I totally agree. Andthen the other thing is I was
gonna mention too is good mediaupdate. That's what I got
distinguishes a good case here.
Like look, you guys can all readdoctor's notes. We can all read
plenty notes. We do not need toregurgitate information for you
guys, right? You want to knowsubjective objective barriers
return to work, you know, MMIand we work really hard our
company And we've come up with atemplate that we're starting to
(25:01):
roll out about standardizingupdates, because God bless all
my case managers, they all writethese long. I'm sure you've seen
the right paragraph, and I lookat them and already my eyes
start to glaze over, like, Oh,God, how can I read this? Give
me the meat, potatoes, you knowwhat's going on? So we're
constantly talking to ournurses, but they're in our case
managers, but they're so used tocharting and hospitals, right,
(25:22):
and they can just write whateverand a lot of times, so we're
trying to streamline thatinformation. And then also
responsiveness is key, like yousaid, communicating. If you guys
ask a question, we give them 24hours to answer they got an
appointment, they have 24 hoursto update. You know, if we treat
telephonic just like field, Idon't care if you're handling
how telephonically they went toa doctor's appointment within 24
(25:44):
hours, you call that doctor,that injured worker you get as
much as you can. So I have neverunderstood how this should just
be normal. You know, I mean, Idon't understand there's a lot
of companies out there that'slike, oh, yeah, you know, a
nurse didn't show up. What doyou mean, a nurse didn't show
up? You know,
Greg Hamlin (25:59):
that's a huge deal.
And it's yeah, it can be a hugedeal if you're counting on it,
if we're counting on it, becauseyou know, we can't be there. So
when you think about some of thechallenges that you have in
Nurse Case, management,obviously, there's probably some
unique ones involved. I canthink of a few. But I figure you
have you have your list as well.
I know that one challenge. Imean, this just comes to the top
(26:21):
of my mind is epic. There's somany states and every state has
their own rules on what you canand can't do. And I imagine
that's something that you got tojuggle on your end, what are
some of the other things thatyou see?
Mollie Kallen (26:31):
Yeah, and that's a challenge, because rulings and
laws are always changing, youknow, so we always try to stay
on top of that, that'sdefinitely challenging
boundaries is an issue. It'svery hard as a case manager, and
I kind of alluded to it before,we feel like sometimes we're
pushed and pulled in lots ofdifferent directions, octagon
about that circle, all thedifferent stakeholders, well,
(26:51):
they might not all have the samegoal, you know, the injured
workers goal might be to stayout of work, but nobody else's
goal is to get them back, orvice versa. Our job is to kind
of do what's ethically correctfor everybody, but also kind of
like manage the claim. So we'regetting good outcomes. So lots
of times you feel you're beingpushed and pulled and our case
managers sometimes because theyespecially with the cat cases
(27:12):
that Paloma handles, you getvery connected to these injured
workers and their families. Soyou have to walk a fine line and
not become overly connected,that you have to maintain that
objectivity. Because we at theend of the day, we're
professionals, we have a job todo, and we can't be pushed and
pulled by even the familymembers, you know, we want to do
(27:33):
what's best. But you know, yourfamily member might want a hot
tub being built in their home.
And that might not be medicallynecessary or right now
financially efficacious foranybody to do. So you know, you
have to kind of walk that fineline. And we're we're very
careful about that. We'relooking at emails, we're looking
at reports. And you can kind ofsee when it starts to veer. And
we that's when we kind ofintercede again, being proactive
(27:54):
versus reactive. If there's aproblem, you just jump on it.
And if we have to transfer file,we will we hate to do that.
Sometimes it's the converse,sometimes the personalities
don't get along at all, whetherit's a case manager, an injured
worker, the case manager, thedoctor, case manager and the
adjuster, you know, so we'redealing with people and I always
tell customers and potentialcustomers that we're going to
make mistakes, we're humanthings are gonna happen, but
(28:16):
we're going to own it and try tofix it and learn from it. So
boundaries is a big deal. Likefor example, like I said,
They'll ask us sometimes to takevideo to doctors, we can't get
involved in surveillancesurveillance issues, we can't
have an email, we can verbalizeto a doctor, Hey, did you see
that video that Paloma sent onmy blog. But we can't get
involved with that we haveethics that we have to maintain
(28:38):
as case managers. We can't getinvolved in anything that's
adjusting or surveillance wise,or any of that kind of stuff
either, like, Hey, I didn't getmy check paid. You know, help me
with that. I'm always tellingcase managers, that's not our
job, you need to start to theadjuster.
Greg Hamlin (28:53):
Know, and those are fantastic points. I think, you
know, there's a real move rightnow to claims advocacy, which I
love the concept behind it. Andwe've kind of done our own twist
on that calling an empatheticresolution model. And the main
reason for that my big concernwith the word advocacy is who
are you advocating for? Right?
There are a lot of peopleinvolved in this. There's the
(29:13):
insured the actual employer whopaid a premium to the carrier.
There's, you know, thestakeholders of the carrier,
there's the injured worker whoneeds the right treatment.
There, you know, the list isreally long of all the people
involved. So if I'm advocatingfor the injured worker without
thinking about how it connectsto everything else, going back
(29:34):
to your thing about boundaries,that's challenging. So trying to
find that balance, I think ishard. woma Have you have you
noticed that some in yourexperience on the claim side?
Paloma Duncan (29:46):
Yes, yes, most definitely. And you know,
there's a saying that, you know,a nurse, a nurse has heart so
they have a lot of compassion.
And so I can see how that can bechallenging. So once you're
meeting with these peopleregularly, they have multiple
appointments throughout theweek, then The wife is there you
see their children like youdevelop a bond. But then again,
you kind of have to step back.
(30:07):
And remember, what am I here forwhat are you know, objectively,
you can have that relationshipwith them, which I think is
crucial for them to be able totrust. And you know, that is
all, you know, empathetic. I'mall about that, I believe in
that strongly. But then also,like Greg said, remind remember
the stakeholders and everybodyinvolved and what the big
picture is, overall.
Mollie Kallen (30:27):
Yeah, I talk a lot about social determinants of
health. And I think it's andagain, that's like echoing what
Greg said, the movement in ourindustry right now is empathy,
holistic approach to claims andto injured workers. I think
that's really important, too.
And when you do that, itdefinitely affects the bottom
line. Oh, yeah. We all have tobe aware of the bottom line, we
get that. And I think, though,you know, we've lived in a world
where we've kind of like been inpods in our industry, you know,
(30:48):
you get the adjuster pod, yougot the we're all a family.
We're all right, as we all are ateam and that injured worker
cannot be forgotten. Everybody,you know, thinks, oh, they're
malingering when the statistics10% or less is really, you know,
but that 10% takes up 90% ofyour time we get that. But you
know, not everyone's a player,and most people aren't. And
(31:09):
you're right, yeah, it's to lookat the most Listen, as we were
brought up as case managers,I've talked about this before,
we were told, Don't ever askquestions about their family
life, don't ever ask questionsabout how they're feeling. Stay
out of all that somebody that isthe way we were raised in
industry. So a lot of your casemanagers they know to stay out
of there, they don't want to godown that road, well, we need to
go down that road, because thatroad, affects pain, affects
(31:32):
recovery, affects return towork, you know, affects
compliance, going to therapy,going to doctor's appointments.
So we as case managers need tokind of open our view, and
realize, you know, what, we haveto help them find resources in
their community that could helpthem What if they're having
trouble with food, you know, inthe house, or childcare, to
(31:52):
enable them to go to therapy ora doctor's appointment? So we
need to kind of open our horizona little bit and realize that,
you know, we really do need tokind of address those things.
And it's not dangerous, doingthose things, is dangerous, not
doing those things. It's a wholedifferent paradigm shift than
what we've been taught before.
Greg Hamlin (32:09):
Yeah, I think you're right, I think it's
thinking about the big picture.
And then communication, what yousaid earlier, communicate,
communicate, communicate, we'vegot to be talking to come up
with solutions will ultimatelythe best, the best result is
they get healthy, they get backto work, and the employer has
some back on their workforce,and everybody gets to move
forward. But you know, if wedon't address all the reasons
(32:30):
and obstacles that could bethere, and we might find
ourselves right, fighting oversomething that in the end puts
us in a much worse spot?
Mollie Kallen (32:39):
Absolutely.
Nobody, you know, you want todecrease legal, you want to
decrease psych, you want todecrease pain management, you
know, medications. So how do youdo that? By keeping that
connection with your injuredworker and making them feel
empowered? You know, people feeldisenfranchised, that's when
they're like, oh, you know, Idon't really know, how many
times do we hear from injuredworkers? I never hear from my
employer. They don't care aboutme, you know, so that it's the
(33:01):
littlest thing, right? Thatmotivates somebody to be non
compliant or to hire anattorney. And once you go down
that slope, that's, it's veryhard to relocate
Greg Hamlin (33:13):
spectrum. Trust is hard to rebuild once you lose
it. 100%. And that's kind ofgoes for all parts of life. I
think. So. Yeah. So we've talkeda little bit about empathy. And
we've talked a lot about yourcompany. I know you mentioned
that. One of the big differencesfor your company opposed to some
of the others that are out thereis the seven to 10 years of
(33:36):
experience, what do you feellike are some of the other
differentiators when you decidedI'm going to create my own
company? I wanted to look likethis because I think I have that
with my team. Like, when Ibecame a vice president of a
Claims Department. Those werethe things in my mind, like,
what did I want this to looklike? Why are we going to be
different than our competitors?
And how is that going to besomething that's an advantage as
(33:56):
we're competing in themarketplace?
Mollie Kallen (34:00):
Yeah, three, three main things. So one of the
experiences, we talked abouthaving the footprint, that's
huge. That's, to me, the keydifferentiator enabled us to you
know, not keep files open aslong and by the way, we don't
incentivize case managersdevelop, like in the companies I
was brought up, you know, dowhat you do. And I'm when I'm
onboarding customers, I tellthem right away, okay, I don't
care where are you from, butthis is the way it rolls here.
(34:22):
So the experience makes a bigdifference number one, number
two, is our QA our qualityassurance. So I have a
department made up of allexperienced case managers or
adjusters, you know, people inthe industry, and every case
manager is assigned onecounselor, and this QA
counselor, and we're copied onevery email, and we read it or
whole QA team is on that, youknow, email. So we're reading
(34:45):
the email. So we have a companycalendar, it's voluminous ly
detailed and nobody does thisbecause it's so detail oriented.
We track every milestone ofevery case, doctor's
appointment, Mr. If ce que meall that stuff. up, and we're
tracking when you guys ask aquestion, you need to make sure
that answers in 24 hours, we'retracking after a doctor's
(35:06):
appointment, you know, all thisstuff is being tracked, to give
us all that quality and our casemanagers, even though their
experience, that's the level Iexpect them to be at, you know,
if they get a question and youdon't respond, you get a case,
you need to respond within 24hours, you got an appointment,
and you respond within 24 hours.
So our QA, I've never seen acompany that does it. Usually,
again, we're proactive versusreactive. The only time I see
(35:28):
other companies and Iexperienced this, get involved
is after the problems happened.
And by then you're playing catchup, you know, in life, in
general, when you're behind theeight ball, you're not going to
do as well as when you're 48.
Alright, so the QA is huge. Andthen the third difference, I
think, is our transparency. LikeI said, we're going to take
ownership, we don't pass thebuck, If a mistake is made, and
it's our mistake, we're going toeat time or whatever, and then
(35:52):
learn from it, I do my duediligence, I know there's five
sides to every story. Because Ihave a story of the case manager
to you know, the injured workersays this, The doctor says this,
he just said, you know, I My jobis to kind of drill down and see
what I really feel is real, andthen to learn from it and to
take ownership. So, again, thattransparency travels to other
issues like referrals, you know,I turned down referrals, which
(36:14):
is unheard of in this industry,right? Why would you ever turn
down a referral, you know,because if I don't have the best
case manager to handle it, I'mnot gonna just throw a body on a
firewall, you're not gonna getgood ROI. And I care about my
customers and my customersrespect that. You know, I,
Greg Hamlin (36:32):
I appreciate them all. Because you've done that to
us before where we called you onsomething and you said, Why
could but the travel time justdoesn't make sense. It wouldn't
make sense. And I think you canfind somebody closer who can do
the right thing for you. And Ireally appreciated that instead
of you just saying, Well, I cansolve your problem. And then we
get a bill for, you know, threehours or two hours of travel
time. That doesn't make sense.
Yeah. No, I don't believe
Mollie Kallen (36:53):
in that. Yeah. I mean, I think that, again, being
honest, and treating people likethe way you want to be treated,
you know, I mean, honesty isalways the best policy, I always
tell that to my team, I tell itto my case managers, you know,
if something happened, you know,document it and confess off to
it, you don't want to hide. So Ireally am happy to hear that,
Greg, because you know, and lotsof times, I'll offer, Hey, can I
(37:16):
eat some of the travel time andthe mileage? If I feel I have a
good case manager who knows thedoctor who could do a good job
for you? And if that's the onlystumbling block, then I'll help
out. But I'm always honest, youknow, and I'm very proud of my
team that the same way, becausethat's how our customers trust
us. We talked about trust.
That's huge right here. I mean,a trust with customers.
Greg Hamlin (37:35):
And absolutely, yes. So what's your favorite
part, Molly, of being in thisbusiness?
Mollie Kallen (37:43):
It depends on days. I feel like I wear a
firefighter hat. And I'm puttingout I'm sure you guys feel this
way too, right? Yes, fires allday long. Usually, it's a full
moon. I can't do thecorrelation. There's a full moon
and everybody's blacking out.
Yeah. But what I really love ismaking a difference in people's
lives, no matter how small orlarge. And I was at a partners
meeting with a customer of oursand a guy who was involved in a
(38:06):
catastrophic case, surprise me,it was there and talked about
what a difference casemanagement meant in his life. He
was unconscious, and his wifewas dealing with the case
manager. And he was talkingabout what a difference it made
in his recovery. And I wasstarting to cry, because I
didn't, you know, again, we doour job. And you know, we're
used to doing our job, we kindof forget, but we really do make
(38:27):
a difference, we really doimpact people. So that's the
most rewarding. Another thingthat's rewarding to me is when
you have somebody beingdischarged from the hospital,
they got injured in one place,and they live in another. And I
love it. I call it like asymphony when it works, because
we have one case manager who'sworking with the hospital and
another case manager where theylive. And then the case managers
(38:49):
are talking to each other. Sothat way, when that injured
worker comes home, they're notwaiting two weeks for an
appointment of a robot. So Ilove that kind of synergy that
happens, you know, when you'vegot multiple case managers
working a file together andhelping each other. I just
really enjoy what I do. No, no,two days are the same. Right?
You know, and the day flies byand then it's like three
(39:12):
o'clock, like, oh my god, whathappened? But no, I really
enjoyed I love working with thecase managers, because I know
what their job is and how hardit can be, especially when COVID
happened. You know, I alwaystell my caseworkers to do not do
anything that you're notcomfortable with. Don't put
yourself in the situation, werolled out telehealth that was
great, you know, to have as atool in our toolbox. So I really
respect our case managers are onthe front lines, they do the
(39:35):
hard job, you know, my job isnothing compared to what they
do. So I love all aspects. Ithink of the business and the
vocational case management, allthat other kinds of stuff and do
life care plans. You know, it'skind of need to see like the
whole I stay in my lane. Youknow, people come to me and
said, Hey, do DMEM dotransportation? Yeah, that's
what I do. stay in my lane anddo a good job.
Greg Hamlin (40:00):
Oh, that's fantastic. I couldn't agree more
with you, Molly, my, I wasinterviewing a candidate
yesterday for a position in ourcompany. And he was asking me
like, what, what keeps me going?
He asked me that same question.
And I said the same thing. It'speople, it's a feeling like I
can make a difference. Yeah.
Either the injured workers thatwe work with, or the staff who
worked for me, I felt likethere's opportunities to
(40:20):
hopefully some people's livesare better, because what I'm
doing all day long, and that'sthe goal anyway, and so I can
completely relate to that. Iwant to throw you both a
curveball here to end it out. Soone of the things I feel like
and maybe it's just always beenthis way, but it seems like
there's a lot of yelling andshouting at each other and anger
(40:41):
back and forth when you turn onthe TV of who's right, who's
wrong. And it's created anenvironment that sometimes it
feels like, the only thingsgoing on are really negative.
And I really believe there'sbeautiful things going on. And
so one of the things I decidedto do this season is I wanted
people that we interviewed toshare a memory of a time that
they were truly happy. What werethey doing and what Who were you
(41:05):
with, and it doesn't have to bework related. But I just want to
show people who are listening tohuman side of everybody, because
I think we get so caught up inthe negativity. And I really
believe that there's beauty outthere if we just take time to
acknowledge it. So maybe I'llthrow it to Paloma first and
then have Molly jump in andshare her her memory.
Unknown (41:27):
Sure, sure. So
Paloma Duncan (41:29):
me and my family, we love to travel. And I would
have to say within the pastyear, we've resorted to
traveling to a lot of nationalparks. And one of the happiest
days was when we were at ZionNational Park. And me and my
boys and my husband climbedAngel's Landing out of the way
to the top. But I was proud ofhow far we made it. And just the
journey up there. You know, Ihave a 11 year old, an eight
(41:51):
year old and they're troopers.
But you still heard thecomplaining, you know, hey,
well, how much longer was it?
You know, I'm thirsty, do youhave some Twizzlers? You know,
all those things. But then, youknow, on the way, we also met
very interesting people that we,you know, made relationships
with and connected with. Andonce we got to where we were,
you know, they look down, andthey're like, Wow, we made it
this far. And they didn't thinkthat they could do it. And I
(42:13):
think that was in itselfrewarding. It's obviously a
beautiful park and in apeaceful, you know, situation in
itself. So I think overall, thatjust kind of made my heart very
happy to see that we were alltogether in you know, nature and
with the children, and they wereable to do it. And they thought
they couldn't do it. And we allaccomplish something together.
(42:34):
And I think that was rewardingconsidering everything that we
went through with COVID. And,you know, online schooling and
all of that. It was justsomething we all did together,
and everyone was happy in theend after it was somewhat of a
struggle to get up there.
Greg Hamlin (42:46):
I love that forum.
I bet designs is beautiful. Soif you haven't been people
should go check that out becauseit is definitely one of those
inspiring places. But I think myfavorite thing about what you
shared is that your joy camethrough seeing others and your
family push and do somethingthey didn't know that they could
do, which I think just says alot about who you are promo. So
thanks for sharing that. Molly,what's yours?
Mollie Kallen (43:09):
Oh, I have to convince you to Yeah. It's so
hard to narrow it down. So we'reclose. I'm gonna travel. It's
like, oh, yeah, I have one daywhen I love England, I think in
a previous lifetime if youbelieve in this stuff. Because
I'm walking around London, andpeople stop and ask me for
directions. I feel reallycomfortable there. I feel like
I've been there before. I justadore London. And we finally
(43:31):
have our trip. My family. Myhusband and my son have never
been abroad. So I'm taking themwe were supposed to go two years
ago and then COVID andeverything happens. So we're
going Hey, so I'm very excited.
But it's very different to gotravel like you mentioned and
you guys both know the kids andgoing by yourself. Yeah, you
know, so this is a wholedifferent trip. But anyway, my
favorite time is I was in HydePark. I love staying in the
Kensington area when I'm there.
(43:53):
And I was in Hyde Park on mybirthday just walking through
the park by myself and justreally liking Wow, I'm in
London. I'm in my favorite placein the world. I'm here on my
birthday. You know, it'speaceful. It's relaxing. I'm
looking around all the peopleand just very grateful. You
know, I agree with Palomatraveling, I think it's the best
education. If more of us travelthere'd be less prejudice. More
(44:14):
appreciation for our lives inUnited States. I'm telling you,
I love travel. But gosh, we havea really good here compared to
other countries. So and travelis just key. So that's my first
one I love, you know, being inEngland and stuff. And the
second one is we were inCharlotte over this past
Thanksgiving and again, travelshave taken a whole new meaning
guys, right since we weren'table to do it. I think we're
(44:35):
savoring it more now because wedidn't have the opportunity to
do it. Greg will never have theopportunity to travel. So many
kids, but anyway, but we were inCharlotte, you rented a lake
house and my son had never seenlike fall leaves like he's a
Florida guy and we live in SouthFlorida. Oh yeah. It was
hysterical to watch. He raked apile of leaves. And I said just
(44:57):
jump in. And he's like, WellWhat do you mean? Mom? You know,
he goes, Do I fall back? Do Isit? Do I lean into it? I mean,
there's like a whole bigdiscussion about because I grew
up north, I'm like, do you justjump in God and I jumped in, and
it was just so nice to see. Andyou live through your kids,
right? You lived through theireyes. And for him to kind of
(45:19):
experience Paul, and he neverexperienced it before. It was
just really kind of cool. Sothat was really a happy moment
too.
Greg Hamlin (45:25):
I love that. I love both those thoughts. I I think
for me, I can really relate toyour discussion that your your
your memory in Hyde Park andthat for me, I think some of the
best moments I've had are thosequiet moments where you're
really pondering and you justyou can feel at peace and you'll
like can see where things areclear for a minute and yes, and
not so busy and obviously withwith six kids. There's there's
(45:48):
lots of leaf jumping andcraziness that happens. I could
write a book on crazy Hamlinstories for sure. They're great.
Well, Molly, I've so enjoyedhaving you with us today. I seem
for you Paloma. It's a joy towork with both of you in
different capacities and want tothank all our listeners for
joining us for this episode, andwould remind you to do right
(46:11):
think differently and don'tforget to care. That's it guys.
Hope you join us next time.
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