October 17, 2016
Founder of EK Health's Work as Case Manager Guides Her Business, Ethos
By Emily Brill
Victor Jimenez had been through it. Once 248 pounds of mostly muscle, an athletic build he had coaxed out through sports and sustained doing maintenance at a Sheraton Hotel, he weighed 178 pounds when he woke up in a hospital bed in 2012. Adjusting his eyes to the light, he saw his daughter-in-law, his son and Eunhee Kim.
He had met Kim a few years earlier after working up the guts to sue his employer, the contractor Marin Maintenance Inc., for mishandling his workers' compensation claim. In 2006, he was logging long hours at the Sheraton in San Rafael, California when he slipped while descending a ladder and banged his knee. MMI's insurer authorized a knee replacement, the surgeon botched the job and the contractor sent him back to work anyway, he said. He subsequently broke his kneecap, landed in the hospital and contracted methicillin-resistant staphylococcus, which spread to his shoulders, knees and heart.
Kim was his nurse case manager, hired on his attorney's recommendation. She ran interference with the scores of bureaucracies he navigated daily. Over time, they became friends. But Jimenez didn't expect to see her when he woke up after almost a year in a coma. "I wake up, and she looks at me and says, 'You're awake,'" Jimenez said. "And I said, 'How long I been knocked out?' and she said, 'Awhile.'"
Kim's demeanor is calm and thoughtful, but her wry humor doesn't surprise those who know her. What did surprise Jimenez, though, was to learn, as he did later that year, that he was not Kim's only patient. Not only did she handle a full caseload, he found out, but she ran two companies. "She takes good care of you, man," he said. "I find it hard to believe that this woman does all this work. I don't know how she sleeps or eats — plus, she's got a family on the side she's got to take care of."
Based in San Jose, Kim has been a nurse case manager for more than a decade. She watched the field — which she calls the love of her life — switch to digital record-keeping and add new regulatory requirements. But she hasn't just watched. She jumped in, designing software and programs to allow her to run her managed care practice better, eventually growing a full-fledged company out of her efforts — then another one.
"Starting a business was never a grandiose plan. It was because I was in it," Kim said. "You take one patient at a time, and you take care of them. It's a collection of all these experiences of problem-solving for the patient. That's how the business grew."
Kim started EK Health in 1998. She hired a team, forming the only group of bilingual nurses in managed care in the Bay Area at that time, remembers her colleague Anita Weir, who has worked alongside Kim for decades.
Weir and Kim met while working as nurse case managers in the Bay Area in the 1990s. Weir, who had about a decade of experience in the field when Kim started, was impressed by the newbie's approach: centered, comfortable, yet always on her toes. When Weir got a job at an insurer, she sold Kim the cases she had been managing.
In 2004, California passed a law giving employers the ability to get a second opinion on medical decisions affecting injured workers. Kim began assembling a team of in-state physicians with which EK Health could contract to perform utilization review.
Everyone in the industry was trying to figure out how utilization review would play out in practice, Kim said. With many employers, insurance companies and third-party administrators using paper documents, the statutorily mandated three-day time frame for UR decision turnover seemed daunting.
Weir remembers that time. She was working at Safeway, one of California's largest private employers, as the director of managed care. She saw that EK Health was getting into the UR business. She called up Kim. "I knew if anybody in the space was going do a good job, an ethical job, Eunhee would be one of them," Weir said.
Together, Weir and Kim built a record-keeping system for Safeway to digitize the utilization-review process. Kim realized that with UR in the picture, workers' comp would move more and more into the digital space. She and her husband, a software developer, talked about the need for increased programming in the system, and the two formed DataCare Solutions.
"I said, 'This is what needs to be built,' and that was really the beginning of a long chain of serious software development," Kim said. "There are so many inefficiencies in managed care that we see, and we want to tackle the inefficiencies by use of the software." Kim and Weir saw those inefficiencies at play firsthand. After creating a UR program, the two talked about incorporating bill review into the system.
"One of the frustrations Eunhee and I both had as field case managers was the fact we would negotiate with the physicians and providers, put together a plan of treatment and get the costs under control, and six months later, bills would come in for stuff we never authorized or at rates way above the rates we had authorized," Weir said. "We were doing good things up front, but the company was paying for bills at the back end that didn't match."
"About 20% of the medical payments we were making had not been requested," added Bill Zachry, Safeway's recently retired director of risk management. "We determined we would try to work out a process that would hook up bill review to UR. Prior to that, there was no system in the U.S. that could do that."
Zachry trusted Kim to build it.
"Her collaborative nature was such that she never came in and said, 'This is how you do it.' It was always, 'What do you want to accomplish, and how do you want to get there?'" Zachry said. "That made Eunhee unique. She didn't take a product and say, 'Here's the product.' She said, 'What are you trying to accomplish here?' ... and then she said, 'Let's work with you on figuring out how to get that done.'"
Communication greases the wheels of Kim's world. The CEO continues to work as a nurse case manager. She has one case with 28 people involved. At any given time, they're sending her emails, texting her and calling her, and tight communication is a must, she said. Flexibility and the ability to listen are, too.
"Being a nurse, our process of helping patients starts with the assessment. We have to really assess the whole picture — the whole life of them, what all the issues are — before coming up with any kind of specific plan of how we're going to help them," Kim said. "When you're nursing, you're not only supposed to look at one specific aspect of a disease. You have to look into their cultural background, their healing beliefs, their family support, their philosophical approach to general health. So I'm used to asking questions and digging deeper than what's on the surface."
Kim became a field case manager after spending 10 years as a home health care aide. She got into the field after handling some cases for a friend, a workers' comp case manager who developed cancer. Her friend told her she was good at it, and she figured the field would give her more time with her toddler sons, now 27 and 29. Now, she feels a strong call to remain in the field. "[Injured workers] have all these anxiety-producing experiences, and I felt like I needed to be there to either help them or become a means to get the answer so they have these tools to get better," Kim said. "I find it to be more important for a human being to be dealing with a human being suffering, and helping them to have less suffering."
She said bureaucratic holdup creates artificial suffering for injured workers already dealing with serious medical and psychological issues. When she spends time with someone like Jimenez, with whom she has worked for years, she wants the processes to move faster.
"Think of it as if you're making a UR decision for your family member. When in doubt, think of the patient. What would you do?" she said. "At the end of the day, have the patient in mind. It's a human being you're dealing with. It's not just another number. It's not just another request. We use technical terms that dehumanize why we do what we do."
Jimenez has been mired in the workers' compensation system for many years. He lives on $1,000 a month in Social Security checks while waiting to be declared permanently disabled, and he sued MMI for sending him back to work before he was ready. He has had to navigate hospitals, courtrooms, physical therapy offices and constant health care scares for a decade. A few years ago, he was diagnosed with cancer. After beating that, with "chemo pills" now added to his medicinal regimen, he developed kidney stones. He credits Kim for the fact he's been able to keep his head up.
"I used to play sports, and you always had a cheerleading team in your section. Eunhee has been that for me. She says, 'You're a warrior. Keep fighting. Keep fighting. You're strong, you can do this,'" Jimenez said. "That would encourage me and make me stronger." Sometimes, Kim encourages herself — like when she walks into a business deal and she's the only woman and the only non-white person in the room. She designed EK Health with a focus on bringing up female and minority executives. There aren't enough in workers' comp, she said.
"As the company grew and I had to deal with large corporations, it's quite intimidating to walk onto a stage where most of them don't see a petite Asian woman with an accent saying that I'm the president and CEO," she said. "So there was a trial period of how to overcome my own fear." If Kim cheers on Jimenez every step of the way, she said she has surrounded herself with people who do the same for her. "There's one female chiropractor who told me, 'Everyone puts on their pants one leg at a time, including you. Keep at it. You're smart,'" Kim said. "I needed a mentor who gave me that encouragement: Don't be afraid. You're smart enough. I moved from one country to another country with not much in my hands and came this far and I go, 'I've done far more daring stuff, adventurous stuff than a lot of other people.'"
She also dispels intimidation by focusing on herself and her patients. Nursing has grounded her since her teen years studying the practice at a Catholic university in South Korea. A self-described "bit of a black sheep" as a girl growing up in a family of brothers, she came to the U.S. — "a place where there was less disparity in how the men and women treat each other" — to continue her nursing studies at San Jose State University. Now, she's committed to her business and her patients, but to her, the two have never seemed altogether separate.
"It wasn't that I wanted to set up a business and be successful in business," she said of her motivations for founding EK Health. "I think it was because I am deeply in the trenches."
Article provided courtesy of WorkCompCentral