Category Archives: Profile

Your Personal Health Coach

Vantage Point: A Helping Health Hand

Not every coach is as well known as Pete Carrol of the Seattle Seahawks, but Susan DeLong, our nurse case manager and health coach in our Wenatchee office, is key to our team.

She’s smart, caring, a good listener, and a compassionate advocate. You will probably never see her on TV, but in our members’ eyes, her work is just as important and meaningful as any superstar’s.

Managing a health condition can be hard, and a health coach is someone with extensive experience who can be a consistent source of support. There’s so much information that it can be hard to know what’s key. One of the benefits of a Medicare Advantage plan like ours is the free education and support a health coach can provide.

At Health Alliance, a health coach like Susan can give our members:

  • Answers to questions about their conditions
  • Tools and lifestyle skills to minimize the risk of problems
  • Information about self-care skills
  • Free educational materials and resources about managing conditions
  • Support on the phone at their convenience
  • Help keeping them, their provider, and their caregivers connected
  • Help making the most of their healthcare benefits

Health coaches do not replace medical care from a doctor, but instead work with their primary care physician as part of a team to make sure their management plan is working.

Compassionate nurses like Susan also help identify warning signs for possible health problems, and they make sure members have a plan, day or night, to handle those issues if they become serious.

Susan also works hard to troubleshoot these issues before they become serious health problems. For example, she helps members understand the importance of refilling prescriptions and outlines what they should do if their drugs run out too soon.

Susan even partners with community resource agencies, like Meals on Wheels and the Confluence Health Patient Service Department, to help our members overcome barriers to their care. She knows when a member has a hospital stay or ER visit, and she tracks follow-up appointments and makes sure any meds they’re sent home with will work well with their current prescriptions.

But just like famous coaches, a big part of the job is to motivate. Susan empowers our members to take an active part in their health by setting attainable goals, and we value the important role she plays in our team and in lending a helping hand to our members.

Shannon Sims is a Medicare community liaison for Health Alliance, serving Chelan, Douglas, Grant and Okanogan counties in Washington. She has four sons and two grandsons. During her time off, she performs as part of a rodeo drill team on her horse, Skeeter.      

Love Story through Alzheimer's

Chasing Health: Member’s Love Story of Caring for Wife with Alzheimer’s

As a writer, I get to interview all kinds of people about all kinds of topics, and sometimes I come across a story that gives me goosebumps.

Earlier this year, I interviewed Cary Ulrich, a member who lives in Washington, for the spring issue of House Calls, one of our Medicare newsletters. This former drafter and current fire photographer was kind enough to share his heartfelt story with me.

Cary’s wife was diagnosed with Alzheimer’s a few years ago and passed away after we published this article. But for nearly three years, Cary was her primary caregiver, a tough task for a person watching someone he loves suffer from a disease that does not yet have a cure.

I don’t know if I could handle it, but Cary did. And he even found a way to make something positive out of it. Today, Cary leads caregiver support groups and is writing a book to capture how grateful he is for the time he spent with the love of his life.

November is National Alzheimer’s Disease Awareness Month, and with Thanksgiving coming up, I think it’s the perfect time to share Cary’s story of being grateful while making sacrifices. Maybe it’ll inspire you to join the cause to end Alzheimer’s or thank a caregiver.

Take a Minute to Care about Caregivers

Cary Ulrich, a second-year Health Alliance Medicare member, likes a challenge. The one-time drafter and surveyor at an engineering firm went from designing layouts for Wenatchee Valley’s buildings and subdivisions to taking photos on the frontlines of wildfires.

The toughest challenge he faced wasn’t learning the art of drafting by hand before the drafting world went digital, and it wasn’t going out on his first fire call to take pictures of people putting their lives on the line to save others. It wasn’t even a challenge he enjoyed, but it was his most important, being a caregiver for one of the people he loves most, his wife.

Sharon Ulrich was diagnosed with Alzheimer’s (a type of dementia) after showing some confusing symptoms, like having visions of everything from Old English-style visitors to spies and people trying to break into her home.

At first, doctors couldn’t figure out what was wrong. Was it depression? Dementia? And if she had dementia, what kind was it? At 63 years old, she seemed too young for that.

While doctors looked for answers, Cary stayed by his wife’s side. From her earliest symptoms and first diagnosis in March 2010 to moving her to an adult home in February 2013, Cary was a caregiver. And he quickly learned that being a caregiver can take its own toll.

“I was on the outside going through everything,” he says. “I was very frustrated and angry at the situation, not at her. I had all those feelings, and no one seemed to care about me.”

He watched his wife’s health get worse while knowing he couldn’t help her get better. The woman who’d walked past his back-row church pew almost two decades ago, the one he thought was way too classy to ever even talk to him, now needed him to be her caregiver.

Cary and Sharon

“It’s a hard process,” he says. “I don’t exactly know how I did it, but I’ve gotten to the point where I’ve had to let go of what was and just totally accept her for the person she is now.”

Cary never backed down. Instead, he used his experience of caring for a loved one with dementia to help others do the same, turning his negative situation into something positive.

Today, Cary helps run two caregiver support groups, one specific to dementia at the Grief Place of North Central Washington and a more general one at Aging and Adult Care of Central Washington in East Wenatchee. In both groups, Cary gives support and tips to other caregivers because he believes it will help them feel better and make smarter choices about their own loved ones.

“The more you know when these things happen, the more you can kind of accept them,” he says. “You know you’re going to have to change because your loved one has changed and can’t go back the other way.”

He also talks to nursing classes at Wenatchee Valley College and to first responders in different fire districts to help them know how to work with people with dementia and the family and friends who care for them.

Cary takes on other challenges, too, like helping put on the annual Walk to End Alzheimer’s in Wenatchee. Last year, he lined up sponsors, set up, and took photos for the 2-mile event that raised money and awareness.

Wenatchee's Walk to End Alzheimer's

Cary’s selflessness shines through in everything he does, and the man who likes to take on challenges and still goes out on fire calls hopes to make caregivers’ lives less challenging in the future.

“As a caregiver, you have the memories of what was, but all you have is what is. It’s a very difficult place to be. I know what these caregivers are going through, though. And I want them to know they are valued and can still enjoy life.”

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Your Insurance Team's Support

Vantage Point: We Work Together to Support You

Painted in the stairwell of Samaritan Hospital is an inspirational message, “All of us, for each of you.” The same can be said of our Health Alliance Medicare team in North Central Washington that works together to provide elevated customer service for members and our provider partnerships.

Eileen, our program assistant, is the first face members see when they visit the Wenatchee office. Eileen feels that by supporting staff and prioritizing tasks, she can focus all her attention on members when they come in.

“Health Alliance isn’t just insurance coverage,” she says. “It is a place to come if you have questions, are seeking information, or would just like a cup of coffee and an ear.”

Jessica, our bilingual customer service representative, says, “The most rewarding part of my job is having the ability to see our members face to face, build relationships, and let them know I am here to listen and help.”

Through her role at Health Alliance, Teri, our customer service lead, hopes to insure our members only have good experiences when adverse situations arise. Teri credits the overall team from claims to medical management for its support in helping her achieve her goal.

Major procedures, hospitalization, surgeries, and discharge plans all need prior approval, and Cindy, our utilization review nurse on the medical management team, uses her experience in risk management, coupled with patient advocacy, to take care of our members through major health issues, thus controlling unnecessary costs.

Medicare is not only complicated for our members, it can be complicated for providers as well. Therefore, Leslie, our provider relations specialist, works directly with clinical staff members to help them understand policies, procedures, and operating systems. By providing face-to-face customer service at the provider offices, it makes providers’ jobs easier, positively impacting their care of our members.

The Centers for Medicare & Medicaid Services ranks Medicare Advantage plans on a five-star scale, and factors within that quality scale relate to providers assessing, managing, and controlling chronic conditions. Amanda, our coding consultant, works directly with physicians to provide coding education and finds it rewarding when she and the doctors learn something from each other, ensuring overall great health care to our members.

Whether they’re working with members or providers or making medical decisions behind the scenes, these are just a few of the local people committed to working together toward the common goal of ensuring quality of care, setting Health Alliance Medicare apart in North Central Washington.

Cooking and Health Plans

Advice on Cooking, and on Health Plans

Patricia Kendall has always been a people person.

Known as “the fishlady,” Patricia, a Health Alliance Medicare member from Springfield, Illinois, has written cookbooks and taught fish-cooking classes to share her passion with family, friends, and people she’s never even met.

She’s loved fish since she was a little girl watching her dad catch them at her grandparents’ Minnesota cottage. And she managed her local Jewel-Osco fish department for almost two decades. She teaches in fish earrings and fish slippers and has self-published a series of books. She doesn’t just do it for herself, though. She loves helping and teaching others.

“I never had a publicist,” she says. “But I helped a lot of people, and that’s what I am grateful for.

Kind Words

While she doesn’t expect anything in return, Patricia recognizes helpful people. As a Health Alliance member since 2005 and a Health Alliance Medicare Advantage member for the past year, the fishlady applauds those who have helped her.

“In this day and age, when you have all these big insurance companies, the people at Health Alliance Medicare remain personable,” she says. “They help you without transferring you all around. When I call Member Services, I don’t have to go through endless recordings.

“After a while when you talk to them, you get to know them.”

Patricia knows a thing or two about being personable. She published her cookbooks on her own for eight years before getting help from a local publishing company, binding them on her kitchen table and getting the artwork from her brother. She admits to giving away more cookbooks than she sells and shares free cooking tips with anyone who asks.

‘A Sense of Family’

But even with her cheery outlook, Patricia’s life wasn’t always easy. Family is important to Patricia, and she and her husband of almost 45 years couldn’t have children of their own.

Even so, she worked to make others’ lives happier, healthier, and easier through her cookbooks and classes. Along the way, her niece from the Chicago area stayed with her in Springfield from time to time and brought a special person named Kimberly into Patricia’s life.

After age 5, Kimberly 
didn’t have parents. So the fishlady did what she
 does best and offered to help. Kimberly was 21 at the time.
“We wanted to give her a sense of family,” Patricia says. “We just thought about how people come and go from your life, so one day, we just asked her how she would like to have parents and a home no matter where she goes in the world.”

Patricia and her husband legally adopted Kimberly, giving her a true home and parents.

“She’s kind of a miracle,” Patricia says. “We couldn’t have raised a better girl.”

Patricia has faced other hardships. In 2011, she had an emergency cardiac ablation, a procedure that corrects heart rhythm problems.

She was worried and scared afterward, not knowing if Health Alliance would pay for the costly procedure. But after a quick call, the Health Alliance staff put Patricia’s mind at ease and took care of the claim.

Word of Mouth

Now, Patricia doesn’t just give tips about fish. She still tells her friends, and strangers, how easy and healthy it is to cook and serve her favorite food, but she also offers a tip or two about health insurance.

“I tell so many people about Health Alliance Medicare,” she says. “My advice to people if they are having anything done is to always call Health Alliance Medicare first. They just really come through for you.”

Devoted Bike Rider

Devoted Rider Gets Back on His Bike

“To me,

there’s nothing more exciting than when you’re in a pace line, all you’re hearing is the cranks going swoosh, swoosh, you’re doing 20 miles per hour on the flats, and you’re just cooking it!” says Fred Munson, 68, a Health Alliance Medicare member from Wenatchee.

Make no mistake, Fred loves to ride his bike. The former sheriff’s deputy and hospital security adviser couldn’t be more pleased that retirement gives him so much time to pedal. He rode more than 3,000 miles last year, according to the tiny computer on the handlebars of his custom-built metallic red racing bike, and he’s on track to cover even more this year. But one windy spring day last year, Fred ran into more excitement on his bike than he was after.

“Really, with biking, it’s not a matter of ‘if ’ you’re going to crash. It’s a matter of when,” he says.

Fred was out with friends doing his favorite thing, riding in a pace line. They were rolling along in tight formation, wheels just inches apart, taking turns cutting through the wind at the head of the line so the others could draft.

Just as a rider moved up to take the lead, a gust of wind knocked Fred’s front wheel sideways, and the bikes collided. His wheels caught in the deep grooves of the rumble strip. The rumble strip alerts drivers if they start to drift off the road, but it’s bad news for the thin wheels of a road bike.

“It happened so quick, you didn’t have time to brace for it or think about it,” recalls Fred.

The crash rammed the handlebars into his ribs and tossed him into the road, right into the path of a truck. Fred recalls thinking, “I’m going to get run over.”

A quick-thinking buddy grabbed his own bike and raised it over his head, making himself bigger for the truck driver to see, and the truck was able to stop in time. In fact, the driver gave Fred and his busted-up bike a ride to the local emergency room.

The doctor at Confluence Health, also a cyclist, told Fred he had no broken bones and no internal injuries. The bad news was Fred would miss the 100-mile Apple Century Bike Ride the next Saturday.

Fred ended up with deep bruising, a hole in his arm and some significant damage to the skin on his shoulders and knees. He also came away with a significant medical bill.

Fit and healthy, Fred never had a reason until then to use much of his Health Alliance Medicare coverage.

“They’re right here, and I can talk to them. They’ve been really helpful.”

“I got my bill, and it was over $4,200, and I thought, ‘Well, I guess now we’ll see how good the insurance is,’” he says.

Fred’s total out-of-pocket cost was $65.

“They did it all. I just got the statements to see the transactions happening,” says Fred.

He liked the care and attention he got during the process, face to face, from the staff at the Health Alliance Medicare office in his hometown.

“They’re right here, and I can talk to them. They’ve been really helpful,” Fred says.

Fred is back doing long rides with his friends and shorter trips along the Columbia River with his high school sweetheart and wife of 47 years, Carolyn.

When the snow comes, he’ll head to the YMCA for spin classes. Fred likes the SilverSneakers fitness program that’s part of his Health Alliance Medicare plan.

“That’s where it is, prevention!” says Fred, patting the handlebars of his bike. “This keeps me in good shape year-round.”

Health Alliance On-Call for You

Like New Nurse Line, This Director is Always On-Call

Jane Elliott lives and breathes Health Alliance. She has for years.

“My work is my hobby. We have so many great things going on. Leading efforts to help members doesn’t feel like work to me,” said Jane, Quality & Medical Management director.

Jane also loves our new 24-hour Anytime Nurse Line. Beginning July 1, all Health Alliance members can call 1-855-802-4612 to get help:

• Deciding if they need to see a doctor right away or set up a visit
• Coping with diabetes, asthma, high blood pressure, high cholesterol, and more
• Finding health care resources

Jane also played a key role in enhancing our wellness benefit. But, she and her team want members to know that if they go in for a wellness visit, they could still get a bill. Adding non-wellness needs into this appointment could result in costs.

”Your doctor might ask, ‘Do you have other things you’d like to talk about?'” she said. “This may lead to topics  that aren’t part of the free wellness benefit.”

To make sure your visit is covered as part of the free wellness benefit, Jane says be clear with your doctor about this appointment up front.

“Tell your doctor you want to focus on your wellness needs. If non-wellness needs come up that aren’t urgent, you can set up a follow-up visit,” she said.

Jane also knows wellness means a healthy work-life balance, even if  the lines blur when she works outside standard work  hours.

“I’m very family-focused, and I feel Health Alliance and our members are part of my extended family,” she said.

Getting a Great Deal

Getting the Best Deal

“I’m always looking at ads to see who’s got the best deal,” Melissa Whitman says.

Who doesn’t love saving money? But how are great deals and health insurance connected? They may be more similar than you think, at least when you see doctors in the Health Alliance network.

“Many of our members are surprised how much they save by staying in-network,” says Melissa, a Health Alliance claims manager. “Going out-of-network can cost members twice as much, and the even more unfortunate part is they often don’t realize that until after their visit or procedure.”

With thousands of doctors and hospitals in-network (and the list growing daily), you don’t need an eye for a good deal. We have people like Melissa for that. Melissa can help with just about anything related to getting your covered care paid for.

Stepping into her cubical proves instantly there’s a lot more to Melissa than claims processing. Her family. Pictures of smiling faces decorate every open space.

“We’re always together. Cooking out,” she said. “In the summer they’re at my pool, and we just got done mushroom hunting.”

Melissa has quite the eye for those hard-to-find morels. For as long as she can remember, mushroom hunting has been an annual adventure.

“The whole family goes. Even my 89-year-old grandma gets her mushroom stick and gets in the woods,” says Melissa with a laugh.

She sums herself up simply. “I’m a city girl. I love my work, my family, and a taste of the country,” she says.