August 27, 2018

At Texas Children’s, we feel strongly that it is our responsibly to educate patients about the health plans we are in network with and how they can access our expert care. Therefore, we want to make sure Amerigroup members are aware that Texas Children’s is not a participating provider with Amerigroup. Those patients have the right to change health plans to ensure continuity of care.

Amerigroup currently insures 9,500 past and present Texas Children’s patients under Amerigroup STAR, Amerigroup STAR Plus, Amerigroup STAR Kids, or Amerigroup Children’s Health Insurance Program (CHIP) plan.

To make sure these patients receive uninterrupted access to care at Texas Children’s, we are recommending they change their coverage to a health plan that Texas Children’s is in-network with. As an eligible STAR, STAR Plus, STAR Kids, or CHIP plan member, they have a choice in the plan they select for coverage. They also have the right to change plans.

“We have been treating these patients out-of-network for the past five years hoping Amerigroup would work with us to either become an in-network provider or educate their customers about the options available to them,” said Kabby Thompson, director of managed care contracting. “It is clear that’s not going to happen. We feel it is in our patients’ best interest to educate them about the plans we are in network with and to help them transition into an in-network plan if that’s how they want to move forward.”

A similar plan of action worked well last November when Texas Children’s became an out of network provider to 6,000 Molina members. More than half have switched to an in-network plan.

A letter has been sent to patient families who have been a Texas Children’s patient within the past year and whose records say they are covered by Amerigroup. Depending on your role at Texas Children’s, you could receive questions from patient families and others about this change. Below is information to help you answer those questions and to places to direct people if you cannot.

“We appreciate your help in getting these patients and families the help they need,” Thompson said. “Their health care is important to us.”

Click here to access the information below and more.

How can Amerigroup patients and families change their health plans?

For Amerigroup STAR, Amerigroup STAR Kids and Amerigroup STAR Plus members: The Texas Medicaid program allows people to change their or their child’s health plan.

  • Patients and their families can learn more by calling the Texas STAR Program Helpline at 1-800-964-2777.
  • Patients and families can request to change their health plan at any time for any reason. If they call to change their health plan on or before the 15th of the month, the change will take place on the first day of the next month.
  • If they call after the 15th of the month, the change will take place the first day of the second month after that. For example:
    • If they call on or before October 15, their change will take place on November 1.
    • If they call after October 15, their change will take place on December 1.

For Amerigroup CHIP members: The Texas Medicaid program allows patients and their families to change their or their child’s health plan.

  • Patients and families can learn more by calling CHIP toll-free at 1-800-647-6558.
  • During the first 90 days after they or their child are enrolled in a health plan, they can change to another plan once for any reason.
  • If they show good cause, they can also change health plans at any time. An example of “good cause” is when they or their child can’t get the care you need through the health plan. An inadequate network or a change in the network status of their treating provider is also considered “good cause.”
  • They can also change health plans during the annual CHIP reenrollment period.

The Texas Medicaid program allows patients and families to change their or their child’s health plan every 30 days. They can learn more about how to do this and begin to make the change by calling the Texas STAR Program Helpline at 1-800-964-2777 (STAR or STAR Plus) or CHIP toll-free at 1-800-647-6558.

Questions patients and families might have about care at Texas Children’s:

As an out of network member, will patients still be able to receive care at Texas Children’s Hospital?

Rescheduling: In cases where Amerigroup has not responded to requests for both out-of-network authorizations and Single Case Agreements before the scheduled visit, Texas Children’s will contact patients/their families before their scheduled visit to reschedule once Amerigroup has responded.

Emergency Medical Care: Amerigroup advises that you go to an in-network provider for emergency care. Texas Children’s Hospital will treat children in the event they have an emergency. If a child is seen in the Emergency Center for emergency care, the medical team will work with the patient and their family to decide how to provide care after the doctor’s medical evaluation. Amerigroup will help find follow up care with a provider who is in network.

Urgent Medical Care: In order to receive urgent care at a Texas Children’s Urgent Care location, Amerigroup must approve an out-of-network authorization. This could be difficult because of the urgent nature of a patient’s condition and the time it takes to get an authorization. Amerigroup may also redirect care to another in-network provider.

Routine Care: In most cases, Amerigroup will require patients and their families to receive routine or urgent care from a network provider. In order to receive care at Texas Children’s, Amerigroup must approve an out-of-network. Amerigroup may also redirect care to another in-network provider.

Who should I contact if I have further questions?

If you want to learn more about changing your or your child’s health plan, you can call the Texas STAR Program Helpline at 1-800-964-2777 or CHIP toll-free at 1-800-647-6558.

If you have questions for Amerigroup, you may call their Member Services department toll-free at 1-800-964-2777. If you are not satisfied with the response from Amerigroup, you can contact the Texas Health and Human Services Commission (HHSC) by calling toll-free 1-866-566-8989.

If you have questions for Texas Children’s Hospital or Texas Children’s Physician Services Organization, you may call us at 832-824-1000 Monday through Friday from 8 a.m. to 5 p.m. Central time. Texas Children’s Pediatrics can be reached at 832-824-2999.

What Medicaid Health Plans is Texas Children’s in-network with?

Texas Children’s Hospital and Texas Children’s Physician Service Organization are in-network with the following Medicaid Health Plans


Texas Children’s Pediatrics is in-network with the following Medicaid Health Plans

Five years ago Texas Children’s Health Plan celebrated the grand opening of The Center for Children and Women, a patient and family-centered medical home for Health Plan members. Now with two locations, one 50,000 square-foot facility located in the Greenspoint area of Houston, and another in the Southwest area, the center has flourished and continues to provide high quality community based primary health care.

“It is actually unbelievable, frankly. Going from a concept to what we have today, and being able to serve so many patients and members and families of Texas Children’s Health Plan,” said Assistant Vice President Tangula Taylor. “It is humbling, quite honestly, just to think about the impact that we’ve been able to make on the lives of so many.”

The Center for Children and Women is designed to ensure that all patients have access to proper care by providing extended hours to accommodate the families’ busy schedules. The Center’s health care model provides comprehensive care for the well-being of the whole patient. This is done with the help of many medical professionals on site every day such as pediatricians, advance nurse practitioners, OB/GYNs, certified nurse midwives, optometry, imaging, a laboratory and an onsite pharmacy, and behavioral health specialists. The medical home provides a means to address the shortage of primary medical care for families enrolled in government health care programs.

“The idea was really to create a comprehensive one stop shop for health care,” Taylor said. “We know that families that we serve have precious time, and when they come in seeking healthcare, we wanted to be able to maximize the time we have with them and bring forth a holistic approach to address all of their care needs in that moment.”

On August 17, the Center celebrated its anniversary with a party open to the community. The event included ice cream and cake, face painting, information booths and goody bags. During the celebration employees gathered along with a patient who was brought into this world by Center providers and has been a patient at the Center for the last five years. The group sang a special birthday song as she and her sister blew out candles.

“It’s like the Center has become part of our family. We come here for everything,” said Ivonne Solis, mother of the patients. “There are days when I feel like I spend the whole day here because one has a dentist appointment, the other is seeing the eye doctor and the other has a general checkup. And I know if she gets sick at school, for example, they see us quickly.”

Across the room enjoying the celebration with her children was Yesenia Cervantes, a former patient of the Center. For Cervantes, the phrase “you will like it so much you will not want to leave” can’t be more accurate. Today, she works as a patient access specialist at the Greenspoint location.

“The first time that I had my appointment I really loved my care, so then I said, I have to be part of this, of the Center,” said Cervantes. “I would love to work with the people here and I would like to be part of this organization.”

Cervantes is just one of the many patients who has experienced first-rate care at the Center. Over the course of five years the Center’s membership has gained over 35,000 distinct patients and nearly 400,000 total visits.

“It was our intention when we opened to grow the Centers to a point where they were completely sustainable, and we have been able to do that,” said Medical Director for Obstetrics and Gynecology, Dr. Lisa Hollier. “And in the process, we are delivering on better outcomes for women and children.”

The Center has received several awards and recognitions since it opened such as; The National Committee for Quality Assurance (NCQA) Level III Recognition four years in a row. The Center is NCQA Patient Centered Medical Home (PCMH) and Patient Centered Specialty Practice (PCSP) recognized. The Center for Children and Women was the first OB/GYN practice in Texas to receive PCSP designation. In addition, the Center is COLA Certified for clinical laboratory compliance and received COLA’s Laboratory Excellence Award and acknowledged by Centering Healthcare Institute as an accredited Centering Pregnancy site, to name a few.

“I see this center continuing to grow and serve the Greenspoint and Southwest communities, but I of course see a third center, a fourth and fifth and a six,” said Chief Medical Officer for Pediatrics, Dr. Heidi Schwarzwald. “Not just in the Houston area, but across our state, serving the needs of Medicaid families.”

With 11 total service lines, the Center for Children and Women has exceeded initial expectations and continues to serve patients with the highest quality care possible with a focus on healthy mothers, healthy babies and children, and healthy communities.

“We are very proud of what we have accomplished in the past five years, and the support we have received at The Center for Children and Women from the community has been energizing,” Lou Fragoso, president of Texas Children’s Health Plan, said. “We know the incredible impact The Center has on helping families stay healthy—it is a privilege to serve our plan members in the Greenspoint and Southwest Houston areas. As we cross this milestone, we are committed to continuing to expand access to the highest quality primary care possible for our plan members.”

View a photo gallery of pictures from the event below.

For more information about Texas Children’s Health Plan The Center for Children and Women visit www.JoinTheCenter.org.

 

Fetal surgeon and Ob-Gyn-in-chief Dr. Michael Belfort is often reunited with his patients, but the recent meeting he had with Sam Hancock was extra special. The teenager and his family made their way from Utah to Houston to meet Belfort, who saved Sam’s life before he was even born. The meeting was Sam’s 18th birthday wish and his parents, Alisa and Dennis, were happy to accommodate as Belfort’s name holds a high regard in their home.

“As a family, we are so grateful for Dr. Belfort,” Alisa said. “He deserves the credit for the skill and knowledge that gave Sam a chance at life.”

When Alisa was pregnant with Sam nearly two decades ago, an ultrasound showed severe swelling of her son’s neck. Doctors told her and Dennis their baby likely had a very serious condition and would not survive.

Later in her pregnancy, doctors noticed fluid building up in Sam’s chest cavity and told her there was no hope. That’s when the family found Belfort, who was practicing in Utah at the time and gave them the option of having fetal surgery. Belfort placed a shunt into Sam’s chest in hopes that fluid being produced would drain from his chest into the amniotic sac, relieving the pressure on his developing heart and lungs. The shunt worked for a short time, but then stopped. Belfort made a second attempt and it was successful in draining the fluid and taking the pressure off Sam’s heart and lungs.

Sam was delivered two months early as Alisa went into early labor because of extra fluid in her amniotic sac, a condition called polyhydramnios, which stretches the uterus making it extremely large. Despite several attempts to decrease the amount of fluid, labor could not be stopped.

Sam spent three months in the neonatal intensive care unit and underwent another surgery to place drains in his chest to relieve excess fluid. When he was discharged, Sam was on oxygen. At 2 years old, he was diagnosed with craniosynostosis, a condition where the skull bones are fused and cause a misshapen head. To correct the condition and to relieve pressure on his brain, Sam underwent yet another surgery.

Despite a rough start in life, Sam is a fighter. Though he battled some academic delays earlier in life, he worked hard to overcome his challenges and recently graduated with a 3.5 GPA and earned his Eagle Scout award. When asked what he wanted for his 18th birthday, he said he wanted to come to Houston to see Belfort, and to thank him for saving his life and never giving up on him.

“There are no words to express what I’m feeling right now,” Sam said after shaking Belfort’s hand and grinning ear to ear. “I am so happy to be here.”

Belfort said meeting back up with Sam and his family was a real treat and that he had never forgotten them.

“It was an unusual procedure at that time,” Belfort said of the operation he did on Sam more almost two decades ago. “I’m really glad it worked out. Sam is a delightful young man.”

During his visit to Houston, Belfort gave Sam and his family a tour of Texas Children’s Hospital and introduced them to Texas Children’s President and CEO Mark Wallace, who was so honored to meet Sam he personally sang Happy Birthday to the teenager.

After talking to Sam about his hopes and dreams, Wallace told him about his 10 leadership maxims and encouraged him to come up with his own personal definition of leadership.

“Now that you are 18, you are old enough to have your own definition of leadership,” Wallace said. “That definition should reflect you, your personality and your beliefs.”

Sam, who is looking forward to the next journey in his life and will soon be looking for a job, promised Wallace he would work on coming up with his personal definition of leadership and share it with him soon.

August 13, 2018

Creating viable, long-term health care solutions for children and mothers worldwide has always been a part of Texas Children’s mission. To further that charge, a new division has been created within the Department of Surgery – the Division of Global Surgery. The division will be led by Dr. Jed Nuchtern, who has been Texas Children’s chief of Pediatric Surgery since 2012.

“This is a wonderful new opportunity for Texas Children’s Hospital, the Department of Surgery and Dr. Nuchtern, said Surgeon-in-Chief Dr. Larry Hollier. “Providing surgical expertise in underserved areas has been a great passion for Dr. Nuchtern, and he has traveled extensively bringing surgical care to children around the world. I would like to thank him for his continued commitment to patient care and surgical excellence.”

Through Global Health programs, Texas Children’s collaborates with international governments and health organizations to share its expertise and best practices, with a strong focus on sustainability. This collaboration includes providing surgical training and direct care and treatment in many underserved nations, such as Argentina, Haiti, Malawi, Mexico, Pakistan, Tanzania and Uganda. Due to lack of resources, facilities, education and support, surgical interventions thought of as routine here in the United States, such as repairing a broken bone or simply suturing a wound, are difficult to perform and thus much less common in these countries. A more complicated procedure like a C-section becomes altogether life-threatening.

The creation of the new Division of Global Surgery will help Texas Children’s forge new partnerships, offer providers opportunities for exposure, and facilitate care and capacity building to improve the lives of children and women across the globe, beginning in sub-Saharan Africa.

Leveraging resources, infrastructure and successful global medical programs already in place in the region – including Baylor International Pediatric AIDS Initiative (BIPAI) Network, Texas Children’s Cancer and Hematology Centers’ Global HOPE (Hematology Oncology Pediatric Excellence), and existing efforts by the Department of OB/GYN – Nuchtern and his team will first focus on surgical care for pediatric cancer patients, 50 percent of which require some form of surgical intervention, to increase surgical capacity. Ultimately, the approach will have the combined effect of improving care of children with cancer as well as those suffering from other pediatric surgical diseases.

“While the initial focus is on cancer surgery, our approach is to help build capacity in children’s surgery overall,” Nuchtern said. “Our goal is to marshal all of the talent and energy of Texas Children’s department of surgery toward the goal of serving children throughout the world.”

Preliminary objectives include identifying individuals interested in participating, working with partners to develop the infrastructure necessary to provide quality care, and organizing a special group tasked with developing training opportunities, a central focus of this initiative. Building on successes and lessons learned, and through continued collaboration with Global HOPE, the long-term vision includes a surgical facility for women and children in Lilongwe, Malawi, expansion of care capacity in Central America, and, ultimately, recognition for Texas Children’s as a leader in global surgical outreach.

“We’re one family, and this is a team effort that requires substantial perioperative support from nursing, anesthesia, pediatrics, radiology and pathology,” Hollier said. “Dr. Nuchtern and the new Division of Global Surgery will coordinate with all hospital services to ensure that Texas Children’s is well-represented when going abroad and that these children and women receive the best possible care.”

Nuchtern will retain his duties as chief of Pediatric Surgery until a successor is found. A national search is currently underway. Pediatric Surgery at Texas Children’s has grown to include outstanding programs in surgical oncology, surgical critical care, colorectal and pelvic health, and basic science research. The GI Surgery program has consistently been recognized as one of the top five children’s hospital programs for GI & GI Surgery in U.S. News & World Report. Under Nuchtern’s leadership, the division also has received national and international acclaim for the separation of conjoined twins’ cases and many cutting-edge fetal surgeries. Additionally, the Trauma program was re-designated as a Level I trauma center and has expanded educational offerings to the state and region.

June 19, 2018

On June 18, Texas Children’s Pediatrics opened its first primary care site in Austin, marking another milestone in Texas Children’s path toward creating a network of quality pediatric care for children and families living in the state’s capital city.

Located at 5625 Eiger Road, Suite 225, in southwest Austin, Austin Pediatrics is managed by Dr. Casey Mulcihy, who has more than 30 years of experience in caring for children. Mulcihy offers a full array of services for children of all ages including well child care or checkups, immunizations, same-day sick appointments, management of asthmas, ADD and/ADHD, and many other common pediatric conditions. He also provides courtesy pre-natal and introductory physician consultations.

Austin Pediatrics is unique because it is a solo pediatric practice, which means patients get one-on-one care with the same doctor at every visit. The office is able to provide 24/7 coverage for after-hours emergencies, through a network of other solo pediatricians in Austin.

“We are very excited about reaching this milestone,” said Kay Tittle, president of Texas Children’s Pediatrics. “It signifies the first step of many more to come in providing quality primary pediatric care to children and their families in Austin and the surrounding area.”

Executive Vice President Michelle Riley-Brown said opening Austin Pediatrics shows Texas Children’s commitment to caring for patients and their families in the Austin area.

“Primary care is extremely important to a child’s overall health and Texas Children’s Pediatrics provides the finest pediatricians dedicated to meeting the health care needs of infants to teenagers,” Riley-Brown said. “We are proud to be offering our expertise to children and families in Austin and are looking forward to being a vital part of their lives.”

Texas Children’s marked its beginnings in Austin on March 6 with the opening of our first Texas Children’s Urgent Care location. Located at 4477 South Lamar Blvd., the office provides high-quality, efficient and affordable pediatric-focused care after hours and on weekends.

Over the next five years, we hope to open more Urgent Care locations as well as continue to build our Texas Children’s Pediatrics network. Additional plans for 2018 include the opening of another Texas Children’s Pediatrics practice in July and the opening of Texas Children’s Specialty Care in Austin.

Scheduled to open in October, Texas Children’s Specialty Care brings subspecialty pediatric care and services into the community where it’s easy for children and families to access it. Our center will be staffed by Texas Children’s board-certified physicians, surgeons, therapists and clinical staff.

“When we say we’re coming to Austin, it means we’re bringing our unique brand of care to your community,” said Melissa Fischer, Texas Children’s Pediatrics director of community business development. “At every Texas Children’s location, children are seen and treated by experts trained to care for them.”

For more information about the new Austin Pediatrics location, click here. For more information about our long-term plans in Austin, click here.

June 5, 2018

In an effort to better serve patients seeking care at one of 10 Texas Children’s Urgent Care sites, wait times for each location have been posted on the Urgent Care website.

“Our goal is to be completely transparent to our families as to how long it takes for them to be seen,” said Melissa Fischer, director of community and business development for Urgent Care and Texas Children’s Pediatrics. “For families that live in between two locations, we believe that posting wait times will help our families choose which site to visit.”

The information also will help manage expectations around wait times, which average about 17 minutes from check-in to being taken to a patient room. Patients spend about 60 minutes from check-in to check-out.

The wait time feature on the Urgent Care website is automatically updated every five minutes based on the number of providers who are seeing patients and the number of patients who have checked in.

The feature was piloted at Texas Children’s Urgent Care Pearland and was then implemented in Austin. As of May, online wait times are available for all Urgent Care locations.

Save My Spot is also available to patients and families visiting one of our Urgent Care locations, allowing them to reserve a time slot from the comfort of their own home. All the patient family member has to do is pre-register online and the check-in process is expedited. Their personal information is also pre-populated which makes the process easier for existing patients.

“Patients and their families now look for ease and convenience in every aspect of their lives,” said Roula Smith, director of Urgent Care business operations. “You are able to save a spot at places like the DMV and restaurants, why not at Urgent Care?”

Smith added that, Save My Spot allows Urgent Cares to stay competitive as well as evenly distribute patients throughout the day to be more efficient overall.

Save My Spot also was piloted at the Pearland location, and is now available at all Urgent Care locations. More than 600 patients have used the feature to date.

Welcome, an electronic check-in process, is another feature that has been created to expedite the registration process. Check-in is done on an electronic tablet, making the experience paperless. This feature is expected to be rolled out to all Urgent Care locations soon.

Texas Children’s Urgent Care was launched in 2014 and currently has 10 locations, all of which are staffed by board certified pediatricians who diagnose and treat a wide variety of ailments, illnesses and conditions, including: asthma, strep throat, fever, minor burns, influenza, ear infections, allergic reactions and more. Procedures provided include: antibiotic injections, breathing treatments, fracture care and splinting, IV (intravenous) fluids, lab services, laceration repair and X-rays onsite.

For more information about Texas Children’s Urgent Care and its locations, click here.

May 29, 2018

On May 23, a day after the opening of phase one of Legacy Tower, another significant milestone was reached in Texas Children’s Hospital’s storied history. At 7:15 a.m., a 9-month-old boy was taken back to a new, state-of-the-art operating room for the first surgery in Legacy Tower, Texas Children’s new home for heart, intensive care and surgery.

Watch this video highlighting the clinical features of Legacy Tower, including the facility’s new operating and transitional ICU rooms.

Dr. Larry Hollier, surgeon-in-chief, Dr. Edward Buchanan, chief of plastic surgery, Dr. Howard Weiner, chief of neurosurgery, and Dr. Robert Dauser, neurosurgeon, along with a team of anesthesiologists, nurses, physician assistants and operating room staff, performed the successful craniofacial procedure. Following the surgery, the patient was taken to the hospital’s new neurological ICU, a first-of-its-kind unit dedicated to pediatric patients who require specialized neurological care.

“As the largest and busiest department of surgery in the country, we are called upon every day to perform some of the most complex surgeries on the sickest of children,” said Hollier. “Legacy Tower is an answer to those calls, and this is the first of many positive outcomes in our new home.”

Weiner agreed and said the new tower is a game changer that will allow various teams at Texas Children’s to offer better family-centric care.

“This is a huge day at Texas Children’s Hospital,” he said. “It’s a privilege to be here and to be part of something so transformational.”

Phase one of Legacy Tower, Texas Children’s 640,000-square-foot expansion, officially opened on May 22 with six technologically-advanced operating rooms for neurosurgery, orthopedics, plastic surgery, transplant and pediatric surgery – one with intraoperative MRI – and 84 ICU beds, including dedicated surgical, neurological and transitional ICU rooms. This milestone will help Texas Children’s continue to provide the highest-quality care possible to patients and families, particularly those children who are critically-ill.

Beginning at 7 a.m. on May 22, seven specially-trained clinical teams safely transported 45 critically-ill patients to their new, spacious, state-of-the-art critical care rooms. More than 150 Texas Children’s staff members were involved in the move, and the careful transfer of the patients took seven hours.

Click here to view a video and photo gallery of the patient move to Legacy Tower.

Dauser said the Legacy Tower, specifically the operating rooms and their location to other specialties and services, are fantastic.

“Having the ability to conduct an intraoperative MRI in a room adjacent to one of the ORs has tremendous advantages,” he said. “Having an ICU dedicated to neuro patients also is a plus.”

Buchanan said such features provide the perfect environment for him and his colleagues to treat some of the sickest and most complex patients in the country.

“We all are very excited,” he said.

The second phase of Legacy Tower will open in September and house Texas Children’s Heart Center®, ranked No. 1 in the nation by U.S. News & World Report for cardiology and heart surgery.