Insights from ISMIE’s risk management team

Risk Management Q&A: Felicia White, MHA

Felicia White serves as a Risk Management Specialist for ISMIE’s Risk Management team. In this interview, she reflects on her diverse healthcare experience – from working as a CNA in a nursing home to managing risk and compliance at a mental telehealth company – and how those roles ultimately led her to a career in risk management at ISMIE.

After many years working in several healthcare settings, I noticed that patient care delivery and treatment is not the same across the board, particularly for patients in need of mental health services. 

Through these experiences I developed my personal motto: If something can be better, then it should be. Regardless of whether a patient has private insurance, Medicare, Medicaid, or no coverage at all, the quality of care should remain the same. Achieving that requires designing systems to ensure that care is truly accessible to everyone. 

It was when I stepped into more administrative and compliance roles that I realized I could help even more patients access quality care by collaborating with others to develop standards and protocols for healthcare professionals to follow. This experience piqued my interest in risk management and ultimately led me to ISMIE.

When it comes to risk management, while I know there is always something new I can learn, clinical documentation has become my niche. Behavioral health is a lot about symptomology – what symptoms brought the patient in, what treatment was given, how do they respond to that treatment, what clinical intervention did you offer to help move the treatment along, and so forth. We call this line of questioning the golden thread of documentation, and I’ve carried this with me to my role as a risk management specialist at ISMIE.

I tie the line of questioning learned in my behavioral health background into all of my risk assessments because every specialty can benefit from a similarly detailed documentation process. To begin, I prepare for a risk assessment by looking for that golden thread of documentation: is there clear documentation; does the documentation state why the patient is seeking treatment; what treatment was given to the patient; how did the patient respond to treatment; were there any barriers to treatment; what interventions were done by the clinician to combat this; and is there a clear treatment plan in place (e.g., blood work, surgery, education, etc.). If any of these parts are missing, I make sure to educate the policyholder about the importance of thorough documentation. I enjoy these conversations and sharing my knowledge because it’s essential to keep meticulous documentation for all patients, even those who have been coming to your practice for years.

I’ve noticed that people are often apprehensive to work in psychiatric units or feel uncomfortable discussing mental health concerns, including self-harm or suicide, with patients. I think this fear stems from a clinician’s concern that the patient might be violent or that they may not know how to respond when someone mentions thoughts of self-harm, but these compassionate conversations are part of providing high-quality and safe patient care.

That said, I’ve recently been pleasantly surprised as I’ve seen more family practice physicians discuss mental health with their patients. During the assessments I’ve conducted, I’ve seen records that demonstrate doctors being diligent about referring patients out for psychiatric care when they don’t feel comfortable or lack the expertise to treat the patient themselves. It was refreshing to see that these physicians aren’t dismissing their patients’ concerns – they’re helping them find the care they need.

Definitely! There are two commonly used tools healthcare professionals can use to help patients with mental health conditions: patient safety plans and support plans. Patient safety plans are typically used with patients who have a history of suicidal or self-harm behavior. Support plans are used for patients with a history of mental health needs who don’t have a history of harm. Both tools help empower patients by teaching them how to control and manage their condition, ultimately giving them agency over their own wellbeing.

Safety and support plans teach the patient to: 

1.  Educate themselves about their mental health condition, including triggers and warning signs.
2. Learn coping mechanisms that help them calm down or de-escalate the situation. Yoga, exercise, socializing with friends, TV, books, music, etc. are some coping mechanisms that can help patients in a crisis. 
3. Surround themselves with their support system. The patient should identify family members, friends, significant other, guidance counselors, teachers and other people who can help make a safe space for them when they’re experiencing a mental health episode.
4. Know when to contact professionals for assistance; members of their treatment team might include their therapist, psychiatrist, primary physician and someone to help them manage medications if they take any.
5. Make their environment safe. For people with a history of self-harm, it’s important that guns, dangerous weapons and other potentially dangerous medications are not easily accessible.
6. Collect their crisis resources. If they’re experiencing a mental health emergency, and they’re still feeling overwhelmed and potentially unsafe after leveraging their coping mechanisms, it’s time to employ their crisis resources. Patients need to be aware of the multiple resources available and curate a list to contact when in need. Some resources include the national and local suicide hotlines, crisis text resources, and the Trevor project, to name a few. It’s key to include resources that are available 24/7 so they can get help no matter what time of day. Be sure to include 911 as well as the last resort.

Patient safety and support plans should be updated consistently and regularly discussed with the patient. Together you can tweak the plan if you notice their medication is not effective or if a coping mechanism they listed is not working for them. Patient safety plans and patient support plans are essential tools in mental healthcare that help to proactively manage risk, strengthen continuity of care and equip patients with strategies and resources tailored to their individual needs.

I want to emphasize the importance of providing consistent, high-quality care to all patients – regardless of their background or the size of your patient population. While there’s still much work to be done to improve our healthcare system, bringing compassion to every patient interaction can make a meaningful difference. No one should be prevented from receiving the care they need. 

Felicia White, MHA, has been with ISMIE since 2024 and brings over 15 years of diverse healthcare experience to her role as a risk manager. With a foundation in patient care, education, compliance and clinical documentation, she is dedicated to ensuring regulatory compliance and mitigating risks within organizations. Felicia has excelled in leading compliance documentation training, developing risk management policies and conducting clinical audits. Her expertise also extends to quality assurance and operational efficiency, honed through her experience managing member information, verifying benefits and developing training materials for new employees. Felicia holds a master’s in healthcare administration with a major in Quality Improvement in Healthcare from the University of Saint Francis, complemented by ongoing pursuit of an MBA at the same institution. Felicia is committed to fostering a culture of compliance, ethics and continuous improvement in healthcare.

The recommendations contained in this article are not intended to define conduct that is appropriate in every case, should not be considered as establishing any standard of care, and do not constitute legal advice. Physicians, clinicians and healthcare providers should take care to ensure that all care rendered reflects the best clinical judgment and complies with the laws and regulations of the state or location at which the care was provided.