September 21, 2020

The Health Plan continues its focus on cultural competency as the deadline nears to complete the state-mandated training. More than 80 percent of employees have taken the course.

Teams have spent the past few weeks in discussion around the 15 national Culturally and Linguistically Appropriate Services (CLAS) standards, their personal experiences, and ways they can improve their work performance in this area.

These discussions, along with recent Cultural Competency Week activities are being managed by the newly developed Cultural Competency Committee. In the future, the committee will ensure that the organization adheres to the national standards and plays an integral role in addressing health disparities.

Provider Relations

Provider Relations Liaison Javier Valdez, who is a 32-year Texas Children’s employee, has seen our organization navigate many cultural shifts and is pleased to be part of these latest efforts.

“I feel that we do well when it comes to cultural competency, but I think we could always do better,” Valdez said. “This is exactly why I’m so glad to hear of the committee’s work.”

In his role Valdez meets the needs of culturally diverse providers who serve culturally diverse members.

“We have a very seasoned team that is close and able to discuss issues openly,” he added. “I think this is why it’s important that we have a bilingual staff that can speak many languages. This way we are able to assist our members in a language they feel the most comfortable speaking.”

Valdez added that a member’s culture is often connected to their social situation, their health and subsequently the solutions to any health care issues. This means that the more we understand a person’s culture, the more we can help them reach their health care goals.

Care Coordination

The Health Plan’s care coordination team also conducted a series of cultural competency discussions starting back in May. The discussions were led by Care Coordination Director Ashley Simms and Assistant Director Katara Butler.

Butler said the team’s conversations centered around a few key themes; including personal accountability regarding cultural biases, keeping others accountable regarding their biases and remaining open to learning more about the culture of others.

“Not only do we serve a diverse member population, but as a team we are also diverse,” Butler said. “As managers it’s important that we give our teams all the tools they need to grow personally and professionally in this area.”

All health plan leaders received talking points to help them host cultural competency conversations. These conversations will provide even more context for the state-mandated training, available in HealthStream.

September 8, 2020

During the recent Cultural Competency Week celebration, Texas Children’s Health Plan employees had a chance to win prizes in exchange for thoughtful responses to questions posed each day.

Prize winners were:

  • Loan Lam, Senior Business Intelligence Analyst
  • Sofia Morffe, Utilization Management Specialist
  • Koby Mitchell, Utilization Management, Manager
  • Kristi Lemmert, Case Management, Manager
  • Adrian McKinney, Case Management, Manager
  • Alicia Ardon, Senior Call Center Representative

A sample of the answers are below and may offer us all ideas on how to best promote cultural engagement.

What are some ways that we can promote cultural competence in our everyday life?

  1. Get to know the community you work with. Talk to colleagues about what their weekend plans were: church, family meal, any traditions, etc.
  2. Be sensitive to colleagues who need to take time out to honor their religion/faith, family traditions – praying, religious holidays, cultural holidays, etc.
  3. Eat different cuisines with your friends and family and understand more about the specific country’s native culture/customs, why they choose certain foods (Is it indigenous, is there a cultural belief behind the food?)
  4. Encourage open dialogue. When there is a view you don’t understand or haven’t heard about, seek to understand.
  5. Create diverse networks. Establish friendships with those who are different from you.

When we practice cultural competence in health care, what are some positive results we can experience as a society?

When we practice cultural competency in health care, the individual is seen for who they are (without judgement), heard for what they say (without our interpretation of what they need), cared for with acceptance and understanding of the barriers they may face. Our job is to assess, provide information, give options and let them choose freely the actions they wish to take without coercion. It boils down to respecting the individual we are serving and all that comes with them, all that has shaped them and meeting them where they are. Cultural competence in health care is letting the person we care for be the expert in their life.

Benefits we can expect to see in society:

  • More trust
  • Self-efficacy
  • Personal responsibility
  • Improved health
  • Decreased bias
  • More respect

When was the last time you interacted with someone from another culture in a meaningful way? What did you learn from the experience?

The last time I interacted with someone of another culture in a meaningful (memorable) way was during a visit to the Sam’s Club. Even though it was some time ago, it still resonates with me today. My daughters were excited about the samples of pizza the Sam’s Club staff were providing. A Nigerian woman was one such staff member. One of my daughters, who is left-handed, stretched out her left hand to accept the pizza. The Nigerian woman became offended and began to mildly scold my daughter.

She explained that in her culture it is rude to accept food with only one hand outstretched and especially the left hand.

My daughter looked confused as to why she was being scolded. I explained to the woman that my daughter and I were not aware of her cultural etiquette and explained the differences pertaining to American culture. I told her my daughter meant no harm and thanked her for the opportunity to learn a bit about her culture. Inside I was actually offended myself that she would impose her culture in a place where it was not known or expected. However, my nursing background and training regarding cultural awareness afforded me a moment of pause to consider her feelings as well. I explained to my daughter that she didn’t do anything wrong, and how different cultures have different observances that we should respect whenever possible.

All employees of Texas Children’s Health Plan must take the state-mandated cultural competency course. It is available on HealthStream until Wednesday, September 30.

August 31, 2020

Expecting mothers will soon receive even higher quality service when they visit The Center for Children and Women.

In response to patient feedback, the obstetrics services at both the Greenspoint and Southwest locations will treat patients with a new personal care team model. This will prevent families from seeing up to 10 different providers and instead offer them their own team of no more than four providers.

“We are excited about this change, especially because it has been made in direct response to one of our most common patient complaints,” said Dr. Faunda Armstrong, assistant medical director for The Center at Greenspoint. “The smaller team model will allow providers to develop a patient plan together, build a closer relationship with families and increase trust at every appointment.”

To ensure that this change – set for mid-September – achieves the intended results, The Center will continue to use the patient satisfaction firm, Press Ganey. The firm’s annual survey results will show the effects of the change.

Additional recent changes include an increased use of telemedicine appointments to keep patients and families safe amid COVID-19 concerns. For more information about The Center for Children and Women visit https://www.jointhecenter.org/.

August 24, 2020

It’s Cultural Competency Week at Texas Children’s Health Plan – a celebration of the cultural differences that exists among the organization’s more than 900 employees, 11,000 providers and 480,000 members.

In celebration, employees will participate in team discussions, have a chance to win prizes by answering a question of the day and learn more about the 15 national cultural competency standards through a state-mandated training course. The course – available until September 30 – is focused on understanding the diversity that exists in people of different races, languages, genders, socioeconomic statuses and beliefs.

“There is no time like the present to pause and celebrate diversity,” said Johnna Carlson, director of Government Programs. “The Health Plan is so excited to be a leader in this conversation. Our entire mission is to serve those who need us – regardless of who they are, what they look like, or what language they speak. This week is simply a highlight on the way we do our jobs each day.”

Although there are 15 national standards around cultural competency, these are rooted in one principal standard, which is to provide effective, equitable, understandable, and respectful quality care and services that are responsive to diverse cultural health beliefs and practices, preferred languages, health literacy, and other communication needs.

This is the standard of highest priority that employees are expected to uphold.

“For me, coming to a country that is so diverse, certainly took me out of my comfort zone and has been such a positive experience,” said Donna Jackson, senior administrative assistant. “To learn and participate in a new cultural experience has made me more open minded and accepting. In general, this makes The Health Plan a more pleasurable work environment.”

Jackson adds that understanding one another’s differences breaks down barriers and makes people feel heard and therefore valued. “As we learn more and become advocates for each other, our children also get to reap the benefits. I truly believe that history will show Texas Children’s will be a better organization because of our focus on cultural competency.”

Watch Connect in the coming weeks to learn more about the national standards. All Health Plan employees are required to take the Cultural Competency training course in HealthStream by Wednesday, September 30.

 

August 17, 2020

Many of you know that I have a 7-year-old daughter. She just started the second grade. Having a child this age means I spend a great deal of time baking cookies, going to dance practices and watching Disney movies. One of our favorite Disney productions is “Princess and The Frog,” the 2009 animation about New Orleans native Tiana and her dreams of owning a restaurant.

There is so much to enjoy about “Princess and The Frog” beyond the actual story. One of those things is Disney’s ability to capture elements of the African-American culture and the culture that exists within the city of New Orleans. To appreciate the cultural elements of the movie is to appreciate the movie itself.

I instantly thought about “Princess and the Frog” when we, at The Heath Plan, began to prepare for the launch of a new state-mandated Cultural Competency course. I began to think about the culture of our organization and I realized something. One of the reasons I enjoy working at The Health Plan is because our employee population, provider network and member base is extremely diverse. But most importantly, there is an urgency to understand our diversity and discover how we can leverage it to improve our business.

This new course – mandatory for all Health Plan employees – is a series of training modules covering 15 national cultural competency standards. It is available now through September 30 on HealthStream. The arrival of the course and an overall focus on culture and communication will be celebrated during The Health Plan’s Cultural Competency Week Monday, August 24, through Friday, August 28. A variety of virtual activities will also take place to highlight the importance of the effort.

I am thrilled to see this happening. In my opinion, there is no higher compliment than to acknowledge and seek to appreciate the differences between each other. This acknowledgment and appreciation improves communication, relationships and an ability to meet each other’s needs. This is essentially the definition of cultural competence.

Watch Connect over the next few weeks for stories that dive deeper into the national standards and provide details on how we are striving to uphold them in our daily work.

July 20, 2020

Care coordination at Texas Children’s – an already challenging job – has become that much more challenging as COVID-19 cases surge in the Houston area. But in true #oneamazingteam fashion, the team of 52 has risen to the occasion and continues to support their multidisciplinary counterparts.

“The entire team is working remotely,” said Jennifer Thorpe, Director of Care Coordination at main campus. “However, with the help of technology and innovative leadership we are remaining successful.”

The department has two primary responsibilities – first, patient care coordination. This means to effectively prepare families for condition management outside of the inpatient setting. The team focuses on timely and safe discharges that prepare families for appropriate management of their conditions.

Secondly, the team is focused on Utilization Management, which is the evaluation of the medical necessity, appropriateness, and efficiency of the use of health care services, procedures, and facilities. In other words, how are services, procedures and facilities being used by a patient? And are these uses necessary, appropriate and efficient? The team focuses on centralized utilization reviews, length of stay management, payer relationships, daily review of observation patients, and authorizations.

“The ability to deliver exceptional care in an effective and cost-efficient way is always the first priority for Texas Children’s,” Thorpe said. “Care coordinators are at the heart of that priority and our resolve is stronger than ever.”

While Thorpe’s team serves main campus patients, there are care coordinators across the system including the health plan team lead by Ashley Simms, the West Campus team lead by Kara Abrameit and The Woodlands team led by Julie Barrett. They all work closely to support one another.

The Department of Care Coordination also has access care coordinators located in the emergency center at Main, West and Woodlands campuses. The access care coordinators focus on patient access at the point of entry, the review for appropriate status, the coordination of admissions, transfers, direct admissions activity at specific locations and partnering with interdisciplinary care teams.

Intended outcomes as defined by Care Coordination success measures are:

  • Decreased Emergency Center admissions for established patients with chronic conditions.
  • A decrease in duplication of efforts for the same patient across the system.
  • A tracking of referrals to community based organizations with appropriate follow up and gap closure.
  • The use of predictive analytics to decrease high cost care and unnecessary utilization of services based on what has happened to provide a best assessment of what will happen in the future.
  • Identification of off the scale “outliers” to rising risk conditions that drive cost and work across the system to close care gaps.
  • An increase in linkage to community based organizations for social determinants of health and tracking of ‘community’ data alongside clinical and claims data to measure intervention care impact on patients with chronic diseases.
  • Management of length of stay via the use of the 3M bi-directional interface.
  • The utilization of patient stratification to look for and intervene on high-risk or determined risk families.
Racial justice in health care

In addition to COVID-19, care coordinators are also positioned to respond to our society’s recent focus on racial and social justice. The Department of Care Coordination reports to Senior Vice President Tabitha Rice. Tabitha lives the core values of Texas Children’s and believes in racial, religious, and gender equality. This is evident in her ongoing efforts to champion change as well as the department’s response to identified socioeconomic barriers in vulnerable and underserved populations. As part of the department’s response, they have reignited efforts to adopt a new electronic platform called “Aunt Bertha,” which serves as a portal for valuable resources.

“A large number of racial minorities are included in groups that face socioeconomic issues,” Thorpe said. “When you are facing challenges with literacy, parenting, employment, or live in a food desert, this can affect your overall ability to stay healthy.”

With just a click of a button, Aunt Bertha would allow families to access social service information such as rental assistance, food assistance, mental health services and much more. Thorpe said there are discussions about how to integrate this platform with Epic and MyChart.

The future of care coordination

Prior to the COVID-19 pandemic, the department had excitedly partnered with Dr. Jennifer Sanders, Gail Vozzella and Dr. Michelle Lyn on the initial phases of the Care Coordination Center, a separate Texas Children’s facility that would serve as a care continuum hub between inpatient and outpatient. Phase one goals for the Care Coordination Center include:

  • All non-TCHP Tier 1 Star Kids patients discharged from an inpatient stay at the hospital will receive a standardized discharge follow-up phone call within 72 hours to ensure they understand their discharge instructions and follow-up visits.
  • Ensuring continuity of care across health care settings by establishing a standardized process to ensure appointments are made prior to discharge.
  • Centralizing the process of obtaining Durable Medical Equipment to meet the therapeutic benefits of patients in need and enhance provider satisfaction.
  • The aim of the Care Coordination Center is to offer one consistent place for patients, families, providers or designees to receive 24/7 high touch coordinated services for recipients of healthcare within the Texas Children’s system. Although the timeline for moving in has been adjusted, those plans are still in the works.

Thorpe reminds the organization that although there are teams 100 perent dedicated to this work, Care Coordination is ultimately the responsibility of both clinical and non-clinical employees throughout Texas Children’s.

When care coordination is done well, we are all adhering to the key elements:

  • Having a shared care plan that forces us to think through responsibilities and potential problems ahead of time.
  • Communicating with patients by explaining treatments, procedures and necessary follow-up actions.
  • Communicating between providers and care givers by telling all the details of the patients’ story when performing a hand-off.
  • Transitioning a patient efficiently between areas within our system or between their stages of care.
  • Organizing a patient’s care for their convenience by taking into consideration things like scheduling, transportation, supplies, medications, etc.
  • Using community resources effectively.

Multidisciplinary team members can access Spok to identify their unit’s assigned Care Coordinator each day. The Care Coordination team is available Monday through Friday 8 a.m. to 5 .m.p and on call until 11 p.m.

For more information about Care Coordination, read a story previously posted at: https://texaschildrensnews.org/coordinating-the-care-of-our-patients/

View team photos at the links below:

Care Coordination Leadership Team

Access Care Coordinators

Inpatient Care Coordinators

Utilization Management Care Coordinators

Greetings, team. My highest hopes are that everyone is staying safe as we continue to live within a new world order. My last edition of Hayes on the Health Plan was published in April when life with the coronavirus was brand new. In that post I wrote tips on how to work from home effectively.

Since then, my colleagues and I have written numerous articles about our organization’s efforts to adapt to life with the virus. We have also published stories about departments within Texas Children’s Health Plan that are exceeding expectations in phenomenal ways. Speaking of phenomenal, we think it’s pretty phenomenal that our newest department – only five months old when the virus hit – has continued to grow and thrive in spite of a global pandemic. Today, I want to introduce you to the newly created Department of Pharmacy.

Director Peter Peter recently took the time to answer a few of my questions. His answers give us an inside view into the work his department does to keep members healthy, operations efficient and costs manageable.

Q: What is the role of the Pharmacy Department at Texas Children’s Health Plan?
A: Director of Pharmacy is a new position, as my predecessor was overseeing both Quality and Pharmacy. Historically, pharmacy at the health plan was seen as a clinical role focusing on medication appeals and provider outreaches. Under my leadership, it is more of an operations role. My department is responsible for overseeing pharmacy benefits for all our members. We also oversee Navitus, our pharmacy benefits management company. In addition, we partner with the Medical Policy team to make sure that medications processed through medical benefits are configured in compliance with the Texas Medicaid Providers Policy Manual (TMPPM). In addition to clinical, there are significant compliance, quality, financial, advocacy, and innovation opportunities that exist within the Health Plan, Texas Children’s system and Texas Medicaid. The health plan is in a unique position because of its access to the hospital system, care coordinators, medical data, and community status compared to other managed care organizations.

Q: How big is the Pharmacy Department and what are the roles of the employees?
A: We are a team of two. I started as the Director of Pharmacy in October 2019. Jerry Wong is the Managed Care Pharmacist, and he started June 2020. I am looking to expand the department with several more employees. The specific roles are still being finalized, but will focus on data analysis, project management, interdepartmental coordination, auditing, and clinical program development. I’m also looking to consolidate some tasks that are currently being handled outside of the pharmacy department.

Q: How does the Pharmacy Department work with the Pharmacy Department at the hospital?
A: There are several opportunities to coordinate with our hospital and retail/specialty colleagues on various clinical and quality related projects. Examples include coordination of care, identifying system savings, and prescriber education. This is an area I am looking to sync with more after staffing up the pharmacy department at the health plan.

Q: What successes has the department had in recent months, weeks? Especially in light of the pandemic?
A: We were able to successfully lobby the state to make formulary changes when COVID-19 shut down Texas to allow members expanded access to medications. We also identified opportunities where members were taking a brand-drug when generic alternatives existed. We launched campaigns to notify prescribers of these opportunities, which have already resulted in significant savings for the system.

Q: What is the vision for the department and what is the greatest work ahead of the department?
A: Combining medical and pharmacy data is what Amazon, Walmart, CVS, and other health care organizations are racing to, but what the health plan already has in house. We are ahead in this regard. However, the greatest work ahead of us is focused on alternative payment models where pharmacies can encourage pharmacist-prescriber collaboration, improved care coordination, reduction in adverse medical outcomes, and overall savings. There are also significant opportunities to partner with the Texas Health and Human Services Commission to expand traditional “pharmacist” services and have them more involved as partners in the overall care of the member.

Q: Any fun facts or things that people would be surprised to know about this department?
A: The pharmacy department oversees pharmacy benefits for over 400,000 members enrolled in STAR, STAR Kids, and CHIP across Texas.