I'm Vanessa Katon, D.O., Medical Director for Maine ASO Contract and Kepro EAP. I began working with Kepro in October of 2019. I live in nearby South Portland, Maine. I enjoy being outdoors and traveling when possible. Some of my favorite experiences have been hiking in Arizona, snorkeling, sailing on a catamaran in St. Kitts, and ziplining over the rainforest in Costa Rica. Iceland is on the list of places for me in the future, and I would like to bike the countryside and visit the hot springs. It would be a dream to be a part of a travel documentary series experiencing different countries and their natural wonders.
I received my medical education at the University of New England College of Osteopathic Medicine in 2013. I am board certified with the American Board of Psychiatry and Neurology in General Psychiatry and Child & Adolescent Psychiatry. I initially began my Psychiatry Residency Training at Good Samaritan Regional Medical Center in Corvallis, Oregon, from 2013-2014 and completed my Psychiatry Residency and Child & Adolescent Psychiatry Fellowship at the Institute of Living in Hartford, CT. After completing my training, I worked with Maine Behavioral Healthcare as an Outpatient Child & Adolescent Psychiatrist in Biddeford, ME. I took up the role of Regional Medical Director at Maine Behavioral Healthcare in Biddeford, ME, before coming to work with Kepro.
Kepro has wonderful people here throughout the organization, and I especially enjoy my Maine ASO team and being part of that team. It is hard to imagine doing this work without the team we have.
A typical day can vary depending on scheduled team meetings, reviews, state meetings, corporate meetings, etc. Still, a typical day usually begins with preparation for the planned second level reviews for that day. Second level reviews typically involve a mix of reconsiderations and formal Fair Hearings related to previously denied or partially authorized services. Reconsiderations are typically scheduled meetings via phone conference requested from a provider to allow for additional information and discussion of clinical content related to a specific member case to determine if eligibility or medical necessity can be met for service approval. A reconsideration happens in 30-60 min, depending on the service in review. Depending on the service in question, a Fair Hearing takes place in 45 to 90 min. At Fair Hearings, I represent Maine DHHS as their contracted third party to present the information and rationale that contributed to a determination on a service to a hearing officer and the member.
I have the opportunity to interact with our members during second level reviews that occur weekly to every other occurrence depending on how many Fair Hearings are on the schedule and the type of service in review for reconsideration. While a reconsideration request requires a provider to be present to provide additional clinical information, it is common for parents of child members or for adult members to join on these calls in a given week if the service in review is a higher level service. Fair Hearings require a member to be present, and often a member requests a provider to also testify on their behalf. At Fair Hearings, members can ask me questions about their case and presented information. I have the opportunity to ask any questions I may have following their testimony.
I typically start the day with a thorough review of new cases, consulting our clinical team during the reviews, working with our local clinical leadership team on meeting InterRater Reliability expectations, attending local Leadership meetings and Clinical Team meetings. I also participate in regular discussions with the State of Maine offices we work with as scheduled. In the past year, the Maine ASO team has worked closely with the Maine Office of Child and Family Services and Office of MaineCare to prepare for our role as Qualified Individual for Qualified Residential Treatment Programs. We have had an incredible team of folks for this implementation which had a soft launch on 10/1/21 and when fully live with new state policy in place on 11/1/21. In preparation for this work, I provided consultation and participated in clinical team meetings with our assessors to ensure reliability in our assessments and process. I am very grateful to my Maine Leadership team members for their work and significant contributions in these meetings. I am also incredibly grateful to have a wonderful group of QI assessors for this work; our assessors are fantastic and rose to the occasion. It was a pleasure to work with them and review cases and assessments during this process.
Lastly, in addition to local Maine contract responsibilities, my role as EAP Medical Director at times involves consultation regarding reportable events such as cases involving Duty to Warn or Mandated Reporting, Return to Work review and approval, and weekly review/sign-off of EAP Credentialing. I also review materials, join corporate AdHoc Credentialing meetings, and alternate as the Adverse Incident Committee chair.
I approach each review as an opportunity to try to help the provider/member in any way I can. I typically work to help them understand and consider services that are exemplary at the right time. That typically involves providing education and guidance as to what contributed to the initial decision on a service request to prepare better for future requests they may make for their clients. Sometimes even when there is insufficient information to overturn a decision, I have seen my efforts to educate and explain things help a provider better understand other services they could consider that may be better suited to the member. It is always a highlight when a provider demonstrates understanding and appreciation of the time spent explaining things further despite the case's outcome.
Despite the seemingly challenging parts of my role, I work hard to help the provider or member understand the reasons for the decision. These efforts lead to opportunities where providers or members learn a bit more and can often get additional information to support many previously denied requests. Having a second level review process contributes positively to accessing necessary services through these scheduled clinical discussions and informative presentations.
Since 1985, KEPRO has helped more than 20 million members lead healthier lives through clinical expertise, integrity and compassion. KEPRO was founded by physicians and clinical expertise is at the core of our organization.
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