April 28, 2025

You may or may not know that I am an insulin dependent individual, having been diagnosed with diabetes over 30 years ago. As a result, I take insulin before each meal, and at bedtime I take a long lasting insulin. My wife does the same as she is also insulin dependent.

Over the past year there have been cases when the insulin we take is in short supply . Demand is greater than supply. That has varied, and generally there are alternative insulins available. Both my wife and I have Medicare Health Insurance and we pay separately for the Medicare Plus Prescription Plan. Our insurance carrier for prescriptions is the “Wellcare Corporation,” now owned by Centene Corporation.

I have written previously that one needs to be an advocate for their own health.

As you all know, most of the healthcare companies have a call center, and that call center is located overseas. However, there are major cultural differences that exist, and most of the time the operator is reading from a script. Try to find an address for a company today, or even a telephone number, almost impossible. If you look at their websites, almost all do not show either. They don’t want to be contacted by their customers.

On April 9thof this year, I received a new prescription for my long lasting insulin. It was sent to the pharmacy and I was told that it was not in stock. As soon as it was available, it would be filled. As of today, it is still not in stock. I tried calling the customer service department of Wellcare, and that was a disaster. Over a period of three days, I spoke to them at least 4 times. Twice we were disconnected, and the other times I asked what options were included on their formulary? A formulary is a list of drugs that are covered by a prescription plan. I never got an answer, and was told I could fill out an exemption form that would allow for a drug outside of their formulary. I was told that this could take 3 weeks or more. Obviously, not a satisfactory solution.

I searched the web and finally found what was supposed to be the email address for their President, Michael Carson. I sent him an email and it went somewhere, but I never heard anyone in return.

I also went to their website, and found a contact form that I could fill out on line. After completion, it would be emailed to someone at Wellcare. I completed the form and sent it in, and in a short time, I received an email back telling me that there were two other long lasting insulins on their formulary, and gave me the names.

I contacted my Physician at UVA Health, and gave him the names of the other approved insulins. I received a phone call from the Physician’s nurse to tell me that they tried to process each of the substitutes, but they received a message “that they were not covered.” Who is on “first base?”

Shortly thereafter, I received another call from my Physician’s office to tell me that the UVAHealth Pharmacy had located the original insulin, and would be filling the prescription, and mailing it direct to me. It is scheduled to arrive by the end of this week.

Today, I sent another email to the President of Wellcare, describing what has happened. I don’t have any hope that I will get a response, but it made me feel good.

Well, this experience leads me to believe the healthcare system in this country is truly broken, and no one is even trying to improve it. I have had that feeling for sometime. How can our legislators, healthcare executives and others continue to allow this to happen?

In my last life, I was a co-founder of a Medicaid Managed Care Company. My two co-founders, and myself, had no healthcare experience when we won a contract in Philadelphia to manage the health of 85,000 Medicaid recipients. We did have government contracting experience, and that was what allowed us to be successful. We received a monthly stipend per individual, and we were responsible for seeing that their healthcare needs were satisfied.

The Commonwealth of Pennsylvania was transferring all risk to us. Essentially, a fixed price contract. If we were successful in managing the members care, we made money, or if not, we lost money.

We had to contract with the providers: hospitals, physicians, pharmacies, etc. This would be the “network” where our members would receive their healthcare. We also had to establish an organization to manage these activities, including claims processing and customer service. We set up a call center in Philadelphia, and found that we needed to staff it with college graduates, who could make decisions based upon the members requirements. This proved to be one of the pillars of our success. We could have followed the practice of going to Asia where the cost would be less, but we would have had more issues. This was also a training ground for upward mobility for the employees. A win, win, for all.

We later expanded the business model to New Jersey, New York City and Michigan. We also expanded our operations, by purchasing a company in Arizona for all of our data processing needs, as well as claims processing. We centralized a call center in New Jersey for all operations. It wasn’t difficult, but you needed to understand what was happening in each operation.

We contracted with a commercial healthcare carrier for our employee health benefit program. We were not legally allowed to include them in our Medicaid Plan. As a result, our Medicaid members had better healthcare, at a cost less than what we had to pay for our employees.

We made an effort to visit each operation weekly or bi-weekly, and walking around the offices, and talking with the employees, as well as meeting with the managers. The discussions with the employees was most valuable, because it gave us insight to real world problems, and issues, that could impact our operation. This allowed us to quickly make adjustments, where necessary. Each operation had their own management team. They embraced this process and began “Managing by Walking Around” also.

“Managing by Walking Around,” what a unique process. No it wasn’t. This was something that I first discovered in 1966, when I was working at Fairchild Hiller in Hagerstown, Md. We were an aircraft manufacturer, employing 4,500 employees.

We were producing the F-27 & FH-227 turboprop for small regional airlines, the FH-1100 Helicopter for commercial customers, the Pilatus Porter for Air America in Vietnam, and undeveloped areas of the world, and we were a sub-contractor to Boeing on the SST, 747, and 720 aircraft. We were also modifying C-123’s for the Air Force to use in Vietnam.

We had production issues, and aircraft were not coming “out the door” on schedule. As a result, we were experiencing delays and cost overruns. This was the first time that a helicopter was being produced in a facility with fixed wing aircraft. This was always considered a no, no, in aircraft manufacturing.

Fairchild had purchased Hiller Aircraft, a helicopter manufacturer in Palo Alto, CA., and moved the operation to Hagerstown. I had just been promoted to Director of Finance and a new General Manager had been hired from Martin Aircraft. He was a manufacturing executive. He had grown up in manufacturing and was not a college graduate. However, he was one of the most talented individuals that I ever had the opportunity to work for.

Every morning, he would spend an hour walking around the manufacturing floor, talking to the workers, and asking them, what would it take to fix some of the manufacturing issues? Where was the bottleneck? How could things be improved?

He required me to accompany him each time he went out onto the floor, and as a result, I found out how my finance organization could assist the manufacturing departments do a better job. One of the major issues that we discovered was that no one knew where work orders where, in the manufacturing process, and what was causing delays . This was a critical factor in getting the manufacturing process streamlined. As a result, I was able to get my Management Information Department to work with the Production Department heads and develop a new work order system. The new system would produce a report each day that would indicate where all the work orders where, and if there were delays, why and how could that delay be fixed?

As a result, the factory workers were involved, and saw that management was trying to make their job better, as well as produce better financial results. In six months, production was moving as it should, and aircraft were moving out the door, on schedule. Another benefit was better communication between management and the workers. A win, win for both.

“Management by Walking Around.” That term wasn’t coined until 1982 by management consultants Tom Peters and Robert Waterman in their book , “In Search of Excellence: Lesson’s from America’s Best Run Companies.”

Their book was the result of research that they had done on successful companies, and why they were successful. What they found was that C.E.O.s, and other top managers, were spending time in their operations instead of all of their time in their office. As a result, they were able to identify issues sooner, and do something about them. The key to “Managing by Walking Around “is to talk to the workers, the ones doing the work, and find out what were their problems, and how could the work be done more efficiently?

This was the key to turning around Fairchild’s production issues, and to our success in the healthcare industry. It appears that many of the companies today have missed the message. I believe this concept is as valuable today, as it was 60 years ago, except it isn’t used that much by C.E.O.’s and top managers. If it were, many of these customer service call center problems could be solved, as well as other management problems.

Sentara Health hired a new C.E.O. a few years ago. He announced, that for the first three months, he didn’t plan to be in his office. He was going to visit all of their operations and meet and talk to the employees. This would give him a good idea of things that they should be working on, to be more successful, and user friendly.

The new C.E.O.of Boeing has been doing the same thing. He has been spending a great deal of time on the production floor, trying to determine the cause for their production problems. Good for him, this is what more top managers should be doing.

One of the things that Peters and Waterman found, was that “the relaxed and regular communication has been shown to improve relationships and make subordinates feel more motivated about their work.” Never a truer statement!

“Managing be Walking Around” makes you aware of what is happening around you. What a unique concept.

Today most top managers fall into the Generation X category, born between 1965 and 1980. As a result, they are the first category of managers that have been born into the tech era, computers and IPhones. One on one discussions are not a strong point of this generation. They would rather communicate by texting or email. What a mistake. If they only knew what they were missing!

It is too bad that today we don’t go back to the 1950’s and 1960’s to see how successful companies operated. They didn’t have all of the technology and data that is available today, but they made use of what they did have. We can always learn a lesson from history.

Jess Sweely

Madison, Va.