December 14, 2020

As we all gear up for 2021, excitement is building about the new Epic Tapestry health care management system. This year has brought significant progress in the project; with testing, communication and training as the focuses going forward.

“In a normal year, we would be proud of the work that’s taken place,” said Richelle Fleischer, senior vice president. “But the fact that we hit project milestones amid a leadership change, a global pandemic, hurricane preparations and so much more is truly remarkable. We can all agree that 2020 has been one for the books and to see Tapestry team members persevere is commendable.”

John Turner, assistant vice president for Information Services, says the project is on track and scheduled to go live in June of 2021. He urges employees to stay engaged. “We are in the homestretch of our roll-out and it’s more important ever that all teams tune into communications and receive the proper training,” he said. “Articles, videos, emails and virtual training sessions will be plentiful next year. Let’s get excited, engaged and trained.”

Employee communications will continue in January. Watch Connect, your inbox and the upcoming Sharepoint site to stay informed. In the meantime, view the series of stories that are linked below.

In pursuit of a healthier planet – Care Coordination (Healthy Planet Module)
https://texaschildrensnews.org/in-pursuit-of-a-healthier-planet/

Being a member is about to get even better – Member Services
https://texaschildrensnews.org/being-a-member-is-about-to-get-even-better/

The Money Matters of Epic Tapestry – Finance & Claims
https://texaschildrensnews.org/the-money-matters-of-epic-tapestry/

An improved provider experience is on the way – Provider Relations
https://texaschildrensnews.org/an-improved-provider-experience-is-on-the-way/

November 30, 2020

The benefits of the Epic Tapestry implementation just keep getting better as we consider our more than 2,500 provider groups.

Our providers – physicians, nurse practitioners, therapists and other specialists – who care for our members will be on the receiving end of an enhanced portal and an improved claims process for their payments.

“Our goal is to constantly improve the experience that our providers have when they care for our members,” said Cade Crumley, assistant director of Provider Relations. “The Tapestry implementation will allow network providers access to enhanced patient data, more timely communication and increased engagement with us.”

But what does this mean, specifically?

More timely and reliable information – Providers will now have no delay in system information updates.

Secure communication and a reduced call volume – Providers can reach out to our staff about members and resolve reimbursement questions by sending direct messages.

Review insurance information – Members’ coverage information, metered benefits, and submitted claims will be available on demand.

Manage referrals – It will soon be possible for providers to submit and review authorizations and notification letters electronically, which simplifies processing for utilization management staff and reduces the number of incomplete requests they receive.

Review and track claims – Providers will be able to review claims they’ve submitted for our members and see claim statuses, even before claims have been fully processed. After claims are processed, the remittance advice appears in the portal with details about payment and covered service.

Manage your population – The new portal will be integrated with Healthy Planet. Providers can also access care management tools, scorecards, and analytics that help to coordinate the care of your patient populations.

Benefits to our employees

“Like many departments at the health plan, Provider Relations is looking forward to this change in our work,” Crumley said. “Epic Tapestry will allow us to work within one system instead of multiple systems. A more efficient work day is definitely on the way.”

***

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 dived into Member Services.

Third was the Money Matters of Epic Tapestry.

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.

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 20, 2020

Providing the highest standard of care for obstetrical patients has always been paramount for the team at The Center for Children and Women. The Southwest location of The Center has recently received the stamp of approval from the state of Texas thanks to a new Level II Maternal Designation issued by Texas Department of State Health Services to CHI St. Luke’s Hospital in Sugar Land.

With more than 90 percent of the obstetrical patients at The Center–Southwest delivering at CHI St. Luke’s, this is a big win for our families and the entire Sugar Land community.

This achievement was spear headed by one of our own, Dr. Michelle Jones. As the Maternal Medical Director at CHI St. Luke’s Hospital in Sugar Land, she led the team through a two-day hospital survey conducted by the American College of Obstetricians & Gynecologist and state health services.

“This Level II Specialty Care designation validates that we can safely and competently provide high quality care for moderate-to high-risk antepartum, intrapartum, or postpartum conditions,” said Dr. Jones, Maternal Medical Director at CHI St. Luke’s Hospital in Sugar Land. “This state-issued designation means that we understand and have implemented the standards of care identified as necessary to provide quality care for obstetrical patients. Recognizing and addressing early warning signs which will help us decrease obstetrical complications is a key focus of our in-patient teams.”

Dr. Jones goes on to say that the designation sends a strong message to patients that we are doing what is best to improve the quality of care for them.

Why is this so important?

Unfortunately, national data shows a continuing trend that although we are one of the richest countries we lag behind other developed countries in the category of insuring good health care for expecting mothers. Maternal mortality and morbidity has increased by at least 200 percent from 1993 to 2014. Black women have a 3.3 times greater risk of complications compared to non-Hispanic white women.

And to make matters even more challenging, three out five pregnancy-related deaths in the US are preventable. Reducing the number of preventable deaths has been the primary goal of reducing maternal mortality initiatives in Harris County.

“We are working with standards of care that will save more lives,” Jones said. “And this designation will ensure that we are accountable for the care with provide. I am proud of our team and excited for our patients.”

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.

September 29, 2020

Although focused efforts to train employees in the area of cultural competency ends on Wednesday, the health plan will continue to make this mission a priority throughout the year.

The past eight weeks have created space for self-reflection and team discussions around culture. However, the importance of this topic will have an effect that is sure to ripple past the September 30 course deadline.

Stephanie Lyons, an Enterprise Systems Manager, said she has appreciated the recent spotlight that the course has placed on these topics. The spotlight has confirmed her previous efforts to embrace the diversity of her team and allow everyone to benefit from it.

“In late 2019 we began a lunch series called Tasty Fridays,” Lyons said. “It was a time when everyone was encouraged to bring a dish that was unique to their home country or culture. We all could partake, which led to natural discussions around the food and family traditions.”

Lyons said talking about culture was ideal and imperative because her team comes from a variety of countries and continents.

She added that she can appreciate working for an organization that does well in this area and continues to improve. “My team works with Member Services and Marketing and Community Outreach – both areas that are first-contact areas for our members. Those teams work hard to meet diverse language and culture needs. Overall, I think the health plan does a great job at being culturally competent for our membership and each other.”

Take-Aways
  • All health plan employees must take the Cultural Competency course, available on HealthStream by Wednesday, September 30.
  • The 15 national Culturally and Linguistically Appropriate Services (CLAS) standards can be found here.
  • To review past Connect stories on this effort, click the following links: Team Discussions, Ideas, Cultural Competency Week, Hayes on The Health Plan.