March 19, 2019

Patients along with their family members and even neighbors had the opportunity to enjoy Spring Break at an event hosted by The Center for Children and Women that included tons of family fun open to the community. The Center invited families to take part in over-the-top entertainment all while picking up a few health and wellness tips to get kids through the remainder of the school year.

The Center introduced this event about 5 years ago targeting physical fitness strategies and goals for children. This year they decided to bring this family affair back for Nutrition month.

“We have a lot of tips on nutrition, some on healthy snack options, along with resources that perhaps they would not have known about if they had not attended this event,” Marketing Manager at Texas Children’s Health Plan, Veronica Arzayus said. “We also welcome the opportunity for the community to see the Center and all the wonderful services that it offers while enjoying the festivities. This is definitely something that you would want to take your kids to in a safe and comfortable environment.”

This two-weekday event was held last week at The Center’s Greenspoint location on Wednesday and at the Southwest location on Friday. Despite unexpected rain and thunderstorms on the first day, according to The Health Plan, over 500 attendees flooded The Center as activities were brought inside.

Events such as this are important as one of our system-wide operational goals focuses on childhood obesity. The goal is to help prevent diabetes, high blood pressure, and high cholesterol in children, and promote a healthier lifestyle overall.

“It is important to shine a positive spotlight on healthy nutrition, activity, exercise, etc., all while engaging with the community in a meaningful way,” Vice President of Texas Children’s Health Plan, Tangula Taylor said. “I think that’s part of us giving back, helping, assisting, partnering with our community, the families that we serve to share healthy lifestyle options and alternatives that can have an impact on their overall quality of life.”

Along with providing educational material on nutrition, thanks to the corporate sponsors of the event, The Houston Food Bank, the Houston Dynamo, corporate partners, The Children’s Museum of Houston and Boys and Girls Clubs of Greater Houston, and community partner Kids Meals, there were also food and activities for the entire family to encourage exercise and healthy eating habits.

Other activities included, mini Zumba lessons, music and fun performances with a live DJ, face painting, an inflatable obstacle course hula hoop/ jump rope competitions, and a healthy snack tasting challenge.

With a total of over 800 participants for both days this year, The Center is excited to see this event continue annually.

“I’d like to see it grow. When you have an event such as this, you want it to be successful in terms of the number of participants, target audience, and then, once it’s successful, you want it to grow,” Taylor said. “We want to connect with more families, tell them about the Health Plan and the Center and ultimately be a partner for them along their health and wellness journey.”

March 5, 2019

When opportunities arise, Texas Children’s Emergency Management plans functional active shooter exercises on our campuses. Thanks to the leadership and staff of the Texas Children’s Health Plan, or the first time on February 27, the exercise was geared toward those who work in an office environment rather than a clinical space.

The purpose of these exercises is to test Texas Children’s emergency notification procedures, staff training for response to an active shooter (Run, Hide, Fight), and to give our law enforcement partners a chance to practice their tactical response to an active shooter. Holding this training in an administrative rather than a clinical setting provided an excellent opportunity to test the “Run, Hide, Fight” training and a different environment.

The most important aspect of the exercise is the difference in an administrative setting versus a healthcare setting. Hospitals have multiple patient rooms and storage rooms for other medical purposes, whereas, in most office buildings there are large open areas that have cubicles. When the staff practice the “Run, Hide, Fight” method, most people’s first thought is to hide under a cubicle desk.

“That is not the safest place during an active shooter situation,” manager of Texas Children’s Emergency Management Aaron Freedkin said. “They need to find another place, either leave the floor or find a room that they can lock or block the door with furniture. That’s preferable to just hiding under a desk.”

The exercise included 175 participants, 14 logistical volunteers, 32 observers and 48 law enforcement officers such as: UT Police, Bellaire Police, Houston Police Department, Precinct 5 Constables Office, and Pasadena Police Department SWAT. Having multiple agencies involved in simulating an active shooter incident response creates an environment that is as realistic as possible and allows law enforcement agencies to practice their skills in a new environment. A secondary benefit is having the opportunity to train in the office setting, which would be valuable in the event of a real active shooter incident. It is a chance for them to train together with other agencies and get exposed to different training aspects that ultimately have the same basic goals and mission.

“We are excited to partner with these law enforcement agencies,” Freedkin said. “They get many opportunities to practice in empty buildings with law enforcement participants. This exercise will give them all a chance to practice their building clearing and searches with the unpredictability of non-law enforcement officers playing the role of victims and so there is definitely something in it for everyone participating.”

After the participants arrived, they were put through a safety briefing with Texas Children’s Hospital Emergency Management, followed by further orientation with The University of Texas Police Department, and “Run, Hide, Fight” training provided by Texas Children’s Security. During these exercises blank ammunition was used to simulate gunfire to increase realism while maintaining safety.

Law enforcement was staged on the 13th floor and the exercise began as they proceeded down the stairwell. Meanwhile, there is a person on the 12th floor acting as the aggressor toward employees. The challenge then comes as the aggressor engages in a discussion with the employee that may result in them not thinking immediately about, “Run, Hide, Fight.” After the exercise is reset and begins a second time, there is quicker movement of people because they have had time to immediately think about it and learn from their initial mistakes.

“It is always interesting to observe an exercise such as this because people react in unexpected ways such as seeking shelter and protection in places that are not ideal,” Freedkin said. “That is one of the reasons we conduct this training so that people have an opportunity in advance to consider their training and what their reaction should be.”

There were three sessions and all were structured the same way. Between the first evolution and second evolution of each session, a portion of the scenario changed. A debrief discussion was later held and everyone was able to reflect on their reactions.

“The exercise went extremely well and was well received by the exercise participants and senior leadership who were present,” Freedkin said. “For future exercises, we are working with our law enforcement partners to add additional elements of realism to the exercise while still maintaining the safety of our participants.”

The Emergency Management Team looks forward to providing more trainings geared toward the administration staff throughout the system, and wants people to know if an opportunity comes up to participate in an active shooter exercise like this, staff should take advantage of it. The more realistic your training experience the better you’re going to react in an actual incident.

February 4, 2019

For Jarred Bolt, receiving a job offer near the end of his internship with Project Search at Texas Children’s Health Plan (TCHP) was as unexpected as it was exciting.

“When I received the great news from my job coach, I said, ‘This is impossible! How am I hired?’ And everyone cheered,” said Bolt, who’s now a claims and transactions entry clerk with the Health Plan.

Project Search, the program that brought Bolt and the Health Plan together, was launched in 1996 out of Cincinnati Children’s mission to help people with disabilities find employment opportunities. TCHP partners with Houston Independent School District (HISD) and the Texas Workforce Commission to place students with intellectual developmental disorders and other diagnoses in Project Search internships at the Health Plan. The program is in its third year at TCHP, and Bolt is their first internal hire.

“Jarred is just very personable,” said Health Plan Claims Administration Manager Jenni Aguilar. “He always speaks, and he always has a smile on his face. He’s just a good, smart young man, and he is a really good asset for our team.”

Throughout the duration of their year-long internships with Project Search, interns rotate to different departments where they learn various areas of the business, acquire new skills and meet new people. During Bolt’s final rotation, the Claims team started a big project that required all hands on deck. Although Bolt was interning in another department, the Project Search coaches suggested he be placed on the Claims project.

Bolt was a natural. He sped through data entries, and his work helped the team to push the project across the finish line. His dedication and willingness to step up caught the eye of Health Plan leaders, and he officially started as a full-time Claims employee in August.

For many of the interns, the skills they learn through Project Search are brand new. And typically by the end of the internships, they are able to apply their newly learned skills – like computer literacy and business etiquette – in future positions.

“You just have to give them a chance,” Aguilar said. “These kids are really smart. They may sometimes communicate a little bit differently or handle things a little bit differently, but that’s what makes them unique.”

Bolt rides the Metro to work, he clocks in by 7 a.m., and he promptly starts checking off tasks. He prizes punctuality and pitching in where needed. Some of the skills he’s learned, in addition to vast computer know-how, include mailing handouts, distributing mail and scanning forms.

“The Project Search partnership is a strong example of one of the many ways Texas Children’s invests in building healthy communities,” said Dr. Heidi Schwarzwald, chief medical officer of pediatrics at Texas Children’s Health Plan.

To qualify as interns with Project Search, students must be 18 to 22 years old and meet certain requirements, such as having a high school diploma or GED. At the Health Plan, in addition to their internship rotations, they take classes from an HISD teacher once a week. The application process gets competitive, as there are only 10 spots available, but the Health Plan hopes to eventually increase capacity.

“This is a program that could successfully expand across the system, and I’d be happy to talk to anyone who would want to be an advocate for seeing it through,” Schwarzwald said. “The more all of us at Texas Children’s get involved in programs like Project Search, the greater the influence we can have on helping differently abled people thrive.”

January 7, 2019


The Centers for Children and Women at Texas Children’s recently received community pharmacy practice accreditation from the Center for Pharmacy Practice Accreditation (CPPA). This accreditation demonstrates Texas Children’s ongoing commitment to high quality care and patient safety.

With approximately 33,000 community pharmacies located across the United States, The Centers in Greenspoint and Southwest are the first in Texas to gain this esteemed accreditation.

“Gaining this voluntary accreditation is an important way for us to show our investment in continuous improvement of our pharmacy practice,” said Yen Phan, pharmacy manager at The Centers for Children and Women. “Our team worked very hard to meet the rigorous CPPA requirements for accreditation, and we will continue to focus our efforts on providing exceptional patient-centered care.”

The CPPA, a non-profit organization, recognizes pharmacy practices that foster medication safety and effectiveness, ensure continuous quality improvement and facilitate desired patient health outcomes.

The Centers at Greenspoint and Southwest implemented several initiatives to meet the CPPA standards for community pharmacy accreditation including creating a Quality Committee that provides an organized forum to review quality metrics and develop solutions to prevent potential medication errors. The Quality Committee also assessed overall performance and identified areas in need of quality improvement.

“The surveyors were very impressed with our best practices and model of care,” Phan said. “Our hope is that our best practices can serve as a benchmark for other community pharmacies to replicate.”

For more information about the CPPA accreditation process, visit www.pharmacypracticeaccredit.org
For more information about The Center for Children and Women, visit www.jointhecenter.org

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.

 

August 2, 2018

Over the course of a two-and-a-half-day meeting in late February, 18 Texas Children’s system leaders came together to strategize streamlining business operations between Texas Children’s Hospital and the Texas Children’s Health Plan. Led by Lou Fragoso, president of the health plan, and Richelle Fleischer, senior vice president of Revenue Cycle at Texas Children’s Hospital, the group worked to challenge business as usual, with an eye toward transforming how the system runs.

This “rapid improvement event,” organized and facilitated by the Texas Children’s Business Process Transformation team, was a key step in the We Are Family initiative, a multi-month undertaking by Texas Children’s system leaders committed to breaking down barriers between the hospital and the health plan in an effort to help the organization work more efficiently as a singular entity. Among the working group’s goals was to plot a roadmap of and deconstruct the revenue cycle process between the hospital and the health plan in order to identify waste and collaborate on solutions that will increase the system’s efficacy.

“We sought to take advantage of our ‘system-ness’ to create a seamless interchange of claim processing, with the potential to save over $30 million in the process,” Fleischer said.

The driving force behind this effort is a desire to leverage the shared organizational identity between Texas Children’s Hospital and Texas Children’s Health Plan in order to reach the common goal of improving patient care.

“During the rapid improvement event, we had a room full of people who wanted to do the right thing for Texas Children’s,” Fragoso said. “When we work together, we can reduce unnecessary or duplicative work, improve the member or patient experience, use data to help deliver better health outcomes, and ultimately make Texas Children’s a leading force in advancing how care is delivered.”

“The biggest accomplishment of the event was the building of relationships between the health plan and the hospital team,” echoed Dr. Heidi Schwarzwald, chief medical officer of Pediatrics at Texas Children’s Health Plan. “Opening new lines of communication, creating efficiencies, and reducing waste will allow for more resources to be available for innovation and improvements in care coordination and delivery throughout our system.”

The We Are Family initiative kicked off in December 2017 with the initial process assessment and event design planning phase taking place between January and February 2018. Further implementation planning followed February’s rapid improvement event, with project kickoffs beginning in April. Implementations and transitions are now underway, with reports of these projects’ measurable results expected in Q4.

Of the 71 ideas suggested at February’s event, the team consolidated and selected 14 high-impact solutions, with 12 projects centered around these solutions currently ongoing. One project has focused on improving antiquated communications technology between the health plan and the hospital. The health plan and the hospital previously relied on fax communications to exchange patient information, a cumbersome and time-consuming process.

Based on the collaborative solutions recommended at the rapid improvement event, the system has transitioned to an entirely digital communications process, thereby reducing administrative burden and allowing employees to focus on timely claims processing and communication with members and providers.

“Ultimately, we’re giving our most important assets, our people, time back in their days,” said Dr. Lia Rodriguez, medical director at Texas Children’s Health Plan. “We’re reallocating resources to focus on what we do best: providing our patients and their families with the best care possible.”

Projected improvements resulting from the We Are Family initiative include:

  • 25,000 hours saved
  • 85,000 fewer phone calls
  • 68 percent fewer handoffs
  • 11,000 reduced paper claims
  • 12,000 faxes eliminated
  • 1,200 reduced appeals

“Just imagine if we take the results from our collaborative effort in February and apply that same concept across the rest of our system,” said Fragoso, who revealed that Texas Children’s Hospital and Texas Children’s Health Plan are already working on a second We Are Family initiative, this time focused on improving outcomes and experience for health plan members by using the hospital’s specialty pharmacy. “As we begin to think differently about how we interact, Texas Children’s will redefine what it means to be a health system in the future. When we unite as one amazing team to improve the lives of the families we serve, Texas Children’s has the ability to completely transform the way care is delivered.”