— ADVERTISEMENT —
HAWAII AT WORK
She’s on the case
Melissa Bojorquez helps HMSA
Melissa BojorquezTitle: Case-management supervisor
Job: Directs a staff of four case managers at Hawaii Medical Service Association
Question: What does a case manager do?
Answer: Well, that can be answered by many words, but to keep it simple, really a case manager is an individual advocate. They're supposed to work on behalf of their client, member, patient -- whatever you want to call them -- to navigate a really complex system. It could be health care, government benefits or the hospital system. But really case managers assist with coordinating care to make sure that their clients are getting access to the services of the best value to them -- and hopefully the best quality, too, or at least the quality of care that they want.
Q: How many case managers are there at HMSA?
A: We have a staff of four social workers, and we have support staff for the social workers. We also have a nurse that does our triage, and then myself as the supervisor.
Q: What's triage?
A: Triage is when someone evaluates the case when it comes in: Is it complex? Who does it need to be assigned to? Is it a medically fragile child, because if it is, we have someone who works with medically fragile children. We also have someone who works on mental health issues, and another on geriatric cases. We also have a case manager that works on our palliative care program.
Q: What's the palliative care program?
A: It's a program for members who may be at the end-stage of their disease process, but they're not yet ready for a hospice. What's different about our palliative care program is I have a social worker that goes out and provides home visits to members, and it's more focused around helping them establish their advance directive care plan and supportive services. It's sort of pre-hospice. We work with people before they go into hospice, to help them transition into hospice care much more easily.
Q: What's a typical recent case that you worked on?
A: Well, right now what comes to mind is some of our members who are end-stage, meaning terminal illness, and really trying to help them understand what their benefits are and about advance directives.
Q: Advance directives? What's that?
A: Oh, you know, the whole Terry Schiavo thing -- making sure they leave advance directives.
Q: That's like a will?
A: It's for patients to establish how they want their care to be, and it's not limited to ventilation or CPR. It could be as specific as where do you want to be -- I want to be at home, I want music playing -- and if they're in the hospital, what the physician should be aware of in terms of the technology. Do you want to be on a ventilator or respirator, do you want CPR? Our role really is to empower our members so they can better navigate the system.
The other thing we do is work with the families. That's where conflict sometimes happens. Our medical system sometimes requires advance directives, but our culture here is really family-based, and patients rely on their families to help make decisions. So a lot of it is our case members help our members and their families through these difficult processes.
Q: Do you tend to get emotionally involved in your cases?
A: Yeah, you know, it's tough. The type of situations we have are very emotional, and it's important to have a good team to always check with each other on how we're doing. It can be very emotionally draining.
Q: Why does HMSA offer this service? Is it to save money or what?
A: We're not a program that is reporting savings. We're really more member-focused. The organization has this so our members who have complex needs can have access to individuals who are trained to be able to coordinate care. I don't think people realize that HMSA was actually started by social workers, nurses and teachers back in 1938, so it really fulfills the mission. Our mission is affordable health care in the community. But more than that is the kind of services we are building for the community, and having case managers helps provide members the service of coordinating care.
A: We have extensive training -- extensive. HMSA is very supportive when it comes to continuing education. We have internal education opportunities, we go to conferences. We're required to get certification in our area.
Q: As a case manager, do you ever fail to achieve what you're seeking, like if you apply for insurance coverage for something but it doesn't qualify?
A: Oh yeah, we deal with that a lot. Especially when we're in situations where there's benefit maximums and the clients have met their maximums. So what we've learned to do is work with the community and help our members access the next available resource. We have to coordinate with other programs, such as the Department of Health programs and so on.
Q: How long have you been doing this?
A: I'm going on my 14th year. I can't believe it. I always count it by going by the age of my daughter. I started here when she was a baby, and I never thought I'd be here this long. I chose HMSA because it had a gym where I could work out during my lunch hour and after work, and it was very family friendly.
Q: What were you doing before?
A: I had been a social worker on the mainland. I was working with several different retirement communities in Arizona.
Q: Is that where you grew up?
A: No, I'm actually a local girl. Went to Pearl City High. Went to UH, got my undergraduate degree in social work. I enjoyed geriatrics, so I thought going to Arizona retirement communities would be a good opportunity, so I went.
Q: What brought you back?
A: Having my first grandchild for my parents. So I came home for them, and between a wonderful place to live and raise a family and a great place to work. I'm still here, 14 years later. (Laughter) And there continues to be new opportunities that always make this job a challenge. It's very nice.