When Robin Roeder needed advice on moving forward with her cancer care, Sanford Health Plan case manager Mindi Smith was there for her.

Written by Mick Garry

Robin Roeder (guest): Cancer is exhausting. It's an exhausting, lonely journey. And to have Mindi there, she was my go-to. She was, she was like my Superman. I would tell people I have a rockstar case manager and I'm not afraid to call her.

Narrator: This is Health Insurance Simplified, a podcast series by Sanford Health Plan. The conversation today is about the value and importance of tools like Healthy Pathways, Sanford Health Plan's care management program. Our guests are Mindi, a lead case manager with Sanford Health Plan, and Robin, a cancer survivor, and a champion on how the program helped her during her cancer journey. Our host is Mick Garry.

Mick Garry (host): Hello, I'm Mick Gary. I'm a writer for Sanford Health News and we are here today to talk about Sanford Health Plan's care management program, Healthy Pathways. We're going to learn more about how it can be a vital tool in helping people sort out some of the complexities of health care.

So how can Sanford Health Plan's Care Management services help you to help with that? Today we have Mindi Smith and Robin Roeder. Mindi is a Sanford Health Plan care manager, and Robin is a Sanford patient whose cancer recovery has included a lot of moving parts.  Throughout this process, Mindi has been there for Robin, helping her navigate the healing process.

So here we are. Let's hear this story. Let's start with Robin. Tell us a little bit about your health journey. Give us a little bit of context for where this started for you.

Robin Roeder (guest): I was diagnosed with a rare and aggressive cancer called mucosal melanoma. In October of 2016, I had surgeries to obtain clear margins sentinel lymph node biopsy. There is no lymph node involvement, and I chose to do six months of a harsh chemo, Cisplatin and Temodar. And as of May of 2017, I finished the chemo and I was declared in remission. I stayed in remission, actually, NED, which stands for no evidence of disease for six and a half years. April of 2022, I came into Sanford for my first annual PET scan, and lo and behold, a pesky lymph node lit up. And that started this two-year journey. After the diagnosis, there was a biopsy, and it was determined it was the mucosal melanoma. I did four infusions of Ipi Nivo, which is Opdivo Yervoye. I finished that in October, end of October. And within 10 days I developed acute pancreatitis, and I was hospitalized for that.

I got out of the hospital on Friday and Monday after I was refused a PET scan because of high glucose, I thought his machine was broken. In fact, I told him his machine was broken. Mindi called me that night and at first I thought she was selling something and I, and I was a little delirious because I had really, really high blood sugar level and incoherency is part of that. And as I got to talking to Mindi, I realized, you know, she's not selling anything. She's calling here to help me. That's the night Mindi saved my life and sent me to the ER.

Mick Garry (host): How are you feeling today?

Robin Roeder (guest): Today my cancer has come back. It's in two spots. I am taking part of a clinical trial at Sanford, which involves nanoparticles, sounds kind of space age, and it involved radiation. And right now, I'm doing Keytruda, otherwise known as Pembro. I have scans at the end of next month and to restage the cancer and see where we're at.

Mick Garry (host): So how did you find out about this care program? How did you get aligned with Mindi?

Robin Roeder (guest): She called me after I was hospitalized as a follow up after you get released from the hospital to see how I was doing. And that's when I started telling her about how I was feeling. And she guided me to the ER that night. And then she has continually followed up with me and called to see how I'm doing. As I travel this journey, I got a referral to a major cancer center that's familiar with this rare cancer. It's so rare that not every doctor, in fact, it'll take two and a half careers for a doctor to see mucosal melanoma. So I wanted to not only have my team locally, I also wanted to have a high-volume team on board. And Mindi was instrumental in all of the hiccups and setbacks that accompanied that referral.

Mick Garry (host): What was it like to all of a sudden have this resource when I'm sure that, as you described it, a hundred things coming at you a hundred times a day, to have this resource where you could make this call and you're going to be able to talk to somebody who could give you some information that's going to help you?

Robin Roeder (guest): Oh, it was, it was such a relief. I mean, cancer is exhausting. It's an exhausting, lonely journey. And to have Mindi there, she was my go-to. She was, she was like my Superman. I would tell people I have a rockstar case manager and I'm not afraid to call her. So, she really took a lot of the load off of me, not only with her medical knowledge, but her knowledge of how the systems work, how the authorization process works, how everything in the insurance realm works that most patients aren't aware of. Not only her medical knowledge and her knowledge of the systems, but the mental health and the emotional support. I mean, there were times I called her in tears, and she would talk me down from the ledge and say, okay, how are we going to come back from this? And she was just a great support.

Mick Garry (host): My next question was going to be how do you describe what she does when you're talking to other people? And you've kind of touched on that a little bit about that, my goodness, you've told us that she's been a huge part of your recovery and continued treatment.

Robin Roeder (guest): Oh yeah. I have a support group, a Facebook support group, that's been also very instrumental in my journey. And there are times when there's another warrior that is having issues with out-of-network referrals, and I'm like piping in right away going, do you have a case manager? You know, this is what my case manager did. You need to contact your insurance and see if they have the case management program and get your case manager on board and your journey is just going to be a lot easier. And with Mindi, and she would always say, “I'm going to take care of this. You just focus on you.” So, I was able to focus on my health and what I needed to do, and Mindi took care of the rest. And I call it noise. She took care of the noise.

Mick Garry (host): Mindi, can you tell us a little bit about what you and your colleagues do? What are your priorities? How do you get through a day?

Mindi Smith (guest): Absolutely. So, at Sanford Health Plan, we have what's called a care management program. It's a group of qualified individuals that specialize in a variety of different things. Within our program, we offer services to our members at no additional cost to their benefit plan. And those services can range from health care needs of all sorts, whether that's complex case management, transitional care, like leaving the hospital, which was what Robin fell into. ER services and end stage renal, oncology services, social work services and more. It's very individualized and unique to the member. And so we recognize that going through a medical condition is, is challenging and it's scary. And we want to be there to support our members in any way that we can. And we also recognize what a challenge it is navigating that while you're at home. And so our services are done completely telephonically over the phone. We're not there to take place of their care team. We're just there to help support, and that is individualized and based off of whatever the needs of the member are. And so we usually just do a phone call or two to those members once they're at home, we work towards helping them meet their goals. We help them navigate the system, we help provide resources for those that for depending on or, or varies, whatever the patient may need.

Mick Garry (host): Now we've heard about this infamous initial phone call. From your perspective, how did that phone call go? I'm just essentially asking because this is how you, you and Robin hooked up.

Mindi Smith (guest): Yes, this was our first initial call. She had been recently discharged from the hospital, which fell into my specialty of work. It was a few days after a hospital stay. So my goal was just to touch base with her, see how she's doing. We offer our services available to any member regardless if they've been in the hospital, regardless of what their condition is, but that service is offered to them and they can take it or not. And so I had called Robin, explained who I was and what the purpose of our call was, and just after a few minutes of talking together, realized she was having an episode of high blood sugar, which was new for her. And so we talked a few minutes on the phone and that's when I directed her to the ER just based from a, a safety standpoint. Her blood sugar was over 500 at the time. And so we left that conversation with the intent of, you're going to go to the ER, I'm going to call you in a couple days and check in and we'll see where this goes from there. So that was our very first initial encounter.

Mick Garry (host): How did you come upon this part of that this was something you wanted to do with your career?

Mindi Smith (guest): You know, I've been a nurse for about 16 years. All of that career has been within Sanford. The last two and a half years have been within the health plan. But previous to that, I worked in a clinical setting, a clinic that was pediatrics, family medicine, internal medicine, and OB-GYN. So I have a wide variety of experience, but I really enjoy making that personal connection and, and trying to help patients when they need it most. And so this career allows me to do all of those things. So it's an interesting career. We certainly don't always have every initial encounter happen that way where it involves, you know a medical crisis. But when those do happen, it's very rewarding on my end as well.

Mick Garry (host): I would guess that for a lot of people you, you have to explain to them exactly what the types of things that you could really help people with. And, and perhaps they aren't aware initially that people like you even exist. I would guess that that would be part of it too – to make sure that they know that these are things I can help you with and you should seek me out or, or one of my colleagues.

Mindi Smith (guest): Absolutely. And that's, you know, the whole message behind this is that when you're going through a medical condition or a crisis of some sort, the hardest job is to take care of yourself. You know, we want to take that load off for you. You should just be able to care for yourself. You shouldn't have to do the work of knowing what you need when you need. We have resources and professionals even within your own health insurance that could help you through that. And so that's the whole point of the story, is that we want you to know that you don't have to go it alone. We're here to help support you in any way we can. And we're not meant to know every answer, but we're meant to guide you along the way.

Mick Garry (host): Tell me a little bit about Robin and the rapport that you've developed with her over this time. And obviously it's something kind of special. That's why we're here today.

Mindi Smith (guest): That first call to Robin, certainly I make dozens of phone calls every day. So they're, they're not always this type of story, but that first call, she graciously picked up the phone. I explained what I was there for. She's a rock star in every stretch of the imagination. She listened, I listened back. We talked about what she was going through. I think we were probably only on the phone for about the first five minutes when the answer was, you know, I'm not a doctor, but my advice if I were you, is to go to the ER. And she accepted that advice. She followed it. I mean, she has done all the right things in terms of what a patient should do. She's put her trust in me just as much as I've put my trust within her. And so, you know, anytime that you go through a medical crisis alongside somebody, you're pretty bonded right off the bat.

You know, that first call really got our feet wet. Every call after that, you know, has only gotten us closer. And, you know, we've established a really good rapport and a really good bond. And I'm just grateful to be part of her journey. You know, this is her journey. She's a true warrior through this, and she has defied a lot of odds. And the fact that I'm just able to assist her is really what fills my bucket to being a nurse every single day. When you know that you can help people and when you know you've made a difference, you know, it's, it's one thing to be successful, but it's another thing to be impactful. And it's filled my cup just as much as it's helped hers.

Mick Garry (host): Robin, when you're thinking about how this has gotten to this point and somebody was going to just ask you how things are going, what are some things that you could tell people that you've learned about health system, about your cancer and all those things, about Mindi? What are some of the things that come to mind right away?

Robin Roeder (guest): How much time do we have? You know, I would not be here today if it wasn't for Mindi. And you know, she will not readily admit that. I mean, seriously, when she sent me to the ER, I walked into the ER, I was DKA, which means that I have too much sugar for too long in my bloodstream, and it is potentially a life-threatening situation with diabetics. And it was only because I showed up to the ER. Like, like Mindi said, my blood sugar was pushing 600 and we don't know how long it had been high. I was put on in the ICU and put on insulin drip. And if I would've waited, I might not be here today because of the DKA.

Mindi has helped me in so many other ways and taking the stress off, like she just made sure that before I showed up for any appointment, any scan, any test, any treatment, that the authorization was already there and I wouldn't have to worry about it. And that was huge. What I'd like to tell others about the Sanford plan is, Mindi, other than my oncologist, Mindi was the most valuable tool in my toolbox. I've said it again, I don't know where I'd be. I tell everybody, she's my rockstar. If people aren't using this service, they are missing a very valuable tool in their fight, in their journey. I can't strongly urge them enough to reach out and find their case manager.

Mindi Smith (guest): We're not just unique to oncology. That's the case here today. But if you are a Sanford Health Plan member, I would encourage you to reach out to the Sanford Health Plan. If you're looking for resources or guidance, or assistance with helping manage or navigate your condition, please call us. We would be happy to have somebody on our team visit with you and place you with one of our members that can help you through that. We don't want you to be alone.

Mick Garry (host): You can connect with a Sanford Health Plan team member to learn more or enroll in a program. You can call (888) 315-0884.

Explore Sanford Health Plan's care management programs for more information.