Shannon Boling shares her passion for patient advocacy and her team07/21/22 12:07:pm
Shannon Boling, executive director of utilization review, wants to clear up any misconceptions about what she and her team do.
“People often think of utilization review as an administrative function, working only on the insurance side of cases,” says Shannon. “That’s true in many organizations, but at Rogers, we are so much more than that.”
The utilization review team works with insurance companies to obtain initial and ongoing authorization for treatment, in addition to handling appeals and claims issues. Shannon says patient advocacy is the most important part of the job.
“My team is passionate, and they are good at what they do,” she says. “Patients call us when they’re anxious about ongoing coverage. We help keep them calm and reassure that we are fighting for them. Even after discharge, we are often still advocating for patients by working through their appeals and making every effort to get denied days overturned. That work has resulted in returning $750,000 back to the Foundation this fiscal year, which is money that can go to other patients in need.”
This November will mark five years since Shannon joined Rogers. She began as the director of utilization review and was promoted to her current position six months ago. Shannon oversees utilization review for Southeast Wisconsin and the outpatient clinics across the country. Managing a team of 70 people requires constant communication, she says.
“I connect with my leadership team in the morning, and we meet in the afternoon daily,” she says. “I want to know if there are cases we’re having trouble getting insurance coverage for, any we anticipate getting a denial on, or anything that needs to be escalated. If there are concerns, I take those cases to clinical leadership.”
Shannon says another key part of her job is meeting with payors to build relationships and showcase what Rogers does with the goal of helping patients.
“I have regular meetings with all our larger payors to review issues or concerns, as well as collaboration opportunities,” she says. “We’ve had a decrease in denials consistently year over year while increasing length of stay. When payors have a better understanding of what we do, they understand why we’re asking for the treatment time. It’s better for the patient, and less expensive, to have an extra day or two in treatment than to have a readmission.”
Shannon is excited about a data sharing pilot she is currently involved in with Children’s Community Health Plan (CCHP), affiliated with Children’s Wisconsin, which she hopes will be a model for use with other payors.
“The data sharing agreement with CCHP allows us to see where our patients are readmitting outside of Rogers,” she explains. “These agreements give us the ability to leverage data science techniques to pick up on predictive factors to determine who might be at risk of readmission. We are able to identify those at risk, and we can provide targeted intervention in real time to help prevent readmission.”
Shannon says advocating for patients and families is rewarding, and she is proud of all her team does.
“They are the unsung heroes,” she says. “It brings me joy to see not only how fun and supportive they are of each other, but also their hard work. I’m very grateful to have such an amazing team. They fight hard, and they make a difference for our patients and families through their advocacy.”
She recalls a former patient case that showed her Rogers’ Mission in action.
“I received a call on a Friday afternoon for a child in residential where insurance issued a denial for continued coverage,” she says. “The parents were halfway across the country and frantically trying to get a plane ticket to get their child. We were able to keep the child through the weekend while we worked with insurance to appeal. That gave the family time to breathe while we discussed options. I know we are a business, but Rogers puts patients first. The kindness and generosity of Rogers is something I have never experienced in any other behavioral health company. It’s very impressive, and I’m proud to work here.”
Getting to know Shannon
Shannon was born in Michigan, lived in Minnesota, and now resides in Louisiana with quarterly trips to Wisconsin. She loves living a few hours away from beaches on the Gulf of Mexico. Shannon recommends visiting New Orleans and eating at Olde Nola Cookery for the best gumbo and etouffee, walking the riverwalk, and sitting on a patio on Bourbon Street where you never know what you will see.
She has two “amazing” boys, 16-year-old Noah and 18-year-old Ethan. Noah is the chef of the family and is considering a career in culinary arts. Ethan works at the Blue Zoo Aquarium in Baton Rouge and is dive-certified.
Shannon adores pugs and is a member of two pug rescue groups. She is actively involved in the rescue and loves adopting seniors. She has two pugs of her own, Otis and Darlene, who are “spoiled rotten” and are the utilization review team’s mascots.
She is also an avid runner and runs as many as 12 miles a day to decrease stress and clear her head.