November 30, 2020

The story you are about to read is part of an ongoing series about Texas Children’s efforts to care for women and children around the globe. The series highlights Texas Children’s efforts in Malawi, one of the 17 countries we currently serve. Today’s story focuses on the Texas Children’s Global Health Corps and how its members support the hospital’s mission.

The Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital (BIPAI) Centers of Excellence are supported by Texas Children’s Global Health Corps and the Dr. Kelly Descioli Global Child Health Residency.

The partnership brings doctors to countries where we work to learn, teach and help provide much-needed clinical services. Residents spend one year of their four-year residency program at one of our global health sites in Africa.

The Texas Children’s Global Health Corps is a successor to the landmark Pediatric AIDS Corps, founded by BIPAI in 2005, which has trained and sent about 150 pediatricians and family doctors to Africa to help scale up medical programs for children and families affected by HIV/AIDS. BIPAI, thanks in large part to its partnership with the Texas Children’s Global Health Corps, now provides HIV/AIDS treatment to about 320,000 children and families – more than any other program worldwide.

In Malawi, the partnership with the Global Health Corps has brought several pediatricians to the Center of Excellence there, including Amy Benson and Allison Silverstein, who talk in the following Q&A about their experience treating children with HIV/AIDS and other aliments in a low-resource setting.

Why did you choose to become involved in Texas Children’s Global Health?

Amy: After college, I was in the Peace Corps in Bolivia, and because of that experience, I knew I wanted to become a doctor and work in a low resource setting. Working in Global Health Corps has helped me reach that goal. It’s exactly what I want to be doing.

Allison: When I was in medical school, I took a year off between my third and fourth year and worked in Rwanda and Zambia doing policy work and helping to build research capacity. It was powerful but I wanted to be able to help clinically. I interviewed at a lot of residency programs but most connected with the model at Baylor and Texas Children’s. The way these organizations are truly building capacity and setting up this huge infrastructure to provide unparalleled care is how I ended up in the Global Health Corps.

Describe what you do in Malawi with the Global Health Corps.

Allison: Most of my time is spent in clinic at the Center of Excellence with pediatric HIV/AIDS patients. A typical day begins with a staff huddle that includes going over caseloads and doing a little singing and dancing to get us off on the right foot. Then, we see patients. Some of them are coming to the center to fill their medication or for a routine checkup. Others are sick and not feeling well, and we do our best to provide them with the best possible care. We see about 100 patients a day.

Amy: In addition to caring for patients at the Center of Excellence, I spend one week each month working at Kamuzu Central Hospital, the largest hospital in Lilongwe. At the hospital, I see children who have HIV/AIDS and have either been admitted to the hospital due to complications of the disease or who have been newly diagnosed. In addition to treating their immediate medical needs, I help get them hooked up with longer term services.

How has your work with the Global Health Corps made you a better doctor?

Amy: When I go outside of my comfort zone, it helps make me a better person and a better doctor. Being able to help take care of people and learn about people who have many different needs and struggles, helps me to understand people in a different way and to be more empathetic. And, that makes me a better doctor for sure, no matter where I’m working or who I’m working with.

Allison: I’m more thoughtful in my decision-making. When you don’t always have accessible imaging or the labs that you want, you have to rely on your clinical skills – your history and physical – and bring it all together to treat the patient.

Is there a patient or an experience that has made a significant impact on you?

Allison: I treated a 6-year-old patient who had recently lost her mother to tuberculosis. Not long after the mother’s death, the girl’s aunt brought the child to us with symptoms consistent with gastroenteritis. While treating her for that, we discovered the girl, like her mother, had tuberculosis. The girl’s aunt was devastated thinking she was going to lose her niece as well as her sister to the disease. But, she didn’t, and she was so unbelievably thankful for the treatment and attention we provided to that child.

Amy: What’s left an impression on me is the network of caregivers at the COE who work together to help these children and their families. For example, I was working in the hospital one day when a mom took her very sick baby home before she was ready to be discharged. One of our community health nurses knew where the woman lived, went to her village and convinced the mom to bring her child back to the hospital where the child could receive medicine for her newly diagnosed illness – HIV/AIDS. She made an effort to understand the mom and the reasons she had left and to offer the support that the mom needed to return. Without people like the community health nurses, that child might never have come back.

For more information about Texas Children’s Global Health Corps, click here. To make a donation to Texas Children’s global health efforts, click here.

November 23, 2020

The story you are about to read is part of an ongoing series about Texas Children’s efforts to care for women and children around the globe. The series highlights Texas Children’s efforts in Malawi and Colombia, two of the 17 countries we currently serve. Today’s story focuses on Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital and its network of Centers of Excellence that have saved a generation of children and young mothers from the ill effects of and possibly death from HIV/AIDS.

Phoebe Nyasulu has six siblings, only two of whom are still alive. Like many in sub-Saharan Africa, Nyasulu spent years watching HIV/AIDS erase the people she loves from her life. When she discovered she could have done something to help save them, she first became angry and then dedicated to advocating for the rights of people in Malawi who are living with the life-threatening disease.

“My goal is to make sure the people of my country know their HIV/AIDS status, and that if they are positive, link them to care,” Nyasulu said. “I don’t want others to die prematurely like my brothers and sisters did.”

In 2012, Nyasulu’s efforts to combat the spread of HIV/AIDS and help those who are infected led her to the Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital network. Over the years, Nyasulu has worked in various capacities at BIPAI’s Center of Excellence (COE) in Malawi and is now executive director of the program she and many others credit for saving a generation of children and young mothers from the ill effects of HIV/AIDS.

“Before BIPAI came into Malawi, children with HIV/AIDS were not accessing treatment and were left to die,” Nyasulu said. “Now, they are getting the medical care they need and are growing into healthy adolescents and young adults.”

A recipe for success

The groundwork for Baylor-Malawi’s operations was laid 14 years ago with the establishment of the Baylor College of Medicine Children’s Foundation-Malawi and the construction of the Baylor College of Medicine-Abbott Fund Children’s Clinical Centre of Excellence (COE) in Lilongwe. The center is part of what is the largest care and treatment network based at an academic institution supporting programs for HIV-infected and -affected children.

Providing care and treatment to nearly 300,000 children, BIPAI has established public-private partnerships in 10 countries across sub-Saharan Africa as well as Latin America and Romania. These partnerships now extend beyond the scope of HIV/AIDS and tackle other conditions in the developing world such as cancer, tuberculosis, malaria, sickle cell and malnutrition.

“The BIPAI network provides a solid framework for some of the best maternal and child health specialists in the world to share best practices and resources in care and treatment, medical education, and clinical and operational research focused on HIV/AIDS, tuberculosis, malaria, malnutrition, neglected tropical diseases and other conditions impacting the health and well-being of children and families worldwide,” said Michael Mizwa, the chief executive officer of BIPAI. “We are always looking for ways to expand the scope and reach of our services, never allowing anything to distract us from our commitment to children and families.”

Created in 1996, the BIPAI network was developed with the goal of improving the health and lives of HIV-infected children and families globally through expanded access to HIV/AIDS care and treatment, capacity building, health professional education and training and clinical research.

With initial support from Houston’s Sisters of Charity of the Incarnate Word, Abbott Fund and AmeriCares, the first center of excellence (COE) in the BIPAI network was created in Romania in 2001. Deaths among children with HIV declined from 15 percent to 1 percent and provided the first proof of concept for providing large-scale HIV treatment to children in a limited resource setting.

The Botswana-Baylor Children’s Clinical COE opened in 2003 with funding through Bristol-Myers Squibb’s Secure the Future program, and treated 1,200 children that year. The model proved to be a success and garnered attention from other governments, leading to centers being established in Lesotho, Eswatini, Malawi, Tanzania and Uganda.

When BIPAI entered Malawi, the country was experiencing an HIV/AIDS epidemic that was ravaging families such as Nyasulu’s. The country had little to no resources to fight the epidemic, misinformation was spreading about the disease and a negative stigma was quickly being attached to those who had HIV/AIDS.

“People were beginning to lose hope,” Nyasulu said. “They couldn’t see how to turn things around.”

A beacon of light

On any given day of the week, the Center of Excellence in Malawi’s capital is a hub of activity from the moment it opens in the early morning until it closes in the late afternoon. Often times, people are scattered across the facility’s lawn before its doors open anxious to get inside and receive the care they need to continue living with HIV/AIDS.

Some are waiting to see one of the center’s clinical workers, visit the center’s pharmacy to pick up medication or talk with a social worker, while others are there to participate in one of the center’s many programs aimed at helping adolescents adhere to their care program.

“Baylor-Malawi is the largest provider of pediatric HIV care and treatment services in the country,” Nyasulu said. “The COE in Lilongwe has an active case-load of more than 3,000 patients with 2,000-plus on medication. The average enrollment is 23 new patients per month. We are a very busy center.”

The center’s team also provides staff to support the pediatric ward at Kamuzu Central Hospital and Area 25 District Health Centre in Lilongwe, works in four busy government health centers in other areas of Lilongwe and performs outreach across the country. The team supplies technical expertise to various HIV technical working groups of the Ministry of Health as they consider various policy issues and management guidelines related to pediatric HIV.

Over the past decade, these efforts have helped make a huge dent in the number of people in Malawi infected and affected by HIV/AIDS. One of those people is Pacharo Mwachitete.

Mwachitete was born with HIV/AIDS and started coming to the Center of Excellence when he was 13. He is now 25 and is a mentor for the center’s Teen Club, one of the center’s various adolescent programs that focus on providing psycho-social and care and treatment support to young people with HIV/AIDS.

“I learned so much from the people I met at the center and through Teen Club,” Mwachitete said. “Without this place and its programs I’m not sure I would be here today.”

Doris Lidamlendo, a 19-year-old Teen Club graduate, agreed and said the skills she learned while in Teen Club taught her how to live with HIV/AIDS. She learned what to do when she was stressed, healthy eating habits, the importance of taking her medicine and more. Most of all, Lidamlendo said she met people like herself.

“Being able to hear how other people like myself have lived with a similar problem has always been a motivation for me,” said Lidamlendo, who recently finished high school and would like to go to college for either civil engineering or social work. “It has made me grow and I am convinced without it you wouldn’t be talking to the girl you are talking to now.”

Judy Lungu is the special projects and training coordinator for Baylor-Malawi and coordinates all of its adolescent programs, including Teen Club, Camp Hope, a Transition Training, Young Mother’s Program and a Teen Support Line. She said the goal of the programs is to teach young people with HIV/AIDS the importance of taking their medication and to convince them that they are not alone in their journey with the disease.

“We believe that for the health of the adolescents to improve and for them to live positively, they must understand that taking their medication is a matter of life and death,” Lungu said, adding that it’s often times easy for a young person who is feeling good and wanting to be more like their non-HIV/AIDS peers to decide to stop taking it. “We also feel it is important for them to know there are people like them who are going through the same thing, and that they are loved and are worthy of being loved.”

The programs Lungu runs are a tremendous success so much so the Malawi Ministry of Health and other partners have embraced the concept and organized similar programs across the country.

For more information about Baylor College of Medicine International Pediatric AIDS Initiative at Texas Children’s Hospital in Malawi, click here. To make a donation to Texas Children’s global health efforts, click here.

November 16, 2020

Since most of us have managed a household budget, this analogy will hit home.

The amount of money coming in matters. The amount of money going out matters even more.

The rate at which the money comes and goes is important.

And the ability to pay our bills on time is paramount.

It isn’t much different at Texas Children’s. Managing the organization’s resources is the work of several team members across multiple departments. Thanks to Epic Tapestry, the health care management system set to launch next summer, their work will be better informed, more efficient, more accurate and yield improved results.

A tale of two departments

For the third story in our series we are focusing on Finance and Claims, two departments that are directly connected to the management of the financial resources at the health plan.

Let’s take Finance first.

“We are thrilled to see Tapestry coming,” said Jenny Little, Vice President for Financial Services at Texas Children’s. “This new system will introduce automation to several functions that are currently manual. This will help free up the team’s time for more in-depth analysis to inform strategic decision-making. It will also help to secure the control environment of the Health Plan, which improves our accuracy and reputation with the State, our members and our peers.”

In addition to automation, Little says that Tapestry will provide more data and insights on how the health plan and the hospital can work together to propel our mission. This will not only inform and improve our financial performance, but it will also inform how we can truly help our members and patients.

“We’re talking about an ability to work more efficiently, and also have better outcomes with the work that we do. It doesn’t get any better than that. Because of this, we are hoping there is also increased job satisfaction for our employees,” Little said.

All of this couldn’t be done without the amazing Health Plan leadership team, including Ryan Thompson, Director of Finance and Christina Milan, Assistant Director of Finance. They are both leading the transition and representing Finance on this important transition.

Great gets even greater

Now, let’s return to our household budget analogy. Remember when we talked about paying our bills? This is where the Claims department comes in.

After our providers take care of our members, they submit a bill for their services – a claim. We accept or deny these claims based on a set of criteria. If we accept the claim, we pay for their services.

The Claims department is already doing an extraordinary job following a restructure and reignition by Director April Riggs. Under Riggs’ leadership, the department is performing better than ever.

“But we never rest on our laurels,” Riggs said. “And we too are excited to see Tapestry coming. Our workflow will significantly improve after the implementation. It will ensure that our systems are robust enough to guarantee the accurate and timely payment of claims.”

Riggs added that the pandemic has introduced new challenges, such as a need to process more claims for telemedicine and telehealth services. Her team has made the adjustments and Tapestry will be a great help if further adjustments are needed in the future.

But why is now the right time?

“COVID-19 showed Texas Children’s just how valuable the health plan is to the entire system,” said Little. “While the pandemic caused the hospital to lose money, the health plan made money – $95 million. In actuality, the health plan really saved us. Any investment in the health plan is an investment in the entire organization.”

Little added that having Mark Mullarkey at the helm during this time is significant. Mullarkey, who is the president of Texas Children’s Health Plan and an Executive Vice President for Texas Children’s, has a strong reputation for his focus on operational efficiency and results.

“We now have the right leader in place,” said Little. “And we know that makes all the difference.”

Missed the other stories in our series? Check them out!

The first one was all about Care Coordination and the Healthy Planet module.

The second one was all about Member Services.

On November 4, Texas Children’s Heart Center® leaders, alongside President & CEO Mark A. Wallace, gathered for an intimate ribbon cutting ceremony to commemorate the opening of the hospital’s first-of-its-kind facility for adults with congenital heart disease.

The 27,000-square-foot space, situated on the 24th floor of Texas Children’s Lester and Sue Smith Legacy Tower, includes a 16-bed inpatient unit, outpatient clinic, cardiac rehab gym, diagnostics lab and more.

“This is the #1 Heart Center in the world and it just got even better,” Wallace said. “Only at Texas Children’s is this possible, especially during this time and this era.”

That same day, the outpatient clinic saw its first patients in the new, state-of-the-art space.

“Texas Children’s has always been innovative in the treatment of congenital heart disease with Drs. Denton Cooley, Dan McNamara, Edward Singleton and others paving the way for this population that’s increased over time,” Dr. Peter Ermis, medical director of the Adult Congenital Heart (ACH) Program, said. “We’re picking up their mantle and carrying on their legacy, and I think it’s appropriate that we’re doing so in the Lester and Sue Smith Legacy Tower. We’re seeing some of those exact same patients they cared for as kids.”

The new facility is a game changer for this patient population. About 1.6 million adults currently live with congenital heart disease in the United States, but they are a rare patient within an adult hospital environment. Treatment for these patients within an adult hospital does not allow them to get the unique care they need. In a children’s hospital, the majority of cardiac patients have congenital heart disease, and these adults with congenital heart disease are not as unique.

“Until now, patients have been managed somewhat ad hoc – either in pediatric environments or in adult environments with teams that are not particularly experienced in managing congenital heart defects,” Dr. Ed Hickey, surgical director of the ACH Program, said. “That’s all changing here at Texas Children’s. This vision that we’ve realized has come from the top down. Mr. Wallace himself realized that it’s our responsibility to care for these patients irrespective of age, complexity or location.”

The two leaders are excited for the future as Texas Children’s combines the incredible facility, dedicated team and resources to provide the best possible care to adults with congenital heart disease.

The inpatient unit on the 24th floor will open in January 2021. To learn more, visit texaschildrens.org/ACH.

October 28, 2020

Since 2004, the Adult Congenital Heart (ACH) Program at Texas Children’s has provided groundbreaking care, and next week, the hospital will open a first-of-its-kind dedicated facility designed by and for adults with congenital heart disease. The 27,000-square-foot space, situated on the 24th floor of Texas Children’s Lester and Sue Smith Legacy Tower, will include a 16-bed inpatient unit, outpatient clinic, cardiac rehab gym, diagnostics lab and more.

“This innovative approach to care is unprecedented, and another step forward for our no. 1 ranked hospital for cardiology and heart surgery by U.S. News & World Report,” Dr. Cameron Dezfulian, director of the ACH ICU, said. “While we have been caring for adult patients for many years, this dedicated, state-of-the-art space is tailored to them and their families. It will bring together adult practitioners with the expert pediatric congenital heart care of Texas Children’s. Everything we do in this space will be done with the goal of reducing the impact of these conditions on adults living with congenital heart disease.”

Today, there are more adults than children living with congenital heart disease in the United States. Significant advancements in cardiac care, and improvements in survival after undergoing heart surgery as a baby or young child have resulted in this growing population. While it may seem counterintuitive for adults to be cared for at a children’s hospital, data suggests that if you are an adult living with congenital heart disease and are in need of surgery or cardiology follow up, the outcomes are likely to be better if you are operated on by a congenital heart surgeon and cared for by a cardiologist at a children’s hospital.

“It’s important to recognize that adults living with congenital heart disease have unique issues that are not typical to adults with acquired heart disease,” said Dr. Peter Ermis, medical director of the ACH Program, said. “Because of these unique issues, some adults with congenital heart disease do not get the care they need in an adult setting. It’s only after they develop symptoms that they recognize there is an issue, and at that point, it may be too late. Our goal is to keep these patients in our care so we are able to anticipate the issue before they arise.”

Texas Children’s ACH Program is accredited by the Adult Congenital Heart Association (ACHA) and is one of only three accredited programs in Texas. As pediatric patients with congenital heart defects transition into adulthood, members of the team – with the help of our Cardiology Transition Medicine Team – advise patients on health and lifestyle choices for their adult needs, including physical challenges, exercise options and family planning. The ACH Program offers comprehensive medical and surgical care in collaboration with colleagues at Texas Children’s Pavilion for Women and Texas Children’s Fetal Center.

The new outpatient clinic will open November 4. The inpatient unit will open in January. Before the floor opens, a lot of preparation and training took place. On October 8 and 9, multidisciplinary teams successfully completed a series of simulated patient care scenarios on the state-of-the-art floor to test the workflow processes and address any concerns.

The program’s leadership team is comprised of Ermis, Dezfulian, Dr. Ed Hickey, surgical director; Dr. Prakash Masand, director of ACH imaging; and Barbara Vazquez, director of ACH nursing. The program also is home to the largest number of ACH accredited cardiologists in the state, 25 dedicated ACH inpatient nurses, five ACH ICU advanced practitioners, techs, assistants and sonographers.

“We currently care for about 2,200 adult patients, but that number is growing exponentially,” Hickey said. “Due to advancements in medical care, surgical care and technological innovations, about 95 percent of children born with congenital heart disease survive and many reach adulthood. With this new space, we can better provide continuity of care from birth through adulthood.”

October 27, 2020

The health plan’s Member Services department has recently captured attention for record-setting performance. Even amid an onslaught of change, their service has increased and improved.

Could it get any better?

With the implementation of Epic Tapestry next summer, health plan leaders say YES! The performance of the department – and the value they bring to members – is about to be better than ever.

Let’s start with our workforce …

“One of the most significant benefits Epic Tapestry will bring to our team is the use of one system,” said Opera Wagner-Ross, director of Member Services. “Right now, the team must use multiple systems to serve our members, which can be time consuming and complicated. Tapestry will eliminate this.”

Wagner-Ross adds that the implementation will also streamline the communication between all parties involved in a member’s care.

“It’s a domino effect,” she said. “Improved workflow brings improved employee satisfaction. And satisfied employees are certainly more productive.”

So, what are the primary benefits to our members?

In two words – CONVENIENT ACCESS.

Tapestry will allow for the development of an enhanced member portal. Through the portal, families can access a number of convenient tools 24 hours a day/seven days a week, which may reduce the number of phone calls they make or time they have to wait for information.

According to Wagner-Ross, only 5,000 members used the portal last year out of more than 400,000 members. She says the low numbers are due to the portal’s limited functionality and the inability to adequately meet our member’s needs. “We are very hopeful that this will change.”

Moreover, the enhanced portal will improve care for members who are also patients of Texas Children’s Hospital because the portal will integrate with MyChart.

The member portal also includes …
  • Benefit Information: Provides information about the member’s benefits associated with the coverage and links to metered benefits and out-of-pocket benefits.
  • Referrals: Gives members access to information, such as the provider who referred them, who they were referred to, the status of the referral, the start and expiration dates of the referral, and the number of authorized and remaining visits.
  • Claims: Allows members to view their Tapestry claims and paperless explanation of benefits. Members can take a look at what claims have been posted for services rendered to them.
  • TCHP/TCH linked access: Members who are also patients of Texas Children’s Hospital will have expanded access to view Health Plan member features and Texas Children’s MyChart patient features.
  • Temporary ID card: Members can access and print a temporary ID card and request replacements electronically.
  • PCP update: Gives members the ability to electronically request a PCP change via the portal.

Missed the first story in our series? It’s all about Healthy Planet.

Read all about Member Services’ stellar performance.

October 12, 2020

It doesn’t get more exciting than this. Next summer, Texas Children’s employees will begin using a new and improved version of Healthy Planet, a module within the Epic Tapestry health care management system.

The arrival of Healthy Planet means better outcomes for more than 400,000 members of Texas Children’s Health Plan. But it also means less stress for our employees, lower costs for our organization and an even higher level of care across the entire system. (Can we get an Amen?!)

But how exactly is this possible?

Epic’s Healthy Planet application will help us keep track of how well we serve our members. It includes real-time and predictive analytics, daily metric dashboards, wellness registries, and chronic disease registries. It also contains information that allows us to compare our member data to national data on a variety of illnesses.

The module, with its dashboard, gives health care systems and providers information that can help coordinate care delivery, monitor quality and cost, reduce financial risk and engage members through a centralized data warehouse.

Benefits on both sides

“The Health Plan will benefit from having all care coordination documentation in one software system,” said Diane Scardino, Vice President at Texas Children’s Health Plan. “The Texas Children’s System also benefits because documentation for shared members will now live in one location.”

Healthy Planet will also make it possible for clinical care to be better aligned with social and community support for our families. “Outcomes for families will continue to improve because we’ll be able to target populations early, proactively intervene, and align needs,” Scardino added. “Interventions can further be reinforced through both the payor and provider partnerships.”

And if that wasn’t enough, the result of these benefits are bound to cause operational efficiencies as we reduce the need for manual and often duplicative information sharing across the organization.

Which brings us back to Care Coordination …

“It’s fair to say that we currently have a lot of fragmented communication taking place between our teams, both within the health plan and among our care delivery partners,” said Ashley Simms, director of Care Coordination at the health plan. “This will no longer be the case. Integrating into one platform not only creates a tremendous amount of workflow efficiencies, but facilitates more effective communication between the various care teams that work toward optimizing a person’s health.”

With communication more streamlined, employees can spend less time putting out fires and more time performing tasks that bring a higher level of patient satisfaction. This may include tasks like accessing the chronic disease and wellness registries to provide preventative information to patients.

Part of the Epic Tapestry implementation

Healthy Planet is a module being implemented as part of the health plan’s Epic Tapestry implementation. Its build, testing and launch are under the direction of the health plan. However, employees across Texas Children’s will be required to train for its use as our members are cared for throughout the organization.

All parts of the Tapestry project are set to go live in June of 2021. Due to Healthy Planet’s ability to meet such a wealth of needs, it is one of the more anticipated offerings.

Employees will be trained on how to use Healthy Planet and the rest of Epic Tapestry. Training details and dates will be announced at a later date.