By now, I am sure you have heard about the killing of Brian Thompson, the CEO of United, that occurred in Mid-town Manhattan on 12/4/24. The killer has been caught, and the police investigation is ongoing. Hopefully, we will gain more insight into this heinous crime as time passes.

What has been alarming is the reaction from the public that the killing was based on how healthcare insurance companies are using cost-cutting methods to deny care to people to increase profits for the C-Suite and shareholders. Violence or this murder will not fix the inequities that are happening in our complex healthcare system. It will take a team of stakeholders (including the general public – Patients and Caregivers) to revamp a system that seems to have lost its mission.

As a nurse case manager, I see this outcry as a warning to all of us to be careful and take safeguards when we are confronted with threats from people who feel they are wronged by decisions made through guidelines, policies, and laws.

Why is workplace violence exceptionally high now? According to a recent study by Liberty Mutual, here are a few reasons:

• COVID-19 both exacerbated existing sources of violence and opened up new areas of confrontation between healthcare providers, patient families, and the general public.
• The national opioid crisis has led to a rise in drug theft that can turn violent.
• A shortage of mental health resources — combined with increasing pressure on these resources — means more patients wind up in crisis in hospital emergency rooms.
• Hospital environments can trigger fear of illness and pain, which in turn may unleash aggression. Long wait times and overcrowding can exacerbate aggravation.
• Patients in healthcare settings may be experiencing conditions that increase agitation and aggression, such as head injury, withdrawal, or dementia.
• Violence in healthcare across all sectors is increasing due to changes in laws and rules that have limited or made resources harder to obtain.
• Insurance companies’ mandates appear to put profit before safe patient care.

Most people do not understand how the healthcare system works or how healthcare insurance works, as it is not like any other system we utilize in our lives. People feel they do not have a say in the system and are at the mercy of people they don’t know and who do not seem to have their interests at heart.

Healthcare is expensive, and there is little explanation or alternative when a person or loved one is sick. Insurance guidelines are complex and do not mean a lot to the end user, the patient/caregivers. To the average person, insurance companies dictate care instead of the treatment team’s advice. There is an ‘us’ vs. them battle.

Nurse Case Managers, Claims Adjustors and Patient/Health Advocates are the face and voice of the healthcare system. Even though managed care doctors and hospitalists make decisions, WE deliver the news and take the brunt of the patient/family’s feelings. This can put us at risk, so it is important to be alert and have safety protocols.

So, what can nurse case managers do to stay safe? I would ask each of you reading this post to share what you and your organization are doing to keep you safe. If you don’t see any action, bring it up at your next staff meeting.

Here are some tips that might help keep us safe.

1. Approach the situation in a safe environment. If you are face-to-face with someone when delivering bad news, ensure you are in an open environment with help available in case the conversation escalates.
2. If you are threatened, report it right away. Call security and get to a safe place.
3. Do not escalate the discussion. Try to humanize what you say and let the person you are talking to know that you are listening to them.
4. Bring leadership into the discussion and work your way out of the discussion.
5. If you are on the phone with a patient or the family, follow your company processes regarding what information you give out. For example, your first name only so you cannot be found in a directory. I see this more or more…where insurance company personnel do not give the public their last names, director’s phone numbers, or specific information.
6. If you must deliver bad news, bring a solution. Work with the treating physician and administration to find a way to meet the client’s needs. You might be the only person who will do this, but it is an integral part of our role as nurse case managers.
7. Use your contacts to find organizations/suppliers that will work with you to meet the patient’s needs, a discounted cost for self-pay patients, and medication for the patient to take if they cannot afford what was ordered. Ask if there is a payment plan for someone with a large balance due to a high deductible and who does not have the money to pay. Try to find a way to work with the individual. Many people need to understand the impact of high deductibles better when signing up for their health plans. Be patient and try to find a workaround that will meet their needs.
8. Take time to educate your patients on how their insurance works and how to use it best. Employers need to do a better job of educating employees on their policies. People need to know their out-of-pocket costs and are urged to set up savings plans or save money to pay for unexpected healthcare costs. Many people choose to high deductibles to keep premiums lower but do not have the money to pay for care costs until they reach their deductibles. In addition, deductibles are reset annually, so this is an ongoing issue, especially for those with catastrophic or chronic medical problems.
9. Insurance companies have a responsibility to educate their members so they are aware of how policies work.
10. If you are a field, hospital or insurance case manager and have to deliver news that will be hard for a patient or family to understand, try to find a workaround….As a fellow case manager has said, “We are not 1-800 Hell No Case Managers!” We need to take those extra steps to find the resources to meet the patient’s or family’s needs.

The system is complicated, costly, and, at times, unfair. Our roles are not easy, and many people feel helpless due to their illness or inability to address the situation.

We each have a role in humanizing healthcare and making it safe, effective, equitable, and within reach for all when needed.

I hope this article sheds some light on the state of our healthcare system. We are in very precarious times.

The bottom line is to stay safe. Do what you can within your scope of practice. Report anything that might be suspicious or cause you harm, and stay safe.

If you want to comment on this post, please comment in the comment box below or email me at allewellyn48@gmail.com.